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Disorders of the Pleura |

Impact of Thoracentesis on Dyspnea and Quality of Life

Angela Argento*, MD; Margaret Pisani, MD; Terrence Murphy, PhD; Katy Araujo, MPH; Anna Kookoolis, MA; Kelsey Johnson, PA-C; Jonathan Puchalski, MD
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Yale University, New Haven, CT


Chest. 2012;142(4_MeetingAbstracts):488A. doi:10.1378/chest.1389760
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Abstract

SESSION TYPE: Pleural Disease

PRESENTED ON: Sunday, October 21, 2012 at 01:15 PM - 02:45 PM

PURPOSE: Therapeutic thoracentesis is associated with improvement in 6-minute walk test, sleep efficiency, pulmonary function tests and oxygenation. Dyspnea and quality of life (QoL) following thoracentesis have not been objectively quantified. Our objectives were to determine if thoracentesis is associated with improvement in dyspnea or QoL and to measure the correlations between level of improvement, etiology of effusion and volume of pleural fluid removed.

METHODS: Adult patients referred to the Thoracic Interventional Program for thoracentesis between 12/2010 and 12/2011 were offered enrollment. Informed consent was obtained and a pre-procedural questionnaire including medical and social histories, dyspnea assessment with modified BORG (mBORG) and QoL with Short Form 12 (SF-12) was administered. Ultrasound-guided thoracentesis was performed. Fluid volume was measured and samples were sent for routine analysis. Etiology for the pleural effusion was determined by two physicians using medical data and pleural fluid analysis. Patients were assessed at 1-day (mBORG) and 1-month (mBORG, SF-12) post-procedure. Associations between subsequent improvement in dyspnea, etiology of pleural fluid and volume of fluid removed were measured by the change in mBORG as well as by patients' subjective report of dyspnea at 1-day and 1-month follow-up. Improvement in QoL was defined as the change in SF-12 at 1-month follow-up.

RESULTS: 251 patients underwent thoracentesis. Patients were excluded based on bilateral thoracentesis (n=63), repeated thoracentesis (n=27) or those who declined enrollement (n=5). The majority of patients’ dyspnea improved at day-1, although results were not fully sustained at 1-month, regardless of etiology or volume of fluid removed by thoracentesis. Patients’ physical QoL was typically worse 1-month following the procedure, although mental QoL was generally improved. 18% all-cause mortality was observed within one month of thoracentesis.

CONCLUSIONS: Thoracentesis improves dyspnea, although this benefit was only sustained subjectively at 1-month except for patients with malignant and paramalignant effusions. QoL shows improvement in mental but not physical characteristics by SF-12 at 1-month following thoracentesis.

CLINICAL IMPLICATIONS: Additional studies are required to determine characteristics associated with improvement in QoL and high mortality in patients undergoing thoracentesis.

DISCLOSURE: The following authors have nothing to disclose: Angela Argento, Margaret Pisani, Terrence Murphy, Katy Araujo, Anna Kookoolis, Kelsey Johnson, Jonathan Puchalski

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Yale University, New Haven, CT

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