Resolution of Pleural Effusions

Cohen, Mark W.; Sahn, Steven A.

doi:10.1378/chest.119.5.1547

Cited by 100 publications

(65 citation statements)

References 201 publications

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“…[3][4][5][6]16) They were usually recognized incidentally during routine chest plain films and were clinically irrelevant. The collection of pleural fluid may need thoracocentesis with evacuation of effusions, chest tube drainage, or administration of oral indomethacin or cortisone 11) . The temporary presence of pleural effusions may be explained by the empty space being created by elevation of the sternum or atelectasis.…”

Section: Discussionmentioning

confidence: 99%

Pleural Effusion Complicating after Nuss Procedure for Pectus Excavatum

Cheng

Lin

Wang

et al. 2014

Ann Thorac Cardiovasc Surg

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Purpose: The Nuss procedure is a minimally invasive method for the correction of pectus excavatum (PE). Pleural effusion complicating following the Nuss procedure was uncommon but may be critical. We evaluated the risk factors of postoperative pleural effusion after Nuss repair. Methods: We included all patients with PE primarily corrected by Nuss procedure from July 2005 to December 2011. The clinical features, treatment and outcomes of these patients with pleural effusion were analyzed retrospectively. Results: 390 patients (338 men, 52 women) with a mean age of 23.9 years (5-44 years) were included. Postoperative pleural effusion occurred in 10 patients (2.6%). The time of occurrence of pleural effusion was on a mean of 16.6 days (8-32 days) after operation presenting with progressive dyspnea. All of these patients were adults, and 9 patients (90%) were repaired by two pectus bars (p <0.001). Six patients with massive pleural effusion received thoracocentesis (400 ml-1000 ml). All of the effusions were exudative. These patients took short-term indomethacin or steroids without removal of bars and all recovered well after a mean of 40 months (12-72 months) follow-up. Conclusions: Pleural effusion complicating after Nuss procedure was uncommon. It occurred most on adult patients with placement of double bars. Close follow-up in adults after more than one bar insertion is recommended. Administration of temporary medications of indomethacin/steroid and/or thoracocentesis could obtain a satisfying result. Early administration of indomethacin/steroid in adult patients repaired by two bars with mild pleural effusion for preventing pooling of effusion could also be considered.

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Section: Discussionmentioning

confidence: 99%

Pleural Effusion Complicating after Nuss Procedure for Pectus Excavatum

Cheng

Lin

Wang

et al. 2014

Ann Thorac Cardiovasc Surg

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“…Despite the medical treatments, a small percentage of these effusions remain persistent, and adhesions and loculations can develop. 6) In this period, intra-pleural streptokinase, urokinase can be administered or thoracoscopic debridement may be performed. 7) If the process continues as trapped lung, lung volume, diffusion capacity and expiratory flow rates decrease, and chest mechanics deteriorate.…”

Section: Discussionmentioning

confidence: 99%

Long-Term Results of Lung Decortication in Patients with Trapped Lung Secondary to Coronary Artery Bypass Grafting

Çelık

Çelik

Aydemir

et al. 2012

ATCS

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Purpose: To evaluate long-term results of decortications in patients with symptomatic restrictive pleurisy and trapped lung after coronary bypass grafting. Methods: Twenty consecutive patients undergoing lung decortications for trapped lung after coronary bypass grafting were prospectively evaluated. Pulmonary function tests were used as objective criteria, and quality of life was assessed by the Medical Research Council dyspnea scale. A p value <0.05 was considered significant. Results: Twenty patients, 3 women and 17 men, with a median age of 59 years were evaluated. The median time interval between coronary bypass grafting and decortications was 9.3 months. The mean preoperative forced expiratory volume in one second and forced vital capacity were 63.8% ± 7.4% and 50.5% ± 6.6% of the predicted value, respectively, and the improvement rates after decortications were 14.97% ± 6.3% and 17.62% ± 6.38%, respectively. Dyspnea scores improved after decortications (p <0.05). The median follow-up was 25 months. After surgery, 3 patients developed superficial wound infections, and out of 7 patients with prolonged air leaks, 2 underwent re-operation. After surgery, one patient died on day 34 and another, after 3 years. Conclusion: Lung decortications, re-expanding the affected lung, ensures symptom remission and improves quality of life of patients with trapped lung after coronary bypass grafting in the long-term. Keywords: lung, decortication, restrictive pleurisy, trapped lung, coronary artery bypass grafting Ann Thorac Cardiovasc Surg 2012; 18: 109-114 doi: 10.5761/atcs.oa.11.01715 by time intervals. Pleural effusions developed within the first week of coronary bypass surgery are mostly small in amount and tend to resolve spontaneously, or can be treated by one or two simple thoracentesis. A few of them may remain persistent, and large effusions developed at a later stage may lead to trapped lung in time, despite all medical or minimally-invasive surgical approaches. If trapped lung (restrictive pleurisy) develops, the treatment of choice is decortication. Although several authors have reported the results of decortications in patients with trapped lung, long-term outcomes remain uncertain.The aim of the present study was to evaluate the longterm results of decortications performed in patients with trapped lung, developed after CABG surgery.

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“…Interestingly, the negative pressure generated at tip remains basically confined to the fluid pool and is not transmitted to the rest of the pleural space due to the extremely high flow resistance of the pleural space once the visceral pleura adheres to the parietal one (Miserocchi et al, 1992). Recovery from www.intechopen.com pleural effusion may be slow, ranging from weeks to months (Cohen & Sahn, 2001). Removal of chest tubes after fluid drainage of 400-450 cc /day or less appears reasonable (Cerfolio & Bryant, 2008;Cerfolio et al, 2010;Bertholet et al 2010) as it is in the range of physiological daily pleural fluid filtration (an estimated value of 350 ml/day (Miserocchi & Negrini, 1997).…”

Section: Pleural Spacementioning

confidence: 99%