Skip to main content

Main menu

  • Home
  • Current issue
  • Early View
  • Archive
  • Authors/reviewers
    • Instructions for authors
    • Submit a manuscript
    • Institutional open access agreements
    • Peer reviewer login
  • Alerts
  • Subscriptions
  • ERS Publications
    • European Respiratory Journal
    • ERJ Open Research
    • European Respiratory Review
    • Breathe
    • ERS Books
    • ERS publications home

User menu

  • Log in
  • Subscribe
  • Contact Us
  • My Cart

Search

  • Advanced search
  • ERS Publications
    • European Respiratory Journal
    • ERJ Open Research
    • European Respiratory Review
    • Breathe
    • ERS Books
    • ERS publications home

Login

European Respiratory Society

Advanced Search

  • Home
  • Current issue
  • Early View
  • Archive
  • Authors/reviewers
    • Instructions for authors
    • Submit a manuscript
    • Institutional open access agreements
    • Peer reviewer login
  • Alerts
  • Subscriptions

Predictors of outcome of chest tube drainage of nonpurulent exudative pleural effusions

Chimaobi Ikechukwu Nwagboso, Chidiebere Peter Echieh, John Nkemakolam Eze, Stephen Omirigbe Ogbudu, Chibueze Haggai Njoku, Anietimfon Umoh Etiuma, Okokon Odonkwo Bassey
ERJ Open Research 2022 8: 00604-2021; DOI: 10.1183/23120541.00604-2021
Chimaobi Ikechukwu Nwagboso
1Division of Cardiothoracic Surgery, Dept of Surgery, University of Calabar Teaching Hospital, Calabar, Nigeria
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • ORCID record for Chimaobi Ikechukwu Nwagboso
  • For correspondence: kymanwagboso@gmail.com
Chidiebere Peter Echieh
1Division of Cardiothoracic Surgery, Dept of Surgery, University of Calabar Teaching Hospital, Calabar, Nigeria
2Division of Cardiothoracic Surgery, Dept of Surgery, University of Calabar, Calabar, Nigeria
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • ORCID record for Chidiebere Peter Echieh
John Nkemakolam Eze
1Division of Cardiothoracic Surgery, Dept of Surgery, University of Calabar Teaching Hospital, Calabar, Nigeria
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Stephen Omirigbe Ogbudu
1Division of Cardiothoracic Surgery, Dept of Surgery, University of Calabar Teaching Hospital, Calabar, Nigeria
2Division of Cardiothoracic Surgery, Dept of Surgery, University of Calabar, Calabar, Nigeria
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Chibueze Haggai Njoku
3Pulmonology Unit, Dept of Internal Medicine, University of Calabar Teaching Hospital, Calabar, Nigeria
4Pulmonology Unit, Dept of Internal Medicine, University of Calabar, Calabar, Nigeria
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Anietimfon Umoh Etiuma
1Division of Cardiothoracic Surgery, Dept of Surgery, University of Calabar Teaching Hospital, Calabar, Nigeria
2Division of Cardiothoracic Surgery, Dept of Surgery, University of Calabar, Calabar, Nigeria
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Okokon Odonkwo Bassey
1Division of Cardiothoracic Surgery, Dept of Surgery, University of Calabar Teaching Hospital, Calabar, Nigeria
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Figures & Data
  • Info & Metrics
  • PDF
Loading

Abstract

Background Although chest tube drainage is the primary management method for many pleural effusions, it has a failure rate of 9.4–48%. In this study, we examined the factors that predict the outcome of management of nonpurulent exudative effusions. The aim of this study was to determine the predictors of outcomes of chest tube drainage of pleural effusions.

Methodology Consecutive patients who had a chest tube drainage of nonpurulent exudative pleural effusions were followed up in a prospective observational cohort study until extubation and discharge. Data on the management of the patients were recorded, analysed and compared between groups of patients with good and poor outcomes.

Results Of the 52 patients studied, 38 had good outcomes, while 14 had poor outcomes. The mean±sd age was 39.7±15.9 years. Multivariate analysis demonstrated that empyema thoracis complicating drainage was an independent predictor of a poor outcome, while the duration of drainage ≤14 days and duration of illness before presentation <30 days were predictive of a good outcome.

