Pleural manometry in pleural effusion

Galal, Mohamed; Halafawy, Ahmed El; Assal, Hebatallah Hany; El-kabany, Yasmeen

doi:10.1016/j.ejcdt.2016.02.006

Cited by 4 publications

(4 citation statements)

References 10 publications

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“…However, attempts to demonstrate a correlation between pleural pressures or pleural elastance, and the development of REPO in a cohort of 185 patients have failed—the caveat to this being that, in the study, there was only a single case of clinical REPO 18. There are mixed reports as to the efficacy of using manometry to predict clinical endpoints—Pannu et al 19 reported that manometry had no significant impact on symptoms (chest discomfort or dyspnoea) during thoracocentesis, whereas, more recently, Galal et al 20 reported significantly lower pleural closing pressures and higher elastance in patients who became symptomatic during thoracocentesis.…”

Section: Discussionmentioning

confidence: 93%

Re-expansion pulmonary oedema: a novel emergency therapeutic option

et al. 2016

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Re-expansion pulmonary oedema (REPO) is a rare complication of pleural fluid thoracocentesis and has been associated with a high mortality rate. There is limited evidence to inform on its most effective management. We present two cases of large volume thoracocentesis resulting in acute respiratory decompensation that was treated by reintroducing the drained pleural fluid back into the pleural cavity. We also present a review of the literature specifically assessing the reported incidence rate of REPO after pleural fluid drainage. In both of our cases, symptoms and signs of respiratory instability were promptly reversed on reintroduction of the drained pleural fluid into the patient's pleural space-a therapy we have termed 'rapid pleural space re-expansion'. This was not associated with any short-term adverse outcomes. The occurrence of REPO is a rare event with most cohort studies reporting an incidence of between 0% and 1%.

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Section: Discussionmentioning

confidence: 93%

Re-expansion pulmonary oedema: a novel emergency therapeutic option

et al. 2016

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“…The use of similar equipment was later reported by various groups, including Lan et al Villena et al and recently by Galal et al [9,34,40]. Lan et al adopted virtually the same technique as described by Light et al with the exception of using a 16-gauge pleural catheter instead of an Abrams needle and a commercial set of plastic tubes for central venous pressure measurement using the U-tube manometer.…”

Section: Methods Of Pleural Pressure Measurementmentioning

confidence: 90%

“…The system of IV tubing was purged of air with normal saline. The authors stated that the end-expiratory pleural pressure values were recorded during therapeutic thoracentesis [40]. However, due to water column oscillations and internal resistance of this set, the reliability of instantaneous end-respiratory pressure seems to be questionable.…”

Section: Methods Of Pleural Pressure Measurementmentioning

confidence: 99%

Pleural manometry–historical background, rationale for use and methods of measurement

Zielińska-Krawczyk

Krenke

Grabczak

et al. 2018

Respiratory Medicine

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Subatmospheric pleural pressure (Ppl), which is approximately -3 to -5 cmHO at functional residual capacity (FRC) makes pleura a unique organ in the human body. The negative Ppl is critical for maintaining the lungs in a properly inflated state and for proper blood circulation within the thorax. Significant and sudden pleural pressure changes associated with major pleural pathologies, as well as therapeutic interventions may be associated with life-threatening complications. The pleural pressure may show two different values depending on the measurement method applied. These are called pleural liquid pressure and pleural surface pressure. It should also be realized that there are significant differences in pleural pressure distribution in pneumothorax and pleural effusion. In pneumothorax, the pressure is the same throughout the pleural space, while in pleural effusion there is a vertical gradient of approximately 1 cm HO/cm in the pleural pressure associated with the hydrostatic pressure of the fluid column. Currently, two main methods of pleural pressure measurement are used: simple water manometers and electronic systems. The water manometers are conceptually simple, cheap and user-friendly but they only allow the estimation of the mean values of pleural pressure. The electronic systems for pleural pressure measurement are based on pressure transducers. Their major advantages include precise measurements of instantaneous pleural pressure and the ability to display and to store a large amount of data. The paper presents principles and details of pleural pressure measurement as well as the rationale for its use.

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“…The latter is of particular interest since a commonly perceived barrier to widespread manometry use has been its applicability outside of specialist centres. We also used radiographically-defined UL as our comparator, something not consistently performed in studies reporting manometry (19,20). Additionally, radiographs were taken after a period of regular drainage, reducing the likelihood that UL would be obscured by residual fluid.…”

Section: Discussionmentioning

confidence: 99%

Manometry performed at indwelling pleural catheter insertion to predict unexpandable lung

Halford¹,

Bhatnagar²,

White³

et al. 2020

J Thorac Dis

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Background: The finding of unexpandable lung (UL) at an early timepoint is of increasing importance in guiding treatment decisions in patients with malignant pleural effusion (MPE). Pleural manometry is the most common technique to delineate UL, however it has never been measured via an indwelling pleural catheter (IPC). To further the evidence base we analysed all patients in the IPC-PLUS study who had manometry performed during IPC insertion for the ability to predict substantial UL using manometry. Methods: All patients enrolled in IPC-PLUS who had manometry performed at IPC insertion and radiographic assessment of UL at day 10 were included. Elastance curves were visually inspected for each patient. Initial pleural pressure, closing pleural pressure, and terminal elastance were analysed for their differences and predictive ability in those with substantial UL, defined as ≥25% entrapment on chest radiography. Results: A total of 89 patients had manometry performed at IPC insertion with subsequent radiographic assessment of UL and interpretable elastance curves. Those with substantial UL had a significantly lower median closing pleural pressure (−15.00 vs. 0.00 cmH 2 O, P=0.012) and higher terminal elastance (12.03 vs. 8.59 cmH 2 O/L, P=0.021) compared to a combined group with no or partial UL. However, the predictive ability of these factors to discriminate substantial UL was poor, with areas under the receiver operating characteristic curves of 0.695 and 0.680 for closing pleural pressure and elastance respectively. Conclusions: Our results suggest that manometry is not useful in accurately predicting substantial UL when used via an IPC at the time of insertion.

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Pleural manometry in pleural effusion

Cited by 4 publications

References 10 publications

Re-expansion pulmonary oedema: a novel emergency therapeutic option

Re-expansion pulmonary oedema: a novel emergency therapeutic option

Pleural manometry–historical background, rationale for use and methods of measurement

Manometry performed at indwelling pleural catheter insertion to predict unexpandable lung

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