SESSION TITLE: Pulmonary and Sleep Medicine
SESSION TYPE: Slide Presentation
PRESENTED ON: Saturday, March 22, 2014 at 09:00 AM - 10:00 AM
PURPOSE: Routine manometry has been advocated to prevent complications during therapeutic thoracentesis, but has not convincingly been shown to prevent pneumothorax ex vacuo or re-expansion pulmonary edema. As chest pain is correlated with negative pleural pressures, we aimed to determine whether the use of manometry could be associated with less pain during therapeutic thoracentesis.
METHODS: A retrospective chart review of 214 consecutive adults who underwent outpatient therapeutic thoracentesis at our institution between January 1, 2011 and June 30, 2013 was performed. We compared pre-procedural to post-procedural pain and dysnea (using a linear analog scale from 0 to 10) in patients undergoing thoracentesis with or without manometry. We used a multivariate model to adjust for possible confounders like amount of local anesthetic used, volume of fluid removed, operators performing the procedure, and baseline risk factors. The subgroup of large volume thoracentesis (>1000 mL drained) was also analyzed.
RESULTS: Manometry was performed in 82/214patients (38%).On univariate and multivariate analyses, neither the change in pain nor dyspnea scores was significantly different in the manometry versus the control group (p=0.1247 and p =0.2353 respectively). Similar results were also found in the subgroup of large volume thoracentesis ( p=0.3197 for pain, p=0.9978 for dyspnea).
CONCLUSIONS: Using manometry during thoracentesis is not associated with a significant reduction in post-procedural pain or dyspnea. Since manometry has not been shown to decrease thoracentesis-related complications or symptoms, we do not recommend systematic use of manometry during therapeutic thoracentesis.
CLINICAL IMPLICATIONS: The routine use of manometry for all therapeutic thoracenteses does not appear justified at this time. Adequately designed prospective comparative studies are needed.
DISCLOSURE: The following authors have nothing to disclose: Jasleen Pannu, Zachary DePew, John Mullon, Craig Daniels, Clinton Hagen, Fabien Maldonado
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