Comparison of the Use and Accuracy of Methods for Determining Pleural Fluid pH

Tm, Chandler; Eh, McCoskey; Rp, Byrd; Tm, Roy

doi:10.1097/00007611-199902000-00010

Cited by 22 publications

(22 citation statements)

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“…This is in contrast to previous reports by Kohn and Hardie [22] and Chandler et al [21], where the majority (66 and 68%) of hospital laboratories used methods other than BGA. Furthermore, there was no difference between the use of BGA by university-based hospital laboratories compared with non-university-based institutions [21,22]. Kohn and Hardie [22] also reported that the university-based institutions were more likely to use a BGA.…”

Section: Discussioncontrasting

confidence: 91%

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Perception versus Reality: The Measuring of Pleural Fluid pH in the United States

Bowling¹,

Lenz²,

Chatterjee³

et al. 2012

Respiration

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Background: Pleural fluid pH measured by a blood gas analyzer is the only recommended method of pH measurement to guide management for patients with parapneumonic pleural effusions. Not all hospitals use blood gas analyzers for pleural fluid pH determination and it is unknown if physicians are aware of this problem. Objective: To determine if a discrepancy exists between the modality used for measuring pleural fluid pH and how physicians believe it is measured. Methods: We surveyed pulmonologists randomly across the USA by e-mail inquiring how they thought pleural fluid pH was measured at their laboratory. We then independently contacted the laboratory and asked how pleural fluid pH was actually measured. Results: Two hundred and sixty-seven pulmonologists completed the survey. Eighty-six percent of the pulmonologists use pleural fluid pH to manage complicated parapneumonic effusions. Forty-three percent did not recognize blood gas analyzer solely as the most accurate and validated method. Thirty-nine percent of the physicians who use pleural pH to manage effusions and believe that blood gas analyzers are the most accurate were wrong in their assumption that their laboratory was using this tool for pleural pH measurement. Conclusions: Whether it is due to inaccurate knowledge or a perception of how pleural fluid pH is tested, a significant number of pulmonologists, when treating complicated parapneumonic effusions, may be making management decisions based on erroneous information.

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Section: Discussioncontrasting

confidence: 91%

“…Chandler et al [21] reported that 68% of hospital laboratories in the southeastern USA measure pleural fluid pH with either a pH indicator stick or a pH meter and not a BGA. In a similar national survey of 220 hospital laboratories, Kohn and Hardie [22 ]also reported varied approaches: pH meter (35%), BGA (32%) and litmus paper (31%).…”

Section: Introductionmentioning

confidence: 99%

Perception versus Reality: The Measuring of Pleural Fluid pH in the United States

Bowling¹,

Lenz²,

Chatterjee³

et al. 2012

Respiration

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“…The pleural fluid was analyzed for pH using a blood gas apparatus [15](Gem premier 3000, model 5700, Instrumentation Laboratory, Lexington, Mass., USA) and for glucose using a common microbiologic laboratory. An empyema was said to be present if the pleural fluid appeared grossly infected, if the glucose was <40 mg/dl and if the pleural fluid pH was <7.10 [13].…”

