0
Original Research: INTERVENTIONAL PULMONOLOGY |

The Relationship of Pleural Pressure to Symptom Development During Therapeutic Thoracentesis*

David Feller-Kopman, MD, FCCP; Allan Walkey, MD; David Berkowitz, MD; Armin Ernst, MD, FCCP
Author and Funding Information

*From the Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.

Correspondence to: David Feller-Kopman, MD, FCCP, Interventional Pulmonology, Beth Israel Deaconess Medical Center, Deaconess 201, One Brookline Ave, Boston, MA 02215; e-mail: dfellerk@bidmc.harvard.edu



Chest. 2006;129(6):1556-1560. doi:10.1378/chest.129.6.1556
Text Size: A A A
Published online

Study objective: To describe the relationship of patients’ symptoms during therapeutic thoracentesis to pleural pressure (Ppl).

Design: Review of prospectively collected data during 169 therapeutic thoracentesis procedures.

Setting: University Hospital in Boston, MA.

Patients and methods: One hundred sixty-nine patients who had Ppl measured during therapeutic thoracentesis were included in this study. End-expiratory pressures were measured after the withdrawal of 5 mL of fluid and every 240 mL thereafter until the pressure was lower than −20 cm H2O, chest discomfort developed in the patient, or no more fluid could be removed. Patients’ symptoms, including chest pain, chest discomfort, and cough were recorded simultaneously.

Results: There was no correlation between the amount of pleural fluid removed and the development of symptoms. The closing pressures and the total change in Ppl (see the “Materials and Methods” section for definitions), however, were significantly lower in the group of patients who experienced chest discomfort compared to patients who developed cough or were asymptomatic. There was also a trend toward a significantly lower pleural elastance in patients who developed cough compared to that in the other two groups. Additionally, only 22% of patients in whom chest discomfort developed, and 8.6% of patients in whom symptoms did not develop, had potentially dangerous Ppl values (ie, lower than −20 cm H2O).

Conclusions: The development of chest discomfort is associated with a potentially unsafe drop in Ppl values and should be a sign to terminate thoracentesis. It is not necessary to terminate thoracentesis solely because of the development of cough. Without attention to pleural manometry, a significant percentage of patients may develop potentially dangerous Ppl. Although we recommend pleural manometry with all thoracenteses, when it is not used attention to symptoms remains a valuable surrogate.

Figures in this Article

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Figures

Tables

References

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Related Content

Customize your page view by dragging & repositioning the boxes below.

CHEST Journal Articles
PubMed Articles
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543