@article {Sagar1902356, author = {Ala Eddin S. Sagar and Maria F. Landaeta and Andres M. Adrianza and Grecia L. Aldana and Leonardo Pozo and Aristides Armas-Villalba and Christian C. Toquica and Andrew J. Larson and Macarena R. Vial and Horiana B. Grosu and David E. Ost and George A. Eapen and Ajay Sheshadri and Rodolfo C. Morice and Vickie R. Shannon and Lara Bashoura and Diwakar D. Balachandran and Francisco A. Almeida and Mateen H. Uzbeck and Roberto F. Casal and Saadia A. Faiz and Carlos A. Jimenez}, title = {Complications following symptom limited thoracentesis using suction}, elocation-id = {1902356}, year = {2020}, doi = {10.1183/13993003.02356-2019}, publisher = {European Respiratory Society}, abstract = {Background Thoracentesis using suction is perceived to have increased risk of complications including pneumothorax and re-expansion pulmonary edema (REPE). Current guidelines recommend limiting drainage to 1.5 L to avoid REPE. Our purpose was to examine the incidence of complications with symptom limited drainage of pleural fluid using suction and identify risk factors for REPE.Methods A retrospective cohort study of all adult patients who underwent symptom limited thoracentesis using suction at our institution between 1/1/2004 and 8/31/2018 was performed, and a total of 10 344 thoracenteses were included.Results Pleural fluid >=1.5 L was removed in 19\% of the procedures. Thoracentesis was stopped due to chest discomfort (39\%), complete drainage of fluid (37\%), and persistent cough (13\%). Pneumothorax based on chest radiograph was detected in 3.98\%, but only 0.28\% required intervention. The incidence of REPE was 0.08\%. The incidence of REPE increased with Eastern Cooperative Oncology Group performance status (ECOG) >=3 compounded with >=1.5 L (0.04 to 0.54\%, 95\% CI 0.13{\textendash}2.06). Thoracentesis in those with ipsilateral mediastinal shift did not increase complications, but less fluid was removed (p\<0.01).Conclusions Symptom limited thoracentesis using suction is safe even with large volumes. Pneumothorax requiring intervention and REPE are both rare. There were no increased procedural complications in those with ipsilateral mediastinal shift. REPE increased with poor performance status and drainage >=1.5 L. Symptom limited drainage using suction without pleural manometry is safe.FootnotesThis manuscript has recently been accepted for publication in the European Respiratory Journal. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJ online. Please open or download the PDF to view this article.Conflict of interest: Dr. Sagar has nothing to disclose.Conflict of interest: Dr. Landaeta has nothing to disclose.Conflict of interest: M. AdrianzaConflict of interest: Dr. Aldana has nothing to disclose.Conflict of interest: Dr. Pozo has nothing to disclose.Conflict of interest: Dr. Armas Villalba has nothing to disclose.Conflict of interest: Dr. Toquica-Gahona has nothing to disclose.Conflict of interest: Dr. Larson has nothing to disclose.Conflict of interest: Dr. Vial has nothing to disclose.Conflict of interest: Dr. Grosu has nothing to disclose.Conflict of interest: Dr. Ost has nothing to disclose.Conflict of interest: Dr. Eapen has nothing to disclose.Conflict of interest: Dr. Sheshadri has nothing to disclose.Conflict of interest: Dr. Morice has nothing to disclose.Conflict of interest: Dr. Shannon has nothing to disclose.Conflict of interest: Dr. Bashoura has nothing to disclose.Conflict of interest: Dr. Balachandran has nothing to disclose.Conflict of interest: Dr. Almeida has nothing to disclose.Conflict of interest: Dr. Uzbeck has nothing to disclose.Conflict of interest: Dr. Casal has nothing to disclose.Conflict of interest: Dr. Faiz has nothing to disclose.Conflict of interest: Dr. Jimenez has nothing to disclose.}, issn = {0903-1936}, URL = {https://erj.ersjournals.com/content/early/2020/06/01/13993003.02356-2019}, eprint = {https://erj.ersjournals.com/content/early/2020/06/01/13993003.02356-2019.full.pdf}, journal = {European Respiratory Journal} }