Section: Methodsmentioning

confidence: 99%

Penetration of Clarithromycin in Experimental Pleural Empyema Model Fluid

Liapakis

Light²,

Pitiakoudis³

et al. 2005

Respiration

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Background: The degree of penetration of clarithromycin into the pleural fluid has not been studied. Objective: To determine the degree to which clarithromycin penetrates into empyemic pleural fluid using a new rabbit model of empyema. Methods: An empyema was created via the intrapleural injection of 1 ml turpentine followed 24 h later by instillation of 5 ml (10¹⁰) Escherichia coli bacteria (ATCC 35218) into the pleural space of New Zealand white rabbits. After an empyema was verified by thoracentesis and pleural fluid analysis, clarithromycin 30 mg/kg was administered intravenously. Antibiotic levels were determined on samples of pleural fluid and blood samples collected serially over 12 h. Antibiotic levels were estimated using HPLC. Results: The antibiotic penetrated well into the empyemic pleural fluid (AUC_PF/AUC_serum ratio of 1.57). The time to equilibration between the pleural fluid and blood antibiotic levels was 8 h. The peak pleural fluid level (Cmax_PF of 2.88 µg/ml) occurred 1 h (Tmax_PF of 1 h) after infusion and decreased thereafter. The Cmax_serum was 3.53 µg/ml at 1 h after administration. Conclusion: The levels of clarithromycin in the pleural fluid after intravenous administration are inhibitory for most of the usual pathogens causing empyema. The degree of penetration of clarithromycin should be considered when macrolides are selected for the treatment of patients with empyema.

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“…The pH of the pleural fluid was analysed using a blood gas machine [17] (Gem premier 3000, model 5700; Instrumentation laboratory, Lexington, MA, USA), and the glucose and lactate-D-hydrogenase (LDH) levels were analysed using a common microbiological laboratory (the upper limit of LDH in the present study9s laboratory was 460 U?L -1 ). An empyema was said to be present if the pleural fluid appeared grossly infected, if the glucose was v40 mg?dL -1 and if the pleural fluid pH was v7.10 and the LDH was w1,000 U?L -1 [15].…”

Section: Empyema Verificationmentioning

confidence: 99%

Penetration of newer quinolones in the empyema fluid

Liapakis¹

2004

European Respiratory Journal

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The degree of penetration of newer quinolones into the pleural fluid has not been studied. The objective of the present study was to determine the degree to which moxifloxacin and levofloxacin penetrate into empyemic pleural fluid using a new rabbit model of empyema.An empyema was created via the intrapleural injection of turpentine (1 mL), followed 24 h later by instillation of 2 mL (1610 10 ) Escherichia coli bacteria (ATCC 35218) into the pleural space of New Zealand white rabbits. After an empyema was verified by thoracentesis and pleural fluid analysis, moxifloxacin and levofloxacin (25 mg?kg -1 for both, i.v.) were administered. Antibiotic levels were determined in samples of pleural fluid and in blood collected serially over 12 h. Antibiotic levels were measured using HPLC.Each of the antibiotics penetrated well into the empyemic pleural fluid. Antibiotic penetration was the greatest for moxifloxacin (area under the curve (AUC) for pleural fluid/blood (AUCPF/AUCblood) ratio=1.37) followed by levofloxacin (ratio=1.13). The time to equilibration between the pleural fluid and blood antibiotic levels was more rapid for moxifloxacin (3.9 h) than for levofloxacin (4.4 h). With moxifloxacin, the peak pleural fluid concentration (Cmax,PF) was 2.77 mg?mL -1 and occurred at a time to maximum pleural fluid concentration (Tmax,PF) of 6 h after infusion and decreased thereafter. The peak blood concentration (Cmax,blood) was 4.81 mg?mL -1 at 1 h after administration. With levofloxacin, the peak pleural fluid level (Cmax,PF=1.39 mg?mL -1 ) occurred at 6 h (Tmax,PF=6 h) after infusion. The Cmax,blood was 1.88 mg?mL -1 at 1 h after administration.In conclusion, differences were found in the degree of penetration of the two quinolones into infected pleural fluid in rabbits. The clinical significance of these differences is unknown. More studies are needed to evaluate the pharmacokinetic parameters in the pleural space in humans.

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Comparison of the Use and Accuracy of Methods for Determining Pleural Fluid pH

Cited by 22 publications

References 0 publications

Perception versus Reality: The Measuring of Pleural Fluid pH in the United States

Perception versus Reality: The Measuring of Pleural Fluid pH in the United States

Penetration of Clarithromycin in Experimental Pleural Empyema Model Fluid

Penetration of newer quinolones in the empyema fluid

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