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David M. Berkowitz, MD*; Rabih I. Bechara, MD; William Lunn, MD; Momen M. Wahidi, MD; Armin Ernst, MD; David J. Feller-Kopman, MD
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Beth Israel Deaconess Hospital, Boston, MA


Chest. 2005;128(4_MeetingAbstracts):156S. doi:10.1378/chest.128.4_MeetingAbstracts.156S-a
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PURPOSE:  Re-expansion Pulmonary Edema (RPE) is a well described, but rare complication after large volume thoracentesis. The creation of excessive negative pleural pressures (Ppl) has been postulated as a mechanism for the development of RPE. Previous studies in animal models have suggested that RPE is not seen when Ppl is kept greater than -20 cmH20. Similarly, an arbitrary cut-off of 1L has been suggested as a volume limit to minimize the risk of RPE. To date, no large series has examined the safety of large volume thoracentesis and risk of RPE in humans.

METHODS:  Data was collected prospectively during thoracentesis performed by the division of Interventional Pulmonology at Beth Israel Deaconess Medical Center from October 2001 to April 2005. Thoracentesis was performed using Pleura-Seal thoracentesis kit (Arrow-Clark) and pleural pressures were recorded either by simple water manometer or electronic transducer system (Biobench, National Instruments). Complications of thoracentesis were evaluated by medical record review and analysis of post-thoracentesis radiographic examinations.

RESULTS:  Of the 602 patients in the database, 245 had greater than or equal to 1L of pleural fluid removed (range 1000-6550mL) and were included in analysis. Of those, 55 had greater than or equal to 2L removed and 12 had greater than 3L removed. Closing Ppl ranged from +15.6 to -29 cmH20. Nine cases (3.7%) had closing pleural pressures equal to -20 cmH20, and 10 cases (4.0%) had a closing Ppl less than -20 cmH20. One case (0.4%) of RPE was described radiographically, however, the patient suffered no adverse clinical outcomes, and specific treatment for RPE was not required. No case of hemodynamic instability was noted post-thoracentesis. Pneumothorax occurred in only 5 of 245 cases (2.0%).

CONCLUSION:  Pleural fluid in excess of 6L has been safely removed without hemodynamic compromise or clinically significant RPE. The previously suggested pleural pressure cut-off of -20 cmH20 appears to confer a very low risk for RPE.

CLINICAL IMPLICATIONS:  Large volume thoracentesis may be safely performed as long as attention is paid to pleural pressures.

DISCLOSURE:  David Berkowitz, None.

Monday, October 31, 2005

2:30 PM - 4:00 PM




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