Physiologic Basis of Symptoms in Pleural Disease

Abstract

Pleural effusions are commonly encountered and have a significant impact on the respiratory system. The reported effect of thoracentesis on physiologic parameters including oxygenation, lung volumes, and respiratory mechanics is variable likely owing to studies with a small, heterogeneous population of patients.Most patients who are short of breath from pleural effusion experience relief following drainage due to improvement in the length–tension relationship of the respiratory muscles. An observed increase in oxygenation following thoracentesis is likely due to improved ventilation and perfusion matching. Recent advances in methods of measuring pleural pressure provide a greater understanding of the impact of pleural effusion on pleural pressure and changes in pleural pressure with thoracentesis; however, there has been no demonstrated benefit of routine monitoring of pleural pressure to reduce complications from thoracentesis. Manometry does allow for the identification of patients with unexpandable lung which is useful when determining options for pleural palliation. The following article will review the pathophysiological effects of pleural effusion and thoracentesis.

Ipsilateral and contralateral hemidiaphragm dynamics in symptomatic pleural effusion: The 2nd PLeural Effusion And Symptom Evaluation (PLEASE‐2) Study

“…Mean volume drained was 2121 (1206) ml. Drainage improved the radiographic appearance from median grade 4 [3][4][5] at baseline to median grade 2 [1-2] post-drainage (p < 0.001). The VAS breathlessness score improved by a mean of 36.0 mm (95% CI 21.9-50.0, p < 0.001).…”

“…1 The function of the diaphragm, the most important muscle of respiration, is impaired by the presence of pleural effusion and is believed to be an important factor in the associated, often disabling, breathlessness. 2,3 In our recently published PLeural Effusion And Symptom Evaluation (PLEASE)-1 study (n = 150 participants with symptomatic pleural effusion), abnormal movement and shape of the ipsilateral hemidiaphragm were common (50% and 48%, respectively). 4 Furthermore, abnormal ipsilateral hemidiaphragm Deirdre B. Fitzgerald and Sanjeevan Muruganandan contributed equally to this study.…”

A virtual patient in interpretation of massive pleural effusion impact on hemidiaphragm work and an insignificant influence on blood oxygenation

“…Expansion of the rib cage and deformation of the ipsilateral hemidiaphragm contribute to decreased e ciency of inspiratory muscles hindering ventilation 9 . Additionally, paradoxical excursion of the inverted hemidiaphragm might result in pendulum breathing 10 .…”

Malignant Pleural Effusions in the Era of Immunotherapy and Antiangiogenic Therapy

“…9MPEs often produce symptoms of dyspnea, cough, and chest discomfort that significantly reduce QoL. [10][11][12][13] The traditional approach in managing MPE centers on palliative therapies such as improving symptoms over the course of 4 to 6 months via placement of indwelling pleural catheters (IPCs), chemical/surgical pleurodesis, or combination approaches. [14][15][16][17] These invasive procedures can cause patient discomfort, increased health care utilization, and have not been shown to improve survival rates.…”