Effect of Noninvasive Positive Pressure Ventilation During Large Volume Thoracentesis on Pleural Manometry

Abstract

SESSION TITLE: Pleural Disease SESSION TYPE: Original Investigation Poster PRESENTED ON: Wednesday, November 1, 2017 at 01:30 PM - 02:30 PM PURPOSE: It has been observed that the symptoms of chest pain during large volume thoracentesis and the possibility of re-expansion pulmonary edema occur due to a large drop in the intrapleural pressure during large volume thoracentesis. Due to these factors thoracenteses are frequently terminated prior to the removal of maximal volumes. Consequently, patients may have incomplete drainage or need for multiple procedures. This is an initial pilot study to determine whether the application of non-invasive positive pressure ventilation at a relatively low pressure (CPAP 5mm H2O) during large volume thoracentesis could prevent excessive drop in pleural pressure (pPl). METHODS: A prospective, randomized controlled, non-blinded study of 49 consecutive adults who underwent thoracentesis was performed. We compared the changes in opening and closing pPl using a pleural manometry in patients assigned to continuous positive airway pressure of 5 mmH2O (treatment group) and patients without CPAP (control group). The Mann Whitney U test was used to analyze the results. An independent t test was used to compare the average volume drained between the two groups. RESULTS: Patients treated with CPAP 5 mmH2O had a significantly smaller drop in pleural pressures as compared to patients without CPAP (median of -11cmH2O vs -17.5 cmH2O respectively, p = 0.006). The average volume drained was not statistically significant in the CPAP group (1380 ml) vs the non-CPAP group (1371ml) with a p value 0.953. CONCLUSIONS: Our study demonstrates that the application of CPAP at 5 mmH2O is an effective measure to minimize drops in intrapleural pressures during large volume thoracentesis. We did not collect data on patients’ adverse events post procedure. Further studies at potentially higher CPAP pressure, side effects recording and follow-up imaging are needed to evaluate if preventing the drop in Ppl with CPAP will directly correlate with symptoms and adverse effects. CLINICAL IMPLICATIONS: The application of CPAP during large volume thoracentesis is an effective measure to minimize drops in intrapleural pressures, potentially decreasing adverse effects during this procedure. DISCLOSURE: The following authors have nothing to disclose: Karla Cruz Morel, Jonathan Kass, Ziad Boujaoude, Rohan Arya, Diana Kolman, Wissam Abouzgheib No Product/Research Disclosure Information