Conclusion Our results show that the development of empyema thoracis during drainage, a long duration of drainage and a prolonged period of illness before presentation are predictive of the outcome of chest tube drainage.

Abstract

This study of predictors of outcome of chest drainage of nonpurulent pleural effusions found that the development of empyema, a prolonged duration of drainage and a prolonged duration of illness are predictive of a poor outcome of drainage https://bit.ly/3tpK39Y

Introduction

Pleural effusion is an accumulation of fluid in the pleural space [1]. It occurs as a result of increased secretion or reduced reabsorption of fluid from the pleural space and can be classified as transudate or exudate according to its composition and underlying pathophysiology [1, 2]. Exudative effusions are usually due to increased vascular permeability or lymphatic obstruction [3]. Common causes of exudative nonpurulent pleural effusions are malignant neoplasms, parapneumonic effusions and empyema [3–5].

The prevalence of pleural effusion is about 400/100 000 population [6]. Light [7] estimated that ∼1.5 million people develop pleural effusion in the USA every year. Though the prevalence of pleural effusion in Nigeria is not known, it is nonetheless a cause of significant morbidity and mortality with varying outcomes of management.

The fluid is considered an exudate if it satisfies any of Light's criteria [8]. Other criteria, which have sensitivity and specificity of 96% and 93% respectively, were proposed by Romero et al. [9]. Romero's criteria classify pleural fluid as exudates if: pleural fluid lactate dehydrogenase (LDH) is higher than 307 IU·L−1 or pleural fluid cholesterol is higher than 60 mg·dL−1.

The goals of management of pleural effusion are: draining the pleural fluid, adequate lung re-expansion and management of the underlying disease.

Despite some studies showing video-assisted thoracoscopy surgery (VATS) to be of greater benefit in draining complicated exudative effusion, chest tube drainage is still widely used as a standard of care [10–12].

The failure rate of tube thoracostomy in the management of these conditions ranges from 9.4% to 48% [13–15] with attendant morbidities such as additional procedures, higher risk of complications, longer duration of hospital stay and increased cost of care, which negatively affects the social and economic output of patients and that of their dependants. A few studies have investigated the variables predictive of the outcome of chest tube drainage, but these studies have largely been on parapneumonic effusions [13, 16, 17]. It was on this premise that we set out to determine the factors that could predict the outcome of chest tube drainage for nonpurulent pleural effusions and thus identify situations that would require an alternative management approach.

Methods

This was a prospective observational cohort study that was aimed at identifying the factors that predict the outcome of chest tube drainage of exudative nonpurulent pleural effusions, at the University of Calabar Teaching Hospital in Southern Nigeria. Ethical approval for the study was obtained from the University of Calabar Teaching Hospital Human Research Ethics Committee before the commencement of the study.

Consecutive consenting patients who had a chest tube drainage for nonpurulent exudative effusions were recruited over 12 months between April 2015 and March 2016. The sample size was calculated based on a retrospective review of exudative effusions seen in the year preceding the study. All patients who had post-operative chest tube insertion, empyema thoracis at the time of admission or who withheld consent to participate in the study were excluded from the study. Exudative pleural effusion was defined as having LDH levels >307 IU·L−1 and/or cholesterol levels >60 mg·dL−1 [9]. These criteria have shown equivalence to Light's criteria and are used in this study due to cost-efficiency and convenience in our low resource centre, where patients are often unable to pay for multiple tests or are unwilling to allow the multiple blood sampling that is needed to calculate the ratios in Light's criteria. Empyema was defined as the presence of purulent fluid on thoracocentesis [18, 19].

Study procedure

Patients who had pleural effusion underwent a general clinical and investigative workup for pleural effusions, including a detailed history and physical examination, posteroanterior (PA) and lateral erect chest radiographs, and diagnostic thoracocentesis. Fifty millilitres of pleural fluid was sampled for biochemical analysis (pH, glucose, protein, LDH, cholesterol), microbiology (gram stain, cell count and bacterial culture; Ziehl–Nielsen staining for acid and alcohol fast bacilli (AAFB) and Genexpert for detection of Mycobacterium tuberculosis) and cytology for malignancy. Nonpurulent parapneumonic effusion was defined as pleural effusion associated with underlying pneumonia with the absence of purulent fluid on thoracentesis [18, 19].

