Sleep in patients with large pleural effusion: impact of thoracentesis

Marcondes, Bianca; Vargas, Francisco Suso; Paschoal, Fabio Henrique; Cartaxo, Ana Maria; Teixeira, Lisete R.; Genofre, Eduardo H.; Onishi, Roberto; Skomro, Robert; Lorenzi-Filho, Geraldo

doi:10.1007/s11325-011-0529-6

Cited by 18 publications

(17 citation statements)

References 20 publications

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“…Only one published study has examined the effect of pleural effusion on sleep [35 ▪ ] and found poor sleep quality and efficiency in patients ( n = 19) with a large pleural effusion at baseline as measured by the Pittsburgh Sleep Quality Index and overnight sleep studies.…”

Section: Pathophysiological Effects Of a Pleural Effusionmentioning

confidence: 99%

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%

Physiology of breathlessness associated with pleural effusions

Thomas

Jenkins²,

Eastwood³

et al. 2015

Current Opinion in Pulmonary Medicine

View full text Add to dashboard Cite

show abstract

“…This is quite important, as pleural effusions can have a large impact on dyspnea, quality of life, sleep, and exercise. 4,6,52,53 Table 2 summarizes the most recent studies on the physiologic impact of thoracentesis. The physiologic basis for improvements is likely multifactorial.…”

Section: Understanding the Physiologic Impact Of Thoracentesismentioning

confidence: 99%

Thoracentesis

DeBiasi

Puchalski

2016

PLEURA

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Pleural effusions are common and account for high morbidity and mortality in a range of patients. Thoracentesis can provide significant symptom relief and improvement in physiologic parameters including dyspnea, exercise, and sleep. Recent advances, including the use of ultrasound and dedicated procedural teams, have improved the safety of thoracentesis. This has allowed thoracentesis to be performed on higher-risk individuals including those with elevated bleeding risk and bilateral pleural effusions. This review will summarize recent advances in thoracentesis procedural safety, symptom relief following thoracentesis, and understanding of the physiologic basis for such improvements.

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“…1 Therapeutic thoracentesis is associated with improvements in oxygenation, 2 pulmonary mechanics, gas exchange, 3 spirometry, the 6-minute walk test, 4 and sleep. 5 The management of pleural disease has recently undergone a paradigms shif,t whereby patient-centered outcomes, including hospital readmissions, morbidity, and mortality, are paramount. Although the availability of biochemical data in pleural effusions allows physicians to fine-tune individualized patient management, future effusion analysis may allow us to predict outcomes.…”

Section: Introductionmentioning

confidence: 99%

Patient-Centered Outcomes Following Thoracentesis

Argento

Murphy

Pisani

et al. 2015

PLEURA

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Background Pleural effusions impact over 1.5 million people annually in the United States and cause significant morbidity. Although therapeutic thoracentesis is associated with improvement in respiratory parameters, unanswered questions remain regarding its impact. Objective The purpose of this study was to investigate patient-centered outcomes, the need for additional pleural interventions, and mortality in the 30 days following thoracentesis. Methods This prospective observational cohort study was performed in a tertiary care academic medical center between December 2010 and December 2011. Adult patients referred for thoracentesis were offered enrollment. The following characteristics were evaluated both before and at 30 days postprocedure: dyspnea using modified BORG (mBORG), physical and mental quality of life (QoL) using the short form 12, and basic activities of daily living (BADLs). The primary outcomes included changes in these parameters 30 days after thoracentesis. Secondary outcomes included the need for additional pleural procedures and mortality within 30 days of the thoracentesis. Multivariable logistic regression was used for analysis. Results Of the 284 patients who underwent thoracentesis, 80 (28.2%) died within 30 days of the procedure. Of the 163 patients comprising the analytical cohort, 35 (21.5%) patients required an additional pleural intervention within 30 days of the index procedure. Patients who survived more than 30 days following thoracentesis had a sustained improvement in dyspnea and mental QoL, but a minority had improvement in physical QoL or BADLs. Surviving patients demonstrated no significant associations between bilateral and unilateral thoracentesis, volume of fluid removed, or the etiology of the effusion (malignant vs nonmalignant) and improvement in QoL, dyspnea, and BADLs. Relative to nonmalignant etiology, the presence of a malignant effusion was strongly associated with the need for an additional intervention, yielding an odds ratio (95% confidence interval [95% CI]) of 16.92 (5.47-52.37). Patients with hepatic hydrothorax and infectious etiologies of their effusion were also likely to require additional pleural interventions. Conclusion The majority of patients in this cohort demonstrated sustained improvement in dyspnea and the mental aspect of QoL 30 days following thoracentesis, independent of the etiology and regardless of the volume of pleural fluid removed. A minority experienced sustained improvements in the physical aspect of QoL and BADLs. Although 28.2% of patients died within 30 days, nearly 1 in 5 survivors required an additional pleural intervention. These results emphasize the significant clinical impact, morbidity, and mortality experienced by patients who undergo thoracentesis for pleural effusions.

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Sleep in patients with large pleural effusion: impact of thoracentesis

Abstract: Patients with large pleural effusion have poor subjective and objective sleep quality that improves after thoracentesis.

Cited by 18 publications

References 20 publications

Physiology of breathlessness associated with pleural effusions

Physiology of breathlessness associated with pleural effusions

Thoracentesis

Patient-Centered Outcomes Following Thoracentesis

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