Further Inpatient Care:

• Monitoring pleural drainage

  • Record the amount and quality of fluid drained and the presence of an air leak (bubbling through the water seal) each shift.

  • Repeat chest radiographs when drainage falls below 100 mL/d to evaluate whether the effusion has been fully drained. If a large effusion persists radiographically, reevaluate the position of the chest catheter. If the catheter is positioned appropriately, consider injecting lytics through the chest tube to break up clots that might be obstructing drainage.

  • Large air leaks, steady streams of air throughout the respiratory cycle, might be indications of loose connectors or of a drainage port on the catheter that has migrated out to the skin. Alternatively, they might indicate large bronchopleural fistulae.

  
  

Prognosis

• Prognosis varies by underlying etiology.

  • Malignant effusions convey a very poor prognosis, typically measured in months.

  • Parapneumonic effusions, when recognized and treated promptly, typically resolve without significant

    sequelae. However, untreated or inappropriately treated parapneumonic effusions might lead to constrictive fibrosis.