All subjects had 1 g of intravenous ceftriaxone as a prophylactic antibiotic. Under aseptic conditions in the ward procedure room, all patients had insertion of a 28 FG chest tube in the 5th intercostal space along the mid-axillary line under local anaesthesia with 2% lignocaine with adrenaline. The tube was directed posteriorly and upwards, so the tip rested in the paravertebral gutter. The chest tubes were anchored with Nylon 2 sutures with a horizontal mattress technique and connected to underwater sealed drainage without suction. The tube was confirmed to be functional if the fluid in the drainage tubing oscillated with the patient's breathing, towards the chest on inspiration. An erect PA chest radiograph was done on the same day to confirm the position of the tube and adjustments made to the tube position as necessary. Loculated effusion was defined by findings of an irregular scalloped contour of an effusion or fixed fluid in an abnormal location that was not basal on a chest radiograph.

All patients were initially placed on oral paracetamol 1 g every 8 h. The pain response was evaluated and medications adjusted accordingly.

The patients were managed in the thoracic surgery ward by speciality trained nurses. An erect PA chest radiograph was done before removing the chest tube to assess for the degree of drainage and lung re-expansion and to identify failed drainage and the need for additional procedures. In patients with successful drainage of the effusion, the chest tube was removed if there was drainage of ˂200 mL·day−1 for three consecutive days with clinical and radiological evidence of full lung re-expansion.

The decision to remove the chest drain and commence with an additional procedure such as a thoracoscopy or thoracotomy was made based on clinical and radiological evidence of trapped lung or persistent complicated empyema with failure of lung re-expansion. Prolonged drainage was defined as a duration of chest drainage exceeding 14 days. In each case, the patient was followed for 1 month after discharge.

Patients were divided by outcome into two groups: good outcome (group 0) and poor outcome (group 1). Good outcome was defined as successful chest tube drainage characterised by: 1) radiological (chest radiograph) evidence of adequate lung re-expansion with aeration of the lung at the ipsilateral costophrenic angle on an erect PA chest radiograph – taken in full inspiration before chest tube removal – and/or blunting of the costophrenic angle that does not extend to the dome of the ipsilateral diaphragm with preserved ipsilateral cardiophrenic angle on an erect PA chest radiograph taken in full inspiration before chest tube removal; and 2) no need for an additional procedure.

Data collection and analysis

Data on the patient's clinical information, pleural fluid analysis, radiological investigations, course and complications of closed thoracostomy tube drainage (CTTD), total volume drained, the outcome of CTTD and additional therapeutic interventions were collected for analysis. The outcome measure was the success or failure of chest tube drainage. Data generated from the study were entered and analysed using the Statistical Package for Social Sciences (SPSS) IBM version 20. Univariate analysis was done, Continuous variables were presented as mean±sd, while categorical variables were presented as percentages. Continuous and categorical variables were compared using t-test and the Chi-squared test (or Fisher's exact test, where appropriate) to identify factors associated with outcome. Multiple logistic regression was done to identify independent predictive factors of the outcome of CTTD of pleural effusions. Statistical significance was established as p<0.05 and the confidence interval was fixed at 95%.

Results

A total of 55 patients were recruited at the commencement of the study; however, three died before any assessment was carried out. The analysis, therefore, was done for the 52 patients who were assessed consisting of 25 (48.1%) males and 27 (51.9%) females. The mean±sd age of study participants was 39.7±15.9 years. Of the three patients that died, two had stage IV breast cancer with pulmonary metastasis and malignant pleural effusion. The third patient was being managed for advanced lung cancer with malignant pleural effusion. They all died of respiratory failure while on chest tube drainage. All patients were followed up for one 1 month after discharge. The demographic, clinical, radiological, pleural fluid and aetiological characteristics of the studied subjects are summarised in table 1.

