Complications following symptom-limited thoracentesis using suction.
Ala Eddin S Sagar1, Maria F Landaeta1, Andres M Adrianza1
1Dept of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
The European Respiratory Journal
|June 6, 2020
Summary
Symptom-limited thoracentesis with suction is safe for large pleural fluid volumes. Complications like pneumothorax and re-expansion pulmonary edema (REPO) are rare, even when draining over 1.5L.
Area of Science:
- Pulmonology
- Thoracic Surgery
- Critical Care Medicine
Background:
- Thoracentesis using suction is often perceived to carry a higher risk of complications.
- Current guidelines suggest limiting pleural fluid drainage to 1.5 liters to prevent re-expansion pulmonary edema (REPO).
- This study investigates complication rates and risk factors for REPO during symptom-limited thoracentesis with suction.
Purpose of the Study:
- To determine the incidence of complications associated with symptom-limited thoracentesis using suction.
- To identify risk factors for re-expansion pulmonary edema (REPO).
- To evaluate the safety of draining larger volumes of pleural fluid.
Main Methods:
- Retrospective cohort study of 10,344 adult thoracenteses performed between January 2004 and August 2018.
- Analysis of symptom-limited drainage procedures using suction.
- Identification of complications including pneumothorax and REPO, and associated risk factors.
Main Results:
- 19% of procedures involved draining ≥1.5 liters of pleural fluid.
- Pneumothorax occurred in 3.98% (0.28% required intervention); REPO incidence was 0.08%.
- REPO risk increased with poor Eastern Cooperative Oncology Group performance status (ECOG PS) and drainage ≥1.5 liters.
Conclusions:
- Symptom-limited thoracentesis with suction is safe, even for large fluid volumes.
- Pneumothorax requiring intervention and REPO are infrequent complications.
- Drainage of ≥1.5 liters is safe, with REPO risk elevated in patients with poor ECOG PS.
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