Hemodynamic and Pulmonary Changes after Drainage of Significant Pleural Effusions in Critically Ill, Mechanically Ventilated Surgical Patients

Abstract

Drainage of pleural effusions results in increased oxygen delivery and oxygen consumption coinciding with a decrease in pulmonary capillary wedge pressure. The pulmonary arteriovenous shunt decreased, implying an increase in functional residual capacity and improved oxygenation. Further study is needed to determine whether these changes lead to an improved patient outcome (i.e., reduction in length of stay, ventilator days, or mortality).

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

“…The effect of pleural fluid removal has been studied in patients on mechanical ventilatory support. Ahmed et al reported no change in PaO 2 following fluid removal, but reduction in pulmonary artery occlusion, central venous pressure and pulmonary shunt fraction in association with an increase in VO 2 and DO 2 [41]. Doelken et al reported no improvement in PaO 2 , physiological dead space, static or dynamic respiratory system compliance and end-inspiratory airway resistance; passive inflation work was reduced from 3.42 to 2.99 J/L [42].…”

CT Volumetric Analysis of Pleural Effusions

“…Gas exchange is also affected to a lesser degree, with mild improvements in arterial oxygenation and A-a gradients after therapeutic thoracentesis (24,25). In addition, large pleural effusions expand the thoracic cage which in turn shifts the length-tension curve of the inspiratory muscles to an unfavorable position, contributing to the sensation of dyspnea (10).…”

Preemptive Thoracic Drainage to Eradicate Postoperative Pulmonary Complications after Living Donor Liver Transplantation

“…Under the combination of general anesthesia and prolonged placement in a supine position, intrathoracic fluid retention contributes to a decrease in functional residual capacity and compression of lung tissue, causing compressive atelectasis. 26,27 Because atelectasis has several causes, various approaches have been used to prevent this condition, according to its mechanism and cause. 12 Lung mechanics and breathing patterns are often changed postoperatively, resulting in coughing and removal of particulate matter, both of which are particular to pulmonary defense mechanisms.…”