View this table:
  • View inline
  • View popup
TABLE 1

Demographic, clinical, pleural fluid and radiological characteristics of the studied subjects

Bacterial culture was positive in 8 (33.33%) of the 24 pleural fluid aspirate samples taken from patients with parapneumonic effusion. Of these, six grew single isolates and three grew two organisms each. 12 organisms were isolated: 4 (33.3%) Klebsiella pneumoniae, 3 (25.0%) methicillin-resistant Staphylococcus aureus, 3 (25.0%) Pseudomonas aeruginosa and 2 (16.7%) Proteus mirabilis. Three (30.0%) of the 10 empyema samples were positive on bacterial culture: two (50.0%) yielded Klebsiella pneumoniae and one (25.0%) methicillin-resistant Staphylococcus aureus.

The outcome of chest tube drainage was based on the success (good outcome) or failure (poor outcome) of chest drainage. Of the 52 subjects, 38 had a good outcome while 14 had a poor outcome. Twelve of the 14 patients with a poor outcome had additional procedures, while two left the study against medical advice. Of the 12 that had additional procedures, six had thoracotomy and decortication, three had therapeutic thoracocentesis, two had open thoracostomy window and one was treated by VATS. All additional treatments were successful and there was no mortality. The commonest complications of chest tube drainage were empyema (20.0%), followed by subcutaneous emphysema (12.7%) and blocked tube (10.9%). Tube dislodgement and malposition each occurred in 1.8% of patients.

Table 2 shows the relationship between study variables and the outcome of chest tube drainage among study participants. Among participants with a good outcome, the proportion of patients whose drainage was not complicated by empyema thoracis was higher than those who developed empyema (88.1% versus 9.1%, p<0.001). The highest proportion of participants with good outcomes (91.2%, p=0.001) was among those with a duration of illness of <1 month.

View this table:
  • View inline
  • View popup
TABLE 2

Relationship between study variables and outcome of chest tube drainage

Table 3 represents the result of multivariate analysis of variables that have a significant association with the outcome of chest drainage. Independent predictors of poor outcome were male sex (odds ratio: 0.04; 95% CI: 0.004–0.399, p=0.006) and empyema complicating CTTD (odds ratio: 0.011; 95% CI: 0.001–0.151, p=0.001). Patients with these variables were less likely to have good outcomes following CTTD for pleural effusion. However, duration of illness before presentation <30 days (odds ratio: 22.9; 95% CI: 2.154–203.351, p=0.001) and duration of pleural fluid drainage <14 days (odds ratio: 13.2; 95% CI: 1.489–117.015, p=0.020) were independent predictors of a good outcome.

View this table:
  • View inline
  • View popup
TABLE 3

Independent predictors of outcome in chest tube thoracostomy (CTTD) for pleural effusion among study participants

Discussion

The rate of good outcomes in this study was 73.1%. Fourteen (26.9%) of the patients in this study had a poor outcome. Of these, patients with nonpurulent parapneumonic effusions accounted for 57.1% of those with poor outcomes. Studies by Nwofor et al. [20] and Davies et al. [16] reported higher success rates of 86.2% and 85%, respectively. Unlike our study of nonpurulent pleural effusions, Nwofor and co-workers investigated the outcome of chest tube drainage for all pleural collections including traumatic haemothorax, pneumothorax and haemopneumothorax. Davies and co-workers [16] reported an impressive success rate of 85% with chest tube drainage of parapneumonic effusions. This higher rate of good outcome may be explained by their aggressive treatment protocol, which included the use of the radiologically guided chest intubation combined with antibiotic therapy and use of fibrinolytic agents (streptokinase or urokinase), in all cases of effusion they managed. In the study by Huang et al. [17], a success rate of 53% with chest tube drainage was reported, which is much lower than what was found in our study. Their study is not directly comparable with ours because it reported a selected series of patients managed in other centres before referral. All the effusions they studied were of pneumonic origin, unlike in this study.

Similar to our results, Davies et al. [16] in Oxford, investigating a consecutive series of 85 patients who had chest tube drainage for parapneumonic effusions, found that the absence of purulence is predictive of a good outcome, but other studies [17, 20] did not find purulence to be predictive of outcome.

The review by Girdhar et al. [21] suggests that any delay in instituting drainage of pleural effusion increases morbidity and mortality. This agrees with our finding that a duration of illness <30 days was predictive of a good outcome but differs from findings by Davies et al. and other studies [16, 17, 22]. Our findings are, however, consistent with the pathophysiology of pleural effusions, as the longer an effusion is present in the pleural space and not drained, the greater the possibility that it progresses to a viscous fibrinopurulent phase or is complicated by empyema with a thickened pleura, lung entrapment and a poor drainage outcome.

