Ultrasound Evaluation of Hemidiaphragm Function Following Thoracentesis

Abstract

Background: Dyspnea is the major symptom caused by pleural effusion. The pathophysiological pathways leading to dyspnea are poorly understood. Dysfunction of respiratory mechanics may be a factor. We aimed to study the change in diaphragmatic function following thoracentesis. Methods: Patients undergoing thoracentesis at a highly specialized pleural center, underwent ultrasound evaluation of hemidiaphragm movement, before and after thoracentesis was performed. The change was compared to the reduction of dyspnea measured at the modified Borg scale. Results: Thirty-two patients were included. Dyspnea was reduced from 5.01 [95% confidence interval (CI): 4.12-6.04] to 2.6 (95% CI: 1.87-3.4, P<0.0001). Low hemidiaphragmatic movement before thoracentesis on the side of pleural effusion was improved by 17.4 cm2 (95% CI: 13.04-21.08), equalizing movement to the side without pleural effusion. On average, 1283 mL (SD: 469) fluid was drained. Multiple linear regression analysis showed that prethoracentesis ultrasound evaluation of hemidiaphragmatic function was correlated with successful thoracentesis. Conclusion: Hemidiaphragm function is reduced on the side of pleural effusion, and thoracentesis restores function. Improvement in diaphragm movement is related to a reduction in dyspnea.

Safety and utility of indwelling pleural catheters in lung transplant recipients

“…IPCs have the potential to decrease morbidity from repeat thoracenteses or large-bore surgical chest tubes, facilitate earlier discharge to the ambulatory setting, prevent organization of pleural spaces with resultant trapped lung, and optimize lung function. [24][25][26][27] Moreover, we show that IPCs do not need to remain in situ for a protracted time period; in our cohort IPCs led to efficacious results in a median time of 41 days, less than half the time seen in comparison groups. 9,13 Given that the incidence of pleural effusions following lung transplantation is ∼15%-25%, and many patients require hospital admission and multiple procedures to obtain a resolution, a change in paradigm with increased use of IPCs would be impactful.…”

“…Rather, these findings provide validation for future multicenter, prospective studies that assess the safety and efficacy of IPCs in this complex population. IPCs have the potential to decrease morbidity from repeat thoracenteses or large‐bore surgical chest tubes, facilitate earlier discharge to the ambulatory setting, prevent organization of pleural spaces with resultant trapped lung, and optimize lung function 24–27 . Moreover, we show that IPCs do not need to remain in situ for a protracted time period; in our cohort IPCs led to efficacious results in a median time of 41 days, less than half the time seen in comparison groups 9,13 .…”

Breathlessness with Pleural Effusion: What Do We Know?

“…27,31,32 Both diaphragm excursion and thickening have been shown to correlate with invasive measurements of diaphragm function (transdiaphragmatic pressure 32 ). To date, there have been four studies [33][34][35][36] quantifying these measurements using a bedside thoracic ultrasound in patients with a pleural effusion. These studies have assessed the effect of pleural effusions on the diaphragm, and all have considered only the ipsilateral hemidiaphragm.…”

Ultrasound in predicting improvement in dyspnoea after therapeutic thoracentesis in patients with recurrent unilateral pleural effusion

“…Previous studies have identified characteristics associated with a decrease in dyspnoea following thoracentesis including a larger volume drained [ 2 ], less than five septations [ 2 ], a higher level of dyspnoea at baseline [ 4 , 5 ], diaphragm shape or movement [ 4 , 6 , 7 ], benign aetiology [ 4 ] and high pleural pH [ 4 ]. However, the findings are inconsistent [ 2 , 4–6 ], and some studies are limited by evaluating the effect of a combination of various pleural procedures [ 2 , 4 ].…”

“…Impaired diaphragm movement is considered a key pathophysiological mechanism in effusion-related dyspnoea [ 4 , 6 , 10–14 ]. Ultrasound (US) evaluation of diaphragm movement is often performed using the M-mode function or by simple ‘eyeballing’.…”