Effects of Pleural Effusion Drainage on Oxygenation, Respiratory Mechanics, and Hemodynamics in Mechanically Ventilated Patients

Razazi, Keyvan; Thille, Arnaud W.; Carteaux, Guillaume; Beji, Olfa; Brun‐Buisson, Christian; Brochard, Laurent; Dessap, Armand Mekontso

doi:10.1513/annalsats.201404-152oc

Cited by 58 publications

(62 citation statements)

References 32 publications

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“…This reduction in ventilator performed work might predict a reduction in the work performed by the spontaneously breathing patient. Razazi et al reported improvement in respiratory system compliance, end-inspiratory transpulmonary pressure, PaO 2 / FIO 2 ratio and end-expiratory lung volume [43]. A lesser improvement in oxygenation occurred in patients with ARDS.…”

Section: Assessment Of Pleural Effusionmentioning

confidence: 98%

Ultrasonography evaluation during the weaning process: the heart, the diaphragm, the pleura and the lung

et al. 2016

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Section: Assessment Of Pleural Effusionmentioning

confidence: 98%

Ultrasonography evaluation during the weaning process: the heart, the diaphragm, the pleura and the lung

et al. 2016

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“…In mechanically ventilated patients, improvements in PaO 2 :FiO 2 have been associated with the volume drained [14] and the increase in end-expiratory lung volume [15 ▪ ]; those with lower PaO 2 :FiO 2 ratios appeared to have greater benefit. Patients with acute respiratory distress syndrome appeared to have less improvement in gas exchange [15 ▪ ,16]. In mechanically ventilated patients with CHF effusions, the improvement in PaO 2 :FiO 2 after thoracentesis correlated inversely with pleural elastance [17].…”

Section: Pathophysiological Effects Of a Pleural Effusionmentioning

confidence: 99%

Physiology of breathlessness associated with pleural effusions

Thomas

Jenkins²,

Eastwood³

et al. 2015

Current Opinion in Pulmonary Medicine

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Purpose of reviewPleural effusions have a major impact on the cardiorespiratory system. This article reviews the pathophysiological effects of pleural effusions and pleural drainage, their relationship with breathlessness, and highlights key knowledge gaps.Recent findingsThe basis for breathlessness in pleural effusions and relief following thoracentesis is not well understood. Many existing studies on the pathophysiology of breathlessness in pleural effusions are limited by small sample sizes, heterogeneous design and a lack of direct measurements of respiratory muscle function. Gas exchange worsens with pleural effusions and improves after thoracentesis. Improvements in ventilatory capacity and lung volumes following pleural drainage are small, and correlate poorly with the volume of fluid drained and the severity of breathlessness. Rather than lung compression, expansion of the chest wall, including displacement of the diaphragm, appears to be the principle mechanism by which the effusion is accommodated. Deflation of the thoracic cage and restoration of diaphragmatic function after thoracentesis may improve diaphragm effectiveness and efficiency, and this may be an important mechanism by which breathlessness improves. Effusions do not usually lead to major hemodynamic changes, but large effusions may cause cardiac tamponade and ventricular diastolic collapse. Patients with effusions can have impaired exercise capacity and poor sleep quality and efficiency.SummaryPleural effusions are associated with abnormalities in gas exchange, respiratory mechanics, respiratory muscle function and hemodynamics, but the association between these abnormalities and breathlessness remains unclear. Prospective studies should aim to identify the key mechanisms of effusion-related breathlessness and predictors of improvement following pleural drainage.

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“…A further study [8] in a medical ICU demonstrated an early improvement in P/F ratio at 3 h post pleural drainage, and sustained at 24 h post intervention. A recent meta-analysis of a total 118 patients demonstrated an overall 18% improvement in the PaO 2 /FiO 2 ratio after effusion drainage [13].…”

Section: Discussionmentioning

confidence: 87%

“…Results from previous research Razazi et al [8], showed that PaO 2 / FiO 2 before drainage and 24 h after drainage was 191 ± 69 versus 250 ± 106 respectively. Based on this the needed sample is 40 cases.…”

Section: Sample Sizementioning

confidence: 90%

Effect of Ultrasound-Guided Thoracocentesis on Clinical and Physiological Outcomes in Mechanically Ventilated Patients

Ammar¹

2017

J Anesth Clin Res

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Effects of Pleural Effusion Drainage on Oxygenation, Respiratory Mechanics, and Hemodynamics in Mechanically Ventilated Patients

Abstract: Drainage of large (≥500 ml) pleural effusion in mechanically ventilated patients improves oxygenation and end-expiratory lung volume. Oxygenation improvement correlated with an increase in lung volume and a decrease in transpulmonary pressure, but was less so in patients with ARDS.

Cited by 58 publications

References 32 publications

Ultrasonography evaluation during the weaning process: the heart, the diaphragm, the pleura and the lung

Ultrasonography evaluation during the weaning process: the heart, the diaphragm, the pleura and the lung

Physiology of breathlessness associated with pleural effusions

Effect of Ultrasound-Guided Thoracocentesis on Clinical and Physiological Outcomes in Mechanically Ventilated Patients

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