RT Journal Article
SR Electronic
T1 Complications following symptom-limited thoracentesis using suction
JF European Respiratory Journal
JO Eur Respir J
FD European Respiratory Society
SP 1902356
DO 10.1183/13993003.02356-2019
VO 56
IS 5
A1 Ala Eddin S. Sagar
A1 Maria F. Landaeta
A1 Andres M. Adrianza
A1 Grecia L. Aldana
A1 Leonardo Pozo
A1 Aristides Armas-Villalba
A1 Christian C. Toquica
A1 Andrew J. Larson
A1 Macarena R. Vial
A1 Horiana B. Grosu
A1 David E. Ost
A1 George A. Eapen
A1 Ajay Sheshadri
A1 Rodolfo C. Morice
A1 Vickie R. Shannon
A1 Lara Bashoura
A1 Diwakar D. Balachandran
A1 Francisco A. Almeida
A1 Mateen H. Uzbeck
A1 Roberto F. Casal
A1 Saadia A. Faiz
A1 Carlos A. Jimenez
YR 2020
UL http://erj.ersjournals.com/content/56/5/1902356.abstract
AB Background Thoracentesis using suction is perceived to have increased risk of complications, including pneumothorax and re-expansion pulmonary oedema (REPO). Current guidelines recommend limiting drainage to 1.5 L to avoid REPO. Our purpose was to examine the incidence of complications with symptom-limited drainage of pleural fluid using suction and identify risk factors for REPO.Methods A retrospective cohort study of all adult patients who underwent symptom-limited thoracentesis using suction at our institution between January 1, 2004 and August 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 radiography was detected in 3.98%, but only 0.28% required intervention. The incidence of REPO was 0.08%. The incidence of REPO increased with Eastern Cooperative Oncology Group performance status (ECOG PS) ≥3 compounded with ≥1.5 L (0.04–0.54%; 95% CI 0.13–2.06 L). 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 REPO are both rare. There were no increased procedural complications in those with ipsilateral mediastinal shift. REPO increased with poor ECOG PS and drainage ≥1.5 L. Symptom-limited drainage using suction without pleural manometry is safe.Symptom-limited thoracentesis using suction is safe even with large volumes. Pneumothorax requiring intervention and REPO are rare. Drainage ≥1.5 L with ECOG performance status 3 or 4 increased the risk of REPO. https://bit.ly/3ds1Hko