Am. J. Respir. Crit. Care Med., Volume 162, Number 4, October 2000, 1534-1538

Measurement of Pleural Pressure during Therapeutic Thoracentesis

VICTORIA VILLENA, ANGEL LÓPEZ-ENCUENTRA, FRANCISCO POZO, ALICIA DE-PABLO, and PEDRO MARTÍN-ESCRIBANO

Department of Respiratory Medicine, Hospital Universitario 12 de Octubre, Madrid, Spain

The aim of therapeutic thoracentesis (TT) is to aspirate as much pleural fluid as possible. Monitoring pleural pressure (PlP) during TT has been proposed to avoid the adverse effects due to an unintended sharp drop in PlP. The objectives of this study are to ascertain the diagnostic value of the PlP measurement, to find a predictive variable of the amount of fluid that can be removed, to obtain insight into the characteristics of the PlP curve and pleural elastance (PE) during TT, and to describe the complications of TT. Sixty-one unselected patients were studied. Only the four patients with suspected trapped lung had an initial PlP lower than 4 cm H₂O and a PE higher than 33 cm H₂O/L. There was a weak correlation (r = 0.52) between PE during the first 0.5 L aspirated and the total amount of fluid aspirated. Partial PE values were 10, 7.5, and 14 cm H₂O/L at the early, intermediate, and late phases of TT. No complications were found except for nine pneumothoraces. In conclusion, the technique was clinically helpful because large amounts of pleural fluid could be aspirated with few and mild complications, and because it allows clinicians to support the preliminary diagnosis of trapped lung. None of the studied variables was found to predict the suitability of aspirating more than 1.5 L. Rather than being monotonically descendent, the PlP curve shows a three-part line with the deepest slopes at the first and last phases of the thoracentesis.

This article has been cited by other articles:

				D. Feller-Kopman, M. J. Parker, and R. M. Schwartzstein Assessment of Pleural Pressure in the Evaluation of Pleural Effusions Chest, January 1, 2009; 135(1): 201 - 209. [Full Text] [PDF]

				D. Feller-Kopman, D. Berkowitz, P. Boiselle, and A. Ernst Large-Volume Thoracentesis and the Risk of Reexpansion Pulmonary Edema Ann. Thorac. Surg., November 1, 2007; 84(5): 1656 - 1661. [Abstract] [Full Text] [PDF]

				J. T. Huggins, S. A. Sahn, J. Heidecker, J. G. Ravenel, and P. Doelken Characteristics of Trapped Lung: Pleural Fluid Analysis, Manometry, and Air-Contrast Chest CT Chest, January 1, 2007; 131(1): 206 - 213. [Abstract] [Full Text] [PDF]

				J. Heidecker, J. T. Huggins, S. A. Sahn, and P. Doelken Pathophysiology of pneumothorax following ultrasound-guided thoracentesis. Chest, October 1, 2006; 130(4): 1173 - 1184. [Abstract] [Full Text] [PDF]

				F. Rodriguez-Panadero, J. P. Janssen, and P. Astoul Thoracoscopy: general overview and place in the diagnosis and management of pleural effusion. Eur. Respir. J., August 1, 2006; 28(2): 409 - 422. [Full Text] [PDF]

				D. Feller-Kopman, A. Walkey, D. Berkowitz, and A. Ernst The Relationship of Pleural Pressure to Symptom Development During Therapeutic Thoracentesis Chest, June 1, 2006; 129(6): 1556 - 1560. [Abstract] [Full Text] [PDF]

				P. Doelken, J. T. Huggins, N. J. Pastis, and S. A. Sahn Pleural Manometry: Technique and Clinical Implications Chest, December 1, 2004; 126(6): 1764 - 1769. [Abstract] [Full Text] [PDF]

				V. E. Coelho-D'Costa, S. A. Nachman, and J. Salazar-Schicchi Massive Recurrent Transudative Pleural Effusion: Role of Measurement of Pleural Pressure as a Diagnostic Tool Chest Meeting Abstracts, October 1, 2003; 124(4): 275S - 276. [Abstract] [Full Text] [PDF]

				W. G. Petersen Revisiting Thoracentesis Procedures Chest, March 1, 2002; 121(3): 1008 - 1009. [Full Text] [PDF]

				M. J. TOBIN Chronic Obstructive Pulmonary Disease, Pollution, Pulmonary Vascular Disease, Transplantation, Pleural Disease, and Lung Cancer in AJRCCM 2000 Am. J. Respir. Crit. Care Med., November 15, 2001; 164(10): 1789 - 1804. [Full Text] [PDF]