Pleural disease in the intensive care unit

Pleural disease itself is an unusual cause for admission to the intensive c are unit (ICU). Pleural complications of dis eases and procedures in the IC U are common, however, and the impact on respiratory physiology is additive to that of the underlying cardiopulmonary disease. Pleural effusion and pn eumothorax may be overlooked in the critically ill patient due to alteratio ns in radiologic appearance in the supine patient. The development of a pne umothorax in a patient in the ICU represents a potentially life-threatening situation. This article reviews the etiologies, pathophysiology, and manag ement of pleural effusion, pneumothorax, tension pneumothorax, and bronchop leural fistula in the critically ill patient. In addition, we review the po tential complications of thoracentesis and chest tube thoracostomy, includi ng reexpansion pulmonary edema.