The finding in this study that duration of drainage <14 days is predictive of good outcome differs from some other studies [16, 17, 22]. In the study by Huang et al. [17], successful drainage was defined as either complete drainage of pleural effusion or incomplete drainage of pleural effusion but concomitant improvement in fever and leucocytosis with almost complete resolution of pleural effusion on chest radiograph 1 to 6 months later. This does not take into account that symptoms such as fever may resolve due to the resolution of the pneumonic process while the effusion persists. Davies and colleagues [16] allowed only a duration of 7 days before deciding failure of drainage in patients who showed no significant clinical or radiological improvement. Tsai et al. [22] retrospectively studied patients who had VATS and defined failure based on mortality. These studies were on parapneumonic effusions, and the definitions of outcome may not compare well with our study. In our study, the decision to remove the chest drain and commence with an additional procedure was made when there was evidence of trapped lung or complicated empyema with failure of lung re-expansion.

Our results show that for exudative nonpurulent pleural effusions, chest tube drainage alone can be done with a relatively high success rate. We found that the development of empyema thoracis during drainage, a long duration of drainage and a prolonged period of illness before presentation are predictive of the outcome of chest tube drainage.

We acknowledge that the current practice of thoracic ultrasound would have enabled us to better identify complicated effusions that would require aggressive treatment. We did not deploy the use of thoracic ultrasound in our study protocol as it was not available in our institution at the time. Our study was also performed in a single centre and may not be generalisable to the entire population of Nigeria. The small number of patients is also a limitation to this study.

We recommend a more aggressive management such as adjunctive fibrinolytic therapy, VATS or thoracotomy and decortication when empyema thoracis complicates chest tube drainage. Early referral of patients with pleural effusions should be encouraged to enable the institution of prompt and appropriate therapy.

Footnotes

  • Provenance: Submitted article, peer reviewed.

  • Conflict of interest: C.I. Nwagboso has nothing to disclose.

  • Conflict of interest: P.C. Echieh has nothing to disclose.

  • Conflict of interest: J.N. Eze has nothing to disclose.

  • Conflict of interest: S.O. Ogbudu has nothing to disclose.

  • Conflict of interest: C.H. Njoku has nothing to disclose.

  • Conflict of interest: A.U. Etiuma has nothing to disclose.

  • Conflict of interest: O.O. Bassey has nothing to disclose.

  • Received October 25, 2021.
  • Accepted February 22, 2022.
  • Copyright ©The authors 2022
http://creativecommons.org/licenses/by-nc/4.0/

This version is distributed under the terms of the Creative Commons Attribution Non-Commercial Licence 4.0. For commercial reproduction rights and permissions contact permissions{at}ersnet.org

