Improved lung function after thoracocentesis in patients with paradoxical movement of a hemidiaphragm secondary to a large pleural effusion

Wang, Lee-Min; Cherng, Jaw-Ming; Wang, Jeng-Shing

doi:10.1111/j.1440-1843.2007.01124.x

Cited by 47 publications

(46 citation statements)

References 20 publications

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“…In mechanically ventilated patients with CHF effusions, the improvement in PaO 2 :FiO 2 after thoracentesis correlated inversely with pleural elastance [17]. Improvements in oxygenation are greater in patients with diaphragm paradox [18]. No evidence links abnormal gas exchange caused by pleural effusions (and their improvements postthoracentesis) to the symptom of breathlessness.…”

Section: Pathophysiological Effects Of a Pleural Effusionmentioning

confidence: 99%

“…Although thoracentesis can improve the forced expiratory volume in 1 s (FEV 1 ), vital capacity and lung volumes [3 ▪ ,4,5,10,18] the magnitudes of increase are highly variable and often do not correlate with the volume of fluid drained [3 ▪ ,10]. (Table 1 and Fig.…”

Section: Pathophysiological Effects Of a Pleural Effusionmentioning

confidence: 99%

“…1) In 26 patients who had thoracentesis (1.74 ± 0.90 l), the vital capacity and total lung capacity increased by 0.41 ± 0.39 and 0.70 ± 0.20 l, respectively, after 24 h. The improvement correlated best with the Ppl after 0.80 l of fluid had been withdrawn [19]. The effect of thoracentesis on FEV 1 and vital capacity appears to be greater in patients with paradoxical movement of their hemidiaphragm [18]. Another small study ( n = 9) [4] also found similar modest improvements of vital capacity (median 0.30 l) and total lung capacity (0.64 l) compared with the volume of fluid evacuated (1.82 ± 0.60 l).…”

Section: Pathophysiological Effects Of a Pleural Effusionmentioning

confidence: 99%

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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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Section: Pathophysiological Effects Of a Pleural Effusionmentioning

confidence: 99%

Section: Pathophysiological Effects Of a Pleural Effusionmentioning

confidence: 99%

Section: Pathophysiological Effects Of a Pleural Effusionmentioning

confidence: 99%

See 1 more Smart Citation

Physiology of breathlessness associated with pleural effusions

Thomas

Jenkins²,

Eastwood³

et al. 2015

Current Opinion in Pulmonary Medicine

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“…Several other studies17–22 have evaluated the impact of thoracocentesis on various physiological parameters of the respiratory system including spirometric variables,17 18 arterial blood gases,19–21 mechanical properties22 23 and respiratory muscle function 24. All these interesting studies seem to be associated with several methodological drawbacks amenable to factors related with homogeneity of patients' characteristics, causes and size of effusion, quantity of fluid removed, possible concomitant presence of lung lesions, prior manipulations to the pleura as well as the timing of measurements.…”

Section: Introductionmentioning

confidence: 99%

Temporal evolution of thoracocentesis-induced changes in spirometry and respiratory muscle pressures

Michaelides

Bablekos

Analitis

et al. 2017

Postgraduate Medical Journal

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“…Tais fatos seriam os responsáveis pela dispneia associada ao derrame pleural [21]. A diminuição do volume da caixa torácica (diafragma, parede costal e mediastino) parece ser tão ou mais importante quanto o aumento do volume pulmonar para melhoria da dispneia após o esvaziamento do derrame [22].…”

Section: -Objetivos Secundáriosunclassified

Relação entre a elastância pleural e efetividade da pleurodese no derrame pleural maligno recidivante

Araújo¹

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Ao Thiago "Maranhão Machão". Ex-residente, ex-"fellow", mas amigo para toda a vida. Figura ímpar que nunca mediu esforços em me ajudar com as tarefas mais chatas deste trabalho.Aos demais colegas da CCT Ana, Ricardo e Augusto por me acolherem nessa grande equipe.À querida equipe do GPPOT: Márcia e Priscila. Por toda ajuda no decorrer deste projeto e naqueles que ainda virão.Ao biólogo Aristides Correia pela sua paciência sem fim, sempre me ajudando com a análise estatística deste projeto.Aos residentes da Cirurgia Torácica do HCFMUSP que perderam alguns dos seus preciosos minutos para ajudar nos procedimentos e acompanhamento dos pacientes incluídos neste estudo. VI Normatização adotada 71Gráfico 16 -Pontuação obtida na escala de dor EVA no momento inicial (EVA1) e após 30 dias (EVA30). 72Gráfico 17-Elastâncias em 800 ml de acordo com o sítio primário da neoplasia. 75 Gráfico 18-Elastâncias totais de acordo com o sítio primário da neoplasia. 76 Gráfico 19 -Elastâncias em 400 mL de acordo aspecto do líquido. 77 Gráfico 20 -Correlação entre elastância em 400 mL e o Delta Volume. 80 Gráfico 21-Correlação entre elastância em 400 mL e volume pleural à TC1. 80 Gráfico 22 -Correlação entre elastância em 400 mL e volume pleural à TC30. 81 Gráfico 23 -Correlação entre elastância em 800 mL e o Delta Volume 82 Gráfico 24-Correlação entre elastância em 800 mL e volume pleural à TC1. 82 Gráfico 25 -Correlação entre elastância em 800 mL e volume pleural à TC30. 83 Gráfico 26 -Correlação entre elastância total e o Delta Volume.84 Gráfico 27 -Correlação entre elastância total e volume pleural à TC1. 84 Gráfico 28 -Correlação entre elastância total e o volume pleural à TC30. 85 Gráfico 29 -Comparação da efetividade clínica entre os grupos de acordo com o volume da cavidade pleural após a drenagem. 86Gráfico 30-Comparação entre a elastância em 400 mL e efetividade clínica. 89 Gráfico 31-Comparação entre a elastância em 800 mL e efetividade clínica 90 Gráfico 32-Comparação entre a elastância total e efetividade clínica 90 Gráfico 33 -Comparação entre as elastâncias em 400 ml e melhora da dispneia.91 Gráfico 34 -Comparação entre as elastâncias em 800 ml e melhora da dispneia 92 Gráfico 35 -Comparação entre as elastâncias totais e melhora da dispneia.92 Gráfico 36-Comparação entre a elastância em 400 mL e melhora da dor. 93 Gráfico 37-Comparação entre a elastância em 800 mL e melhora da dor.94 Gráfico 38-Comparação entre a elastância total e melhora da dor.

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Improved lung function after thoracocentesis in patients with paradoxical movement of a hemidiaphragm secondary to a large pleural effusion

Abstract: Statistically significant improvement in pulmonary function following thoracocentesis was observed in patients with pleural effusion and PM of the hemidiaphragm. Patient selection may therefore explain the different outcomes of thoracocentesis reported in previous studies.

Cited by 47 publications

References 20 publications

Physiology of breathlessness associated with pleural effusions

Physiology of breathlessness associated with pleural effusions

Temporal evolution of thoracocentesis-induced changes in spirometry and respiratory muscle pressures

Relação entre a elastância pleural e efetividade da pleurodese no derrame pleural maligno recidivante

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