Abstract
BackgroundAlthough the impact of therapeutic thoracentesis on lung function and blood gases has been evaluated in several studies, some physiological aspects of pleural fluid withdrawal remain unknown. The aim of the study was to assess the changes in pleural pressure amplitude (Pplampl) during the respiratory cycle and respiratory rate (RR) in patients undergoing pleural fluid withdrawal.MethodsThe study included 23 patients with symptomatic pleural effusion. Baseline pleural pressure curves were registered with a digital electronic manometer. Then, the registrations were repeated after the withdrawal of consecutive portions of pleural fluid (200 ml up to 1000 ml and 100 ml above 1000 ml). In all patients the pleural pressure curves were analyzed in five points, at 0, 25%, 50%, 75% and 100% of the relative volume of pleural effusion withdrawn in particular patients.ResultsThere were 11 and 12 patients with right sided and left sided pleural effusion, respectively (14 M, 9F, median age 68, range 46–85 years). The most common cause of pleural effusion were malignancies (20 pts., 87%). The median total volume of withdrawn pleural fluid was 1800 (IQR 1500–2400) ml. After termination of pleural fluid withdrawal Pplampl increased in 22/23 patients compared to baseline. The median Pplampl increased from 3.4 (2.4–5.9) cmH2O to 10.7 (8.1–15.6) cmH2O (p < 0.0001). Three patterns of Pplampl changes were identified. Although the patterns of RR changes were more diversified, a significant increase between RR at baseline and the last measurement point was found (p = 0.0097).ConclusionsIn conclusion, therapeutic thoracentesis is associated with significant changes in Pplampl during the respiratory cycle. In the vast majority of patients Pplampl increased steadily during pleural fluid withdrawal. There was also an increase in RR. The significance of these changes should be elucidated in further studies.Trial registrationClinicalTrial.gov, registration number: NCT02192138, registration date: July 1st, 2014.
Highlights
The impact of therapeutic thoracentesis on lung function and blood gases has been evaluated in several studies, some physiological aspects of pleural fluid withdrawal remain unknown
Three patients had to be excluded from final analysis due to low quality of measurements, i.e. high variability of pleural pressure curve that did not allow reliable calculation of Ppl and pleural pressure amplitude (Pplampl)
Our study showed different patterns of Pplampl and respiratory rate (RR) changes during pleural fluid withdrawal
Summary
The impact of therapeutic thoracentesis on lung function and blood gases has been evaluated in several studies, some physiological aspects of pleural fluid withdrawal remain unknown. The number of thoracenteses performed in the USA is reported between 127,000 and 173,000 procedures per year [6, 7], some physiological aspects of pleural fluid removal have not been adequately studied. This is partly because there is no universal and commonly accepted animal model for studying pleural pathophysiology. The relationship between pleural fluid volume and pulmonary function has been evaluated in several human studies These studies showed that the increase in forced expiratory volume at first second (FEV1) and forced vital capacity (FVC) after therapeutic thoracentesis approximates 20–30% of the withdrawn pleural fluid volume [4, 8,9,10]. In a study by Light et al [4], higher postthoracentesis Ppl and smaller Ppl decrease after pleural fluid removal were associated with a more significant improvement in FVC
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