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The Impact of Gravity vs Suction-driven Therapeutic Thoracentesis on Pressure-related Complications: The GRAVITAS Multicenter Randomized Controlled Trial.

Abstract：

BACKGROUND:Thoracentesis can be accomplished by active aspiration or drainage with gravity. This trial investigated whether gravity drainage could protect against negative pressure-related complications such as chest discomfort, re-expansion pulmonary edema, or pneumothorax compared with active aspiration. METHODS:This prospective, multicenter, single-blind, randomized controlled trial allocated patients with large free-flowing effusions estimated ≥ 500 mL 1:1 to undergo active aspiration or gravity drainage. Patients rated chest discomfort on 100-mm visual analog scales prior to, during, and following drainage. Thoracentesis was halted at complete evacuation or for persistent chest discomfort, intractable cough, or other complication. The primary outcome was overall procedural chest discomfort scored 5 min following the procedure. Secondary outcomes included measures of discomfort and breathlessness through 48 h postprocedure. RESULTS:A total of 142 patients were randomized to undergo treatment, with 140 in the final analysis. Groups did not differ for the primary outcome (mean visual analog scale score difference, 5.3 mm; 95% CI, -2.4 to 13.0; P = .17). Secondary outcomes of discomfort and dyspnea did not differ between groups. Comparable volumes were drained in both groups, but the procedure duration was significantly longer in the gravity arm (mean difference, 7.4 min; 95% CI, 10.2 to 4.6; P < .001). There were no serious complications. CONCLUSIONS:Thoracentesis via active aspiration and gravity drainage are both safe and result in comparable levels of procedural comfort and dyspnea improvement. Active aspiration requires less total procedural time. TRIAL REGISTRY:ClinicalTrials.gov; No.: NCT03591952; URL: www.clinicaltrials.gov.

journal_name

Chest

journal_title

Chest

authors

Lentz RJ,Shojaee S,Grosu HB,Rickman OB,Roller L,Pannu JK,DePew ZS,Debiane LG,Cicenia JC,Akulian J,Walston C,Sanchez TM,Davidson KR,Jagan N,Ahmad S,Gilbert C,Huggins JT,Chen H,Light RW,Yarmus L,Feller-Kopman D,Le

doi

10.1016/j.chest.2019.10.025

subject

Has Abstract

pub_date

2020-03-01 00:00:00

pages

702-711

issue

eissn

0012-3692

issn

1931-3543

pii

S0012-3692(19)34190-X

journal_volume

157

pub_type

杂志文章,多中心研究,随机对照试验

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The Impact of Gravity vs Suction-driven Therapeutic Thoracentesis on Pressure-related Complications: The GRAVITAS Multicenter Randomized Controlled Trial.