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Disorders of the Pleura |

Effect of Thoracentesis in the Respiratory Mechanics and Gas Exchange Among Mechanically Ventilated Patients With Different Types and Volume of Pleural Effusion

Karen Sobere Yu, MD; Teresita DeGuia, MD; Maria Encarnita Limpin, MD; William Del Poso, MD
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Philippine Heart Center, Quezon City, Philippines


Chest. 2015;148(4_MeetingAbstracts):426A. doi:10.1378/chest.2249535
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Abstract

SESSION TITLE: Disorders of the Pleura

SESSION TYPE: Original Investigation Slide

PRESENTED ON: Wednesday, October 28, 2015 at 02:45 PM - 04:15 PM

PURPOSE: The objective of this study is to determine the effect of thoracentesis in the respiratory mechanics and gas exchange among mechanically ventilated patients with different types of pleural effusion such as transudative, exudative, moderate and large pleural effusion admitted at Philippine Heart Center (PHC).

METHODS: A prospective, cross-sectional study conducted among admitted patients in PHC from September 1, 2013 to August 31, 2014, who received mechanical ventilation via a cuffed tracheal tube with transudative, exudative, moderate and large pleural effusion undergoing thoracentesis. Respiratory mechanics and oxygenation parameters were measured before and 30 minutes after thoracentesis.

RESULTS: A total of 46 patients were enrolled in the study with mean age of 70 years for which 70% were females and 30% were males. There were 32 transudative pleural effusion and 14 exudative effusion. Generally, there was no significant difference in the changes in mean respiratory mechanics and gas exchange after thoracentesis. There were changes after sub-analysis of each type and volume of effusion. There were improvements on the mean respiratory rate (p=0.003) and plateau pressure (p=0.033) among transudative. The static (p=0.110) and dynamic (p=0.362) lung compliances in transudative effusion also favored improvement but not significant. Both transudative and exudative effusion improved oxygenation. The improvement in respiratory mechanics and gas exchange such as the PaO2 and P(A-a) O2 gradient (p=0.009 and 0.019) after thoracentesis with large effusion is more evident than in moderate.

CONCLUSIONS: An immediate thoracentesis could be beneficial among patients anticipated to have transudative pleural effusion with large volume as measured by ultrasonography.

CLINICAL IMPLICATIONS: This study shows that the influence of ultrasound-guided thoracentesis on simple bedside measurements of respiratory mechanics and gas exchange among mechanically ventilated patients with different types of pleural effusion is variable. There is improvement in terms of positive airway pressures (peak airway and plateau pressures), lung compliances (static and dynamic lung compliances), and oxygenation especially in transudative and large pleural effusion. It is therefore concluded that an immediate thoracentesis could be beneficial among patients anticipated to have transudative effusion with large volume as measured by ultrasonography.

DISCLOSURE: The following authors have nothing to disclose: Karen Sobere Yu, Teresita DeGuia, Maria Encarnita Limpin, William Del Poso

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