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BACKGROUND: Pleural effusions (PEs) frequently occur in patients admitted to the Intensive Care unit (ICU), which may be evacuated through pleurocentesis. The benefits of pleurocentesis and the actual determinants that influence physicians decision-making in performing pleurocentesis are both uncertain. The aim of this study was to determine which determinants clinicians use to decide to perform pleurocentesis.
MATERIAL AND METHODS: A web-based questionnaire survey with clinical vignettes was sent out to physicians in all 95 adult ICUs in The Netherlands. We used 16 case vignettes with 7 varying attributes. Their relative weights were calculated for each level of the attributes by conjoint analysis and expressed in β. The reference value (β=0) was defined as the optimal conditions to perform pleurocentesis; a negative β indicated preference against performing pleurocentesis.
RESULTS: From representatives of the 95 ICUs in the Netherlands, a total of 89 complete questionnaires were collected. The absence of PEs or small amounts of PEs on the chest X-ray (CXR) and chest CT had the largest significant negative effects on preference for performing pleurocentesis. Neither the level of PEEP, nor the PaO2-to-FiO2 ratio influenced the decision to perform pleurocentesis. Finally, also cardiac history and coagulation status did not influence this decision.
CONCLUSIONS: Our study demonstrates that the physician’s decision to perform pleurocentesis in case of large PEs (as objectified by CXR and CT) is based primarily on the difficulty of weaning from the ventilator and neither influenced by the PEEP level, p/f ratio, nor by the presence of abnormalities in coagulation.

Keywords: Intensive Care Units, Pleural Effusion, Questionnaires