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Jeffrey H Barsuk - One of the best experts on this subject based on the ideXlab platform.
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Safe and Effective Bedside Thoracentesis: A Review of the Evidence for Practicing Clinicians.
Journal of hospital medicine, 2017Co-Authors: Richard J. Schildhouse, Jeffrey H Barsuk, Andrew R. Lai, Michelle Mourad, Vineet ChopraAbstract:Background Physicians often care for patients with pleural effusion, a condition that requires Thoracentesis for evaluation and treatment. We aim to identify the most recent advances related to safe and effective performance of Thoracentesis. Methods We performed a narrative review with a systematic search of the literature. Two authors independently reviewed search results and selected studies based on relevance to Thoracentesis; disagreements were resolved by consensus. Articles were categorized as those related to the pre-, intra- and postprocedural aspects of Thoracentesis. Results Sixty relevant studies were identified and included. Pre-procedural topics included methods for physician training and maintenance of skills, such as simulation with direct observation. Additionally, pre-procedural topics included the finding that moderate coagulopathies (international normalized ratio less than 3 or a platelet count greater than 25,000/μL) and mechanical ventilation did not increase risk of postprocedural complications. Intraprocedurally, ultrasound use was associated with lower risk of pneumothorax, while pleural manometry can identify a nonexpanding lung and may help reduce risk of re-expansion pulmonary edema. Postprocedurally, studies indicate that routine chest X-ray is unwarranted, because bedside ultrasound can identify pneumothorax. Conclusions While the performance of Thoracentesis is not without risk, clinicians can incorporate recent advances into practice to mitigate patient harm and improve effectiveness. Journal of Hospital Medicine 2017;12:266-276.
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The effect of simulation-based mastery learning on Thoracentesis referral patterns.
Journal of hospital medicine, 2016Co-Authors: Jeffrey H Barsuk, William C Mcgaghie, Elaine R. Cohen, Mark V. Williams, Jordan Scher, Joe Feinglass, Kelly O’hara, Diane B WayneAbstract:Internal medicine (IM) residents and hospitalist physicians commonly perform thoracenteses. National data show that thoracenteses are also frequently referred to other services such as interventional radiology (IR), increasing healthcare costs. Simulation-based mastery learning (SBML) is an effective method to boost physicians' procedural skills and self-confidence. This study aimed to (1) assess the effect of SBML on IM residents' simulated Thoracentesis skills and (2) compare Thoracentesis referral patterns, self-confidence, and reasons for referral between traditionally trained residents (non-SBML-trained), SBML-trained residents, and hospitalist physicians. A random sample of 112 IM residents at an academic medical center completed Thoracentesis SBML from December 2012 to May 2015. We surveyed physicians caring for hospitalized patients with thoracenteses during the same time period and compared referral patterns, self-confidence, and reasons for referral. SBML-trained resident Thoracentesis skills improved from a median of 57.6% (interquartile range [IQR] 43.3-76.9) at pretest to 96.2% (IQR 96.2-100.0) at post-test (P < 0.001). Surveys demonstrated that traditionally trained residents were more likely to refer to IR and cited lower confidence as reasons. SBML-trained residents were more likely to perform bedside thoracenteses. Hospitalist physicians were most likely to refer to pulmonary medicine and cited lack of time to perform the procedure as the main reason. SBML-trained residents were most confident about their Thoracentesis skills, despite hospitalist physicians having more experience. This study identifies confidence and time as reasons physicians refer thoracenteses rather than perform them at the bedside. Thoracentesis SBML boosts skills and promotes bedside procedures that are safe and less expensive than referrals. Journal of Hospital Medicine 2016;11:792-795. © 2016 Society of Hospital Medicine.
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Factors Associated with Inpatient Thoracentesis Procedure Quality at University Hospitals
Joint Commission journal on quality and patient safety, 2016Co-Authors: Sarah E. Kozmic, Diane B Wayne, Joe Feinglass, Samuel F. Hohmann, Jeffrey H BarsukAbstract:Article-at-a-Glance Background Physicians increasingly refer Thoracentesis procedures to interventional radiology (IR) rather than performing them at the bedside. Factors associated with Thoracentesis procedures at university hospitals were studied to determine clinical outcomes by provider specialty. Methods An administrative database review was performed of patients who underwent an inpatient Thoracentesis procedure in hospitals participating in the University HealthSystem Consortium (UHC) Database from January 2010 through September 2013. The incidence of iatrogenic pneumothorax, mean total hospital costs, and mean length of stay (LOS) were compared by clinical specialty. Results There were 113,860 admissions with 132,472 Thoracentesis procedures performed on 99,509 patients at 234 UHC hospitals. IR performed 43,783 (33%) Thoracentesis procedures; medicine, 22,243 (17%); and pulmonary, 26,887 (20%). The incidence of iatrogenic pneumothorax was 2.8% for IR, 2.9% for medicine, and 3.1% for pulmonary. Medicine and pulmonary had equivalent risk of iatrogenic pneumothorax compared to IR after controlling for clinical covariates. Admissions with medicine and pulmonary procedures were associated with significantly lower costs compared to IR admissions ( p p Conclusion Admissions with medicine and pulmonary bedside Thoracentesis procedures are as safe and less costly than IR procedures. Shifting IR Thoracentesis procedures to the bedside might be a potential way to reduce hospital costs while still ensuring high-quality patient care, provided that portable ultrasound is used.
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Complications of Thoracentesis: incidence, risk factors, and strategies for prevention
Current opinion in pulmonary medicine, 2016Co-Authors: Eric P. Cantey, James M. Walter, Thomas C. Corbridge, Jeffrey H BarsukAbstract:Purpose of reviewAlthough Thoracentesis is generally considered safe, procedural complications are associated with increased morbidity, mortality, and healthcare costs. In this article, we review the risk factors and prevention of the most common complications of Thoracentesis including pneumothorax
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Thoracentesis outcomes a 12 year experience
Thorax, 2015Co-Authors: Mark J Ault, Joe Feinglass, Jordan Scher, Bradley T Rosen, Jeffrey H BarsukAbstract:Background Despite a lack of evidence in the literature, several assumptions exist about the safety of Thoracentesis in clinical guidelines and practice patterns. We aimed to evaluate specific demographic and clinical factors that have been commonly associated with complications such as iatrogenic pneumothorax, re-expansion pulmonary oedema (REPE) and bleeding. Methods We performed a cohort study of inpatients who underwent thoracenteses at Cedars-Sinai Medical Center (CSMC) from August 2001 to October 2013. Data were collected prospectively including information on volume of fluid removed, procedure side, whether the patient was on positive pressure ventilation, number of needle passes and supine positioning. Iatrogenic pneumothorax, REPE and bleeding were tracked for 24 h after the procedure or until a clinical question was reconciled. Demographic and clinical characteristics were obtