This journal is
indexed in Scopus
Year 2019 Vol. 27 No 1
GENERAL & SPECIAL SURGERY
A.R. KHASANOV 1, M.S. KORZHUK 1, K.G. BEZMOZGIN 2, O.O. ZHUKOVA 1, A.A. KINZERSKIY 1
PLEURAL MANOMETRY IN THERAPEUTIC THORACENTESIS TO DETERMINE THE PREDICTORS OF UNWANTED OUTCOMES IN PATIENTS WITH PLEURAL EFFUSION
Omsk State Medical University 1,
A.N. Kabanov Omsk City Clinical Hospital №1 2, Omsk,
The Russian Federation
Objective. To determine the prognostic value of the fluctuations of the intrapleural pressure associated with the act of breathing during thoracocentesis and draining of fluid from the pleural cavity.
Methods. The study included 36 patients who suffered from pleural effusion and underwent thoracentesis. The continuous intrapleural manometry during the procedure was performed. Then control examinations included repeated examination, chest X-ray and ultrasound examination of the pleural cavities. According to their results, patients were divided into 3 groups: group 1 – patients with straightened lungs and without complications (n=18), group 2 – patients with unexpandable lung (n=18), subgroup 2-1 – patients, which thoracocentesis, complicated by pneumothorax (n=6). The comparison criteria were the volume of the removed liquid (ml), the mean intrapleural pressure (cm H2O), the amplitude of the pressure fluctuations associated with the act of breathing, between the inspiration and expiration peaks in quiet breathing before and after the removal of the liquid (cm H2O), the pleural elasticity and change of amplitude of the pressure fluctuations after the draining.
Results. It was found that association among the pleural elasticity and the amplitude change and unexpandable lung were statistically significant (p=0.00283). It was also found out that, with the development of pneumothorax, an increase in pleural elasticity is associated with a decrease in intrapleural pressure fluctuations (p=0.00199). There were no significant associations of development of unwanted outcomes with other comparison criteria.
Conclusions. Association with outcomes is confirmed for pleural elasticity and change of the amplitude of the fluctuations of intrapleural pressure associated with the act of breathing. An objective predictor of unexpandable lung, as well as the occurrence of pneumothorax after thoracocentesis, along with an elevation of pleural elasticity, is a decrease in the amplitude of oscillations of pleural pressure associated with the act of breathing.
- Zielinska-Krawczyk M, Krenke R, Grabczak EM, Light RW. Pleural manometry-historical background, rationale for use and methods of measurement. Respir Med. 2018 Mar;136:21-28. doi: 10.1016/j.rmed.2018.01.013
- Gordon CE, Feller-Kopman D, Balk EM, Smetana GW. Pneumothorax following thoracentesis: a systematic review and meta-analysis. Arch Intern Med. 2010 Feb 22;170(4):332-39. doi: 10.1001/archinternmed.2009.548
- Genofre EH, Vargas FS, Teixeira LR, Vaz MAC, MarchiI E. Reexpansion pulmonary edema. J Pneumologia. 2003;29(2):101-106. doi: 10.1590/S0102-35862003000200010
- Sohara Y. Reexpansion pulmonary edema. Ann Thorac Cardiovasc Surg. 2008 Aug;14(4):205-9. http://www.atcs.jp/pdf/2008_14_4/205.pdf
- World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA. 2013 Nov 27;310(20):2191-94. doi: 10.1001/jama.2013.281053
- Lan RS, Lo SK, Chuang ML, Yang CT, Tsao TC, Lee CH. Elastance of the pleural space: a predictor for the outcome of pleurodesis in patients with malignant pleural effusion. Ann Intern Med. 1997 May 15;126(10):768-74. doi: 10.7326/0003-4819-126-10-199705150-00003
- Seldinger SI. Catheter replacement of the needle in percutaneous arteriography; a new technique. Acta Radiol. 1953 May;39(5):368-76. doi: 10.3109/00016925309136722
- Moon Jun Na. Diagnostic tools of pleural effusion. Tuberc Respir Dis (Seoul). 2014 May;76(5):199-10. Published online 2014 May 29. doi: 10.4046/trd.2014.76.5.199
- Montes JF, García-Valero J, Ferrer J. Evidence of innervation in talc-induced pleural adhesions. Chest. 2006 Sep;130(3):702-9. doi: 10.1378/chest.130.3.702
- Boshuizen RC, Sinaasappel M, Vincent AD, Goldfinger V, Farag S, van den Heuvel MM. Pleural pressure swing and lung expansion after malignant pleural effusion drainage: the benefits of high-temporal resolution pleural manometry. J Bronchology Interv Pulmonol. 2013 Jul;20(3):200-5. doi: 10.1097/LBR.0b013e31829af168
- Staes W, Funaki B. “Ex vacuo” pneumothorax. Semin Intervent Radiol. 2009 Mar;26(1):82-85. doi: 10.1055/s-0029-1208386
- Corcoran JP, Psallidas I, Wrightson JM, Hallifax RJ, Rahman NM. Pleural procedural complications: prevention and management. J Thorac Dis. 2015 Jun;7(6):1058-67. doi: 10.3978/j.issn.2072-1439.2015.04.42
644112, The Russian Federation,
Omsk, Perelet Str., 7,
Omsk State Medical University,
General Surgery Department.
Tel. +7 913 621 48 03,
Algis R. Khasanov
Khasanov Algis R., Post-Graduate Student, General Surgery Department, Omsk State Medical University, Omsk, Russian Federation.
Korzhuk Mikhail S., MD, Professor, Head of General Surgery Department, Omsk State Medical University, Omsk, Russian Federation.
Bezmozgin, Kirill G., Thoracic Surgeon, A.N. Kabanov Omsk City Clinical Hospital №1, Omsk, Russian Federation.
Zhukova Olga O., Intern of General Surgery Department, Omsk State Medical University, Omsk, Russian Federation.
Kinzerskiy, Alexander A., Post-Graduate Student, General Surgery Department, Omsk State Medical University, Omsk, Russian Federation.