Abstract:
BACKGROUND:This study reports the effect of thoracentesis on respiratory mechanics and gas exchange in patients receiving mechanical ventilation. STUDY DESIGN:Prospective. SETTING:University hospital. PATIENTS:Eight patient receiving mechanical ventilation with unilateral (n = 7) or bilateral (n = 1) large pleural effusions. INTERVENTION:Therapeutic thoracentesis (n = 9). MEASUREMENTS:Resistances of the respiratory system measured with the constant inspiratory flow interrupter method measuring peak pressure and plateau pressure, effective static compliance of the respiratory system (Cst,rs), work performed by the ventilator (Wv), arterial blood gases, mixed exhaled Pco2, and pleural liquid pressure (Pliq). RESULTS:Thoracentesis resulted in a significant decrease in Wv and Pliq. Thoracentesis had no significant effect on dynamic compliance of the respiratory system; Cst,rs; effective interrupter resistance of the respiratory system, or its subcomponents, ohmic resistance of the respiratory system and additional (non-ohmic) resistance of the respiratory system; or intrinsic positive end-expiratory pressure (PEEPi). Indices of gas exchange were not significantly changed by thoracentesis. CONCLUSIONS:Thoracentesis in patients receiving mechanical ventilatory support results in significant reductions of Pliq and Wv. These changes were not accompanied by significant changes of resistance or compliance or by significant changes in gas exchange immediately after thoracentesis. The reduction of Wv after thoracentesis in patients receiving mechanical ventilation is not accompanied by predictable changes in inspiratory resistance and static compliance measured with routine clinical methods. The benefit of thoracentesis may be most pronounced in patients with high levels of PEEPi.
journal_name
Chestjournal_title
Chestauthors
Doelken P,Abreu R,Sahn SA,Mayo PHdoi
10.1378/chest.130.5.1354subject
Has Abstractpub_date
2006-11-01 00:00:00pages
1354-61issue
5eissn
0012-3692issn
1931-3543pii
S0012-3692(15)37309-8journal_volume
130pub_type
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