Changes in Pulmonary Mechanics and Gas Exchange After Thoracentesis on Patients With Inversion of a Hemidiaphragm Secondary to Large Pleural Effusion

Wang, Jeng-Shing; Tseng, Chi-Hao

doi:10.1378/chest.107.6.1610

Cited by 88 publications

(72 citation statements)

References 12 publications

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“…We observed a statistically significant increase in lung function variables after thoracentesis, a finding that contradicts the results of Brown et al [21] but is in agreement with several more recent studies [1,2,3, 22]. According to our results, the ratio of FVC change to the amount of fluid removed was 0.27, which is consistent with the studies of Light et al (0.23) [1] and Zerahn et al (0.33) [22].…”

Section: Discussionsupporting

confidence: 85%

“…In an attempt to explain the relief of dyspnea after thoracentesis, several authors have pointed out that there is a discrepancy between the amount of removed fluid and FVC change even when these parameters were positively correlated [1,2,3]. When pleural fluid is aspirated from the thoracic cavity, the removed volume corresponds to the decrease in thoracic cage size and the lung volume expansion.…”

Section: Discussionmentioning

confidence: 99%

“…Interestingly, a discrepancy between the volume of aspirated fluid and the improvement in pulmonary lung function parameters has been observed [1,2,3]. Estenne et al [3] have suggested that relief of dyspnea following thoracentesis results from the reduction in thoracic cage size, which allows the inspiratory muscles to operate on a more advantageous portion of their length-tension curve.…”

Section: Introductionmentioning

confidence: 99%

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Expiratory Flow Limitation in Patients with Pleural Effusion

et al. 2007

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Background: Expiratory flow limitation (EFL) is one of the main mechanisms contributing to dyspnea in patients with chronic obstructive pulmonary disease but has not been explored in patients with pleural effusion. Objectives: It was the aim of this study to determine whether patients with pleural effusion exhibit EFL and to investigate the effect of therapeutic thoracentesis on EFL. Patients and Methods: The study was performed on 21 patients with pleural effusion who were subjected to thoracentesis and measurement of pleural pressure (PP). Spirometry and estimation of flow limitation by the negative expiratory pressure technique were performed before and after thoracentesis. Results: Statistically significant differences were observed in all spirometric parameters. No correlation between the increase in lung volumes and flows and any of the aspirated fluid parameters was observed. Before thoracentesis, 14 out of 21 patients were flow limited, compared with 7 patients after thoracentesis (χ² = 6.151, p = 0.013). Mean values of flow limitation before and after thoracentesis differed significantly. The decrease in flow limitation did not correlate with the increase in the spirometric parameters, the aspirated fluid volume or PP decrease. Conclusions: In the majority of patients with pleural effusion, flow limitation improves after thoracentesis. Flow limitation may be a contributing factor to the sensation of dyspnea in these patients.

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Section: Discussionsupporting

confidence: 85%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Expiratory Flow Limitation in Patients with Pleural Effusion

et al. 2007

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“…The dyspnoea associated with a pleural effusion is likely to be caused by disruption to the normally efficient mechanics of the inspiratory muscles and diaphragm [15,16]; however, in the case of NEL, this may be relatively benign. Excessive fluid drainage in those with NEL can lead acutely to chest pain, distressing cough or a "pulling" sensation in the centre of the chest, although none of these are specific as they may also be associated with other situations, including re-expansion pulmonary oedema (REPO) [17].…”

Section: Nonexpandable Lungmentioning

confidence: 99%

Advanced medical interventions in pleural disease

et al. 2016

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The burden of a number of pleural diseases continues to increase internationally. Although many pleural procedures have historically been the domain of interventional radiologists or thoracic surgeons, in recent years, there has been a marked expansion in the techniques available to the pulmonologist. This has been due in part to both technological advancements and a greater recognition that pleural disease is an important subspecialty of respiratory medicine. This article summarises the important literature relating to a number of advanced pleural interventions, including medical thoracoscopy, the insertion and use of indwelling pleural catheters, pleural manometry, point-of-care thoracic ultrasound, and image-guided closed pleural biopsy. We also aim to inform the reader regarding the latest updates to more established procedures such as chemical pleurodesis, thoracentesis and the management of chest drains, drawing on contemporary data from recent randomised trials. Finally, we shall look to explore the challenges faced by those practicing pleural medicine, especially relating to training, as well as possible future directions for the use and expansion of advanced medical interventions in pleural disease. @ERSpublications Technological advances and greater availability of techniques give a broad range of interventions for pleural disease http://ow.ly/ZNya2

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“…Practically, this retraction of the chest wall is primarily driven by the diaphragm re-assuming its normal dome-shaped configuration. It is, interestingly, this change in diaphragm conformation that may be most responsible for the relief of breathlessness associated with drainage of large pleural effusions, a finding easily visualized by ultrasound, according to the concept of 'lengthtension inappropriateness' [9][10][11].…”

mentioning

confidence: 99%