ICU · Respiratory / ventilation

Pleural Disease — Effusion, Pneumothorax & Chest Drains

Also known as Pleural effusion · Pneumothorax · Chest drain · Tube thoracostomy · Light's criteria · Underwater seal · Tension pneumothorax · Safe triangle · Empyema · Re-expansion pulmonary oedema

Pleural disease in the ICU covers three problems: pleural effusion (a transudate or an exudate, distinguished by Light's criteria, drained if infected or symptomatic), pneumothorax (primary or secondary; managed by observation, aspiration, or a chest drain; tension pneumothorax is a clinical diagnosis treated by immediate needle decompression then a chest drain), and the chest drain itself (inserted in the safe triangle, over the rib, connected to an underwater seal; bubbling indicates an air leak, swinging indicates patency, and cessation indicates resolution; never clamp a bubbling drain). The chest drain is removed when the air leak has resolved and the lung is expanded on CXR. Re-expansion pulmonary oedema is a risk if a large effusion or pneumothorax is drained too rapidly.

Checked against its sources on 2 Sept 2026