References

  1. ↵
    1. Yu H
    . Management of pleural effusion, empyema, and lung abscess. Semin Interv Radiol 2011; 28: 75–86. doi:10.1055/s-0031-1273942
    OpenUrl
  2. ↵
    1. Hooper C,
    2. Lee YCG,
    3. Maskell N, et al.
    Investigation of a unilateral pleural effusion in adults: British Thoracic Society Pleural Disease Guideline 2010. Thorax 2010; 65: Suppl. 2, ii4–i17. doi:10.1136/thx.2010.136978
    OpenUrlFREE Full Text
  3. ↵
    1. Villena Garrido V,
    2. Cases Viedma E,
    3. Fernández Villar A, et al.
    Recommendations of diagnosis and treatment of pleural effusion. Update. Arch Bronconeumol 2014; 50: 235–249. doi:10.1016/j.arbres.2014.01.016
    OpenUrlPubMed
    1. McGrath EE,
    2. Anderson PB
    . Diagnosis of pleural effusion: a systematic approach. Am J Crit Care 2011; 20: 119–128.
    OpenUrlAbstract/FREE Full Text
  4. ↵
    1. Balfour-Lynn IM
    . BTS guidelines for the management of pleural infection in children. Thorax 2005; 60: Suppl. 1, i1–i21. doi:10.1136/thx.2004.030676
    OpenUrlFREE Full Text
  5. ↵
    1. Villena Garrido V,
    2. Ferrer Sancho J,
    3. Blasco H, et al.
    Diagnosis and treatment of pleural effusion. Arch Bronconeumol 2006; 42: 349–372. doi:10.1157/13090586
    OpenUrlCrossRefPubMed
  6. ↵
    1. Pleural effusions
    1. Light RW
    . Pleural effusions. Med Clin North Am 2011; 95: 1055–1070. doi:10.1016/j.mcna.2011.08.005
    OpenUrlCrossRefPubMed
  7. ↵
    1. Light RW
    . Pleural effusions: the diagnostic separation of transudates and exudates. Ann Intern Med 1972; 77: 507–513. doi:10.7326/0003-4819-77-4-507
    OpenUrlCrossRefPubMed
  8. ↵
    1. Romero S,
    2. Martinez A,
    3. Hernandez L, et al.
    Light's criteria revisited: consistency and comparison with new proposed alternative criteria for separating pleural transudates from exudates. Respiration 2000; 67: 18–23. doi:10.1159/000029457
    OpenUrlCrossRefPubMed
  9. ↵
    1. Shatila M,
    2. Arab WA,
    3. Fasih N, et al.
    Comparative study between outcome of intercostal tube drainage and video assisted thoracoscopic surgery in management of complicated parapneumonic effusion in children. J Egypt Soc Cardio-Thorac Surg 2018; 26: 68–72. doi:10.1016/j.jescts.2017.12.002
    OpenUrl
    1. Aziz A,
    2. Healey JM,
    3. Qureshi F, et al.
    Comparative analysis of chest tube thoracostomy and video-assisted thoracoscopic surgery in empyema and parapneumonic effusion associated with pneumonia in children. Surg Infect (Larchmt) 2008; 9: 317–323. doi:10.1089/sur.2007.025
    OpenUrlCrossRefPubMed
  10. ↵
    1. Scarci M,
    2. Zahid I,
    3. Billé A, et al.
    Is video-assisted thoracoscopic surgery the best treatment for paediatric pleural empyema? Interact Cardiovasc Thorac Surg 2011; 13: 70–76. doi:10.1510/icvts.2010.254698
    OpenUrlCrossRefPubMed
  11. ↵
    1. Jamal M,
    2. Reebye SC,
    3. Zamakhshary M, et al.
    Can we predict the failure of thoracostomy tube drainage in the treatment of pediatric parapneumonic collections? J Pediatr Surg 2005; 40: 838–841. doi:10.1016/j.jpedsurg.2005.01.053
    OpenUrlPubMed
    1. Igbokwe J,
    2. Okidi O,
    3. Aja A
    . Management of pleural fluid collection with tube thoracostomy in a tertiary health facility in Abakaliki. Nigeria Ebonyi Med J 2011; 9: 86–89.
    OpenUrl
  12. ↵
    1. Gates RL,
    2. Caniano DA,
    3. Hayes JR, et al.
    Does VATS provide optimal treatment of empyema in children? A systematic review. J Pediatr Surg 2004; 39: 381–386. doi:10.1016/j.jpedsurg.2003.11.045
    OpenUrlCrossRefPubMed
  13. ↵
    1. Davies CWH,
    2. Kearney SE,
    3. Gleeson FV, et al.
    Predictors of outcome and long-term survival in patients with pleural infection. Am J Respir Crit Care Med 1999; 160: 1682–1687. doi:10.1164/ajrccm.160.5.9903002
    OpenUrlCrossRefPubMed
  14. ↵
    1. Huang HC,
    2. Chang HY,
    3. Chen CW, et al.
    Predicting factors for outcome of tube thoracostomy in complicated parapneumonic effusion or empyema. Chest 1999; 115: 751–756. doi:10.1378/chest.115.3.751
    OpenUrlCrossRefPubMed
  15. ↵
    1. Ferreiro L,
    2. San José ME,
    3. Valdés L
    . Management of parapneumonic pleural effusion in adults. Arch Bronconeumol Engl Ed 2015; 51: 637–646. doi:10.1016/j.arbres.2015.01.009
    OpenUrl
  16. ↵
    1. Parapneumonic effusions and empyema
    1. Light RW
    . Parapneumonic effusions and empyema. Proc Am Thorac Soc 2006; 3: 75–80. doi:10.1513/pats.200510-113JH
    OpenUrlCrossRefPubMed
  17. ↵
    1. Nwofor A,
    2. Ekwunife C
    . Tube thoracostomy in the management of pleural collections. Niger J Clin Pract 2006; 9: 77–80.
    OpenUrlPubMed
  18. ↵
    1. Girdhar A,
    2. Shujaat A,
    3. Bajwa A
    . Management of infectious processes of the pleural space: a review. Pulm Med 2012; 2012: 1–10. doi:10.1155/2012/816502
    OpenUrlPubMed
  19. ↵
    1. Tsai YM,
    2. Gamper N,
    3. Huang T-W, et al.
    Predictors and clinical outcomes in empyema thoracis patients presenting to the emergency department undergoing video-assisted thoracoscopic surgery. J Clin Med 2019; 8: 1612. doi:10.3390/jcm8101612
    OpenUrl
PreviousNext
Back to top
Vol 8 Issue 2 Table of Contents
ERJ Open Research: 8 (2)
  • Table of Contents
  • Index by author
Email

Thank you for your interest in spreading the word on European Respiratory Society .

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Predictors of outcome of chest tube drainage of nonpurulent exudative pleural effusions
(Your Name) has sent you a message from European Respiratory Society
(Your Name) thought you would like to see the European Respiratory Society web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Print
Citation Tools
Predictors of outcome of chest tube drainage of nonpurulent exudative pleural effusions
Chimaobi Ikechukwu Nwagboso, Chidiebere Peter Echieh, John Nkemakolam Eze, Stephen Omirigbe Ogbudu, Chibueze Haggai Njoku, Anietimfon Umoh Etiuma, Okokon Odonkwo Bassey
ERJ Open Research Apr 2022, 8 (2) 00604-2021; DOI: 10.1183/23120541.00604-2021

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Share
Predictors of outcome of chest tube drainage of nonpurulent exudative pleural effusions
Chimaobi Ikechukwu Nwagboso, Chidiebere Peter Echieh, John Nkemakolam Eze, Stephen Omirigbe Ogbudu, Chibueze Haggai Njoku, Anietimfon Umoh Etiuma, Okokon Odonkwo Bassey
ERJ Open Research Apr 2022, 8 (2) 00604-2021; DOI: 10.1183/23120541.00604-2021
del.icio.us logo Digg logo Reddit logo Technorati logo Twitter logo CiteULike logo Connotea logo Facebook logo Google logo Mendeley logo
Full Text (PDF)

Jump To

  • Article
    • Abstract
    • Abstract
    • Introduction
    • Methods
    • Results
    • Discussion
    • Footnotes
    • References
  • Figures & Data
  • Info & Metrics
  • PDF

Subjects

  • Respiratory clinical practice
  • Tweet Widget
  • Facebook Like
  • Google Plus One

More in this TOC Section

  • Role of small airway dysfunction in unexplained exertional dyspnoea
  • Patient attitudes to nebulised antibiotics in bronchiectasis
  • Acute health effects of heated tobacco products
Show more Original research articles

Related Articles

Navigate

  • Home
  • Current issue
  • Archive

About ERJ Open Research

  • Editorial board
  • Journal information
  • Press
  • Permissions and reprints
  • Advertising

The European Respiratory Society

  • Society home
  • myERS
  • Privacy policy
  • Accessibility

ERS publications

  • European Respiratory Journal
  • ERJ Open Research
  • European Respiratory Review
  • Breathe
  • ERS books online
  • ERS Bookshop

Help

  • Feedback

For authors

  • Instructions for authors
  • Publication ethics and malpractice
  • Submit a manuscript

For readers

  • Alerts
  • Subjects
  • RSS

Subscriptions

  • Accessing the ERS publications

Contact us

European Respiratory Society
442 Glossop Road
Sheffield S10 2PX
United Kingdom
Tel: +44 114 2672860
Email: journals@ersnet.org

ISSN

Online ISSN: 2312-0541

Copyright © 2023 by the European Respiratory Society