Patterns of pleural pressure amplitude and respiratory rate changes during therapeutic thoracentesis

Monika Zielinska-Krawczyk, Elzbieta M Grabczak, Marcin Michnikowski, Krzysztof Zielinski, Piotr Korczynski, Anna Stecka, Tomasz Golczewski, Rafal Krenke, Monika Zielinska-Krawczyk, Elzbieta M Grabczak, Marcin Michnikowski, Krzysztof Zielinski, Piotr Korczynski, Anna Stecka, Tomasz Golczewski, Rafal Krenke

Abstract

Background: Although the impact of therapeutic thoracentesis on lung function and blood gases has been evaluated in several studies, some physiological aspects of pleural fluid withdrawal remain unknown. The aim of the study was to assess the changes in pleural pressure amplitude (Pplampl) during the respiratory cycle and respiratory rate (RR) in patients undergoing pleural fluid withdrawal.

Methods: The study included 23 patients with symptomatic pleural effusion. Baseline pleural pressure curves were registered with a digital electronic manometer. Then, the registrations were repeated after the withdrawal of consecutive portions of pleural fluid (200 ml up to 1000 ml and 100 ml above 1000 ml). In all patients the pleural pressure curves were analyzed in five points, at 0, 25%, 50%, 75% and 100% of the relative volume of pleural effusion withdrawn in particular patients.

Results: There were 11 and 12 patients with right sided and left sided pleural effusion, respectively (14 M, 9F, median age 68, range 46-85 years). The most common cause of pleural effusion were malignancies (20 pts., 87%). The median total volume of withdrawn pleural fluid was 1800 (IQR 1500-2400) ml. After termination of pleural fluid withdrawal Pplampl increased in 22/23 patients compared to baseline. The median Pplampl increased from 3.4 (2.4-5.9) cmH2O to 10.7 (8.1-15.6) cmH2O (p < 0.0001). Three patterns of Pplampl changes were identified. Although the patterns of RR changes were more diversified, a significant increase between RR at baseline and the last measurement point was found (p = 0.0097).

Conclusions: In conclusion, therapeutic thoracentesis is associated with significant changes in Pplampl during the respiratory cycle. In the vast majority of patients Pplampl increased steadily during pleural fluid withdrawal. There was also an increase in RR. The significance of these changes should be elucidated in further studies.

Trial registration: ClinicalTrial.gov, registration number: NCT02192138 , registration date: July 1st, 2014.

Keywords: Pleural effusion; Pleural fluid; Pleural manometry; Pleural pathophysiology; Pleural pressure; Thoracentesis.

Conflict of interest statement

Ethics approval and consent to participate

The study was approved by the Institutional Review Board (Bioethics Committee) of the Medical University of Warsaw, approval number: KB 105/2012. All participant signed an informed consent for pleural pressure measurements during and after therapeutic thoracentesis, as well as for all additional monitoring procedures (including ECG, lung function testing, pulse oximetry and continuous transcutaneous measurements of oxygen and carbon dioxide pressure) that were prespecified in the protocol of the study.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Methods of pleural pressure measurement and analysis. a Five points selected for analysis and their relation to the relative volume of removed pleural fluid (0, 25%, 50%, 75% and 100% of total removed volume). b An example of pleural pressure curve reflecting five respiratory cycles that was selected for analysis in each point. c Enlarged pleural pressure curve registered during one respiratory cycle and parameters that were measured: end-exp Ppl – end-expiratory pleural pressure, end-insp Ppl – end-inspiratory pleural pressure, T insp – inspiratory time, T exp. – expiratory time, Pplampl – pleural pressure amplitude during a respiratory cycle
Fig. 2
Fig. 2
Changes in pleural pressure amplitude during pleural fluid (PF) withdrawal. Assessment points: 0 – baseline (before PF withdrawal), 1 - after aspiration of 25% of total PF volume, 2 - after aspiration of 50% of total PF volume, 3 - after aspiration of 75% of total PF volume, 4 - after aspiration of 100% of total PF volume
Fig. 3
Fig. 3
Curves representing changes in Pplampl during pleural fluid withdrawal. a All patients (dotted line represents medians). b Patients with systematic increase of Pplampl in all consecutive measurement points. c Patients with initial increase in Pplampl followed by Pplampl decline. d Patients with a general increase in Pplampl interrupted by its transitional decrease
Fig. 4
Fig. 4
Changes in respiratory rate (RR) during pleural fluid (PF) withdrawal. PF – pleural fluid; assessment points: 0 – baseline (before PF withdrawal), 1 - after aspiration of 25% of total PF volume, 2 - after aspiration of 50% of total PF volume, 3 - after aspiration of 75% of total PF volume, 4 - after aspiration of 100% of total PF volume
Fig. 5
Fig. 5
Curves representing changes in respiratory rate (RR) during pleural fluid withdrawal. a All patients (dotted line represents medians). b Patients with initial decline followed by increase of RR in the next measurement points. c Patients with small, but steady increase in RR. d Patients with stable RR followed by its increase in 2nd or 3rd point and decrease at the termination of the procedure

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