Effects of pneumothorax or pleural effusion on pulmonary function.

Abstract

The effects of pneumothorax or pleural effusion on respiratory function as measured by the commonly applied tests were investigated by studying 13 patients (six with pneumothorax, seven with effusion) with and, as far as possible, without air or fluid in the pleural cavity. Measurements included spirometric volumes, carbon monoxide transfer factor (TLco), and Kco by the single breath method, maximum expiratory flow-volume curves, and subdivisions of lung volume estimated by both inert gas dilution and body plethysmography. In patients with pneumothorax "pleural volume" was estimated as the difference between lung volumes measured by dilution and thoracic gas volume measured by plethysmography. In patients with effusion the change in "pleural volume" was equated with the volume of fluid subsequently aspirated."Total thoracic capacity" (TIC) was estimated by adding total lung capacity (TLC) measured by dilution and "pleural volume." Both effusion and pneumothorax produced a restrictive ventilatory defect with reductions of vital capacity, functional residual capacity, and TLC. In the patients with effusion T[C fell after aspiration, suggesting that the pleural fluid produced relative expansion of the chest wall as well as compression of the lung. In patients with pneumothorax, however, there was no difference in TIC with and without air in the pleural space. In the presence of pleural air or fluid there was a slight decrease in TLco and increase in Kco, with a small but significant increase in the rate of lung emptying during forced expiration. With pneumothorax the effects should be more predictable as the pressure in the ipsilateral pleural space is uniform, provided that there is free communication around the lung. The effects of a pleural effusion on the lung and chest wall volumes are less certain as they are likely to be influenced by both the pleural liquid pressure (at the level of the effusion) and the pleural surface pressure (above the pleural effusion).We have examined two groups of patients, one with pneumothorax and the other with pleural effusion, to study the effects of each on the results of the commonly applied tests of pulmonary function. MethodsWe studied six patients with pneumothorax (table 1). In three of these, measurements were made in the presence of a spontaneous pneumothorax and after complete resolution one to three weeks later.The other three patients with pneumothorax had small peripheral bronchial carcinomas and were 60 on 12 May 2018 by guest. Protected by copyright.

Changes in lung volumes and gas trapping in patients with large hiatal hernia

“…HH size also correlated with the magnitude of improvement in VC post-operatively. Reduced TLC in HH patients may be explained by the hernia producing a mild extra-parenchymal restrictive defect similar to that observed in patients with a large pleural effusion or pneumothorax (16), progressive cardiac enlargement due to heart failure (17), obesity (18), kyphoscoliosis (19), ascites (20) and pregnancy (21). Restrictive lung disease may also occur in HH patients due to pulmonary fibrosis associated with gastro-oesophageal reflux (22,23).…”

Pleural effusion in the mechanically ventilated patient

“…Correspondingly, a number of studies in spontaneously breathing patients with unilateral PLEF show disproportionately small increases in lung volumes after large volume thoracocentesis [22][23][24][25][26] and no [22] or poor [23] relationship between volumes of liquid extracted and lung gas volume recovered.…”

Mechanical and morphometrical changes in progressive bilateral pneumothorax and pleural effusion in normal rats

“…1) and pneumothorax yielded higher Est,L and Edyn,L, which led to greater Est,rs and Edyn,rs, respectively. Est,L was also found to increase in pneumothorax [5] and pleural effusion [3][4][5]. Conversely, KRELL and RODARTE [7] found that the slope of pulmonary pressure-volume (P-V) curve was not changed by pleural effusion.…”

“…There are reports mentioning a few aspects of respiratory mechanics in the presence of pneumothorax (PN) or pleural effusion (PE) [1][2][3][4][5][6][7][8][9][10], but most of them deal with spirometry [2,[4][5][6][7][8]10], pleural pressure topography [1,9], and pressure-volume curves [4][5][6][7]. In pleural effusion, only airway resistive properties [2,4,8,10], and chest wall [10] and lung compliance [4,10] were determined.…”