Regarding Indications For Insertion Of A Chest Tube...

A 46-yr -old woman is admitted to hospital with a left basal, community-acquired pneumonia. She is on the appropriate antibiotics. She is still pyrexial four days after admission and a CXR confirms a left pleural effusion. The house officer has performed a diagnostic tap.

Which of the following is an indication to insert a chest drain?
A. Pleural fluid protein level more than 50% of serum protein level
B. Pleural fluid LDH more than 60% of serum LDH
C. Haemorrhagic pleural fluid
D. Pleural fluid pH < 7.2
E. Pleural fluid glucose < 1.6 mmol/l.

Answer:
D Pleural fluid pH < 7.2

Discussion: This woman has a parapneumonic effusion. The indications for chest tube insertion in patients with infected pleural effusions are:
1. Presence of organisms on a Gram stain of the pleural fluid
2. A frankly purulent pleural fluid
3. Pleural pH < 7.2 in the setting of an infected pleural effusion
4. Loculated pleural effusions and
5. Poor clinical progress despite antibiotic Rx.

These indications for chest drain insertion are those proposed by the BTS guidelines.