Abstract
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.
Abstract
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
Footnotes
Author contributions: A.E.S. Sagar and C.A. Jimenez had full access to the all of the data in the study, and take responsibility for the integrity of the data and accuracy of the data analysis, including and especially any adverse effects. M.F. Landaeta, A.M. Adrianza, G.L. Aldana, L. Pozo, A. Armas-Villalba, C.C. Toquica, A.J. Larson, M.R. Vial, F.A. Almeida and M.H. Uzbeck contributed substantially to the study design, data collection, data analysis and interpretation, and the writing of the manuscript. H.B. Grosu, D.E. Ost, G.A. Eapen, R.C. Morice, V.R. Shannon, L. Bashoura, D.D. Balachandran, A. Sheshadri, R.F. Casal and S.A. Faiz contributed to data analysis and interpretation, review and editing of the manuscript.
Conflict of interest: A.E.S. Sagar has nothing to disclose.
Conflict of interest: M.F. Landaeta has nothing to disclose.
Conflict of interest: A.M. Adrianza has nothing to disclose.
Conflict of interest: G.L. Aldana has nothing to disclose.
Conflict of interest: L. Pozo has nothing to disclose.
Conflict of interest: A. Armas-Villalba has nothing to disclose.
Conflict of interest: C.C. Toquica has nothing to disclose.
Conflict of interest: A.J. Larson has nothing to disclose.
Conflict of interest: M.R. Vial has nothing to disclose.
Conflict of interest: H.B. Grosu has nothing to disclose.
Conflict of interest: D.E. Ost has nothing to disclose.
Conflict of interest: G.A. Eapen has nothing to disclose.
Conflict of interest: A. Sheshadri has nothing to disclose.
Conflict of interest: R.C. Morice has nothing to disclose.
Conflict of interest: V.R. Shannon has nothing to disclose.
Conflict of interest: L. Bashoura has nothing to disclose.
Conflict of interest: D.D. Balachandran has nothing to disclose.
Conflict of interest: F.A. Almeida has nothing to disclose.
Conflict of interest: M.H. Uzbeck has nothing to disclose.
Conflict of interest: R.F. Casal has nothing to disclose.
Conflict of interest: S.A. Faiz has nothing to disclose.
Conflict of interest: C.A. Jimenez has nothing to disclose.
Support statement: This research is supported in part by the National Institutes of Health through the MD Anderson Cancer Center Support Grant (CA016672).
- Received January 26, 2020.
- Accepted May 27, 2020.
- Copyright ©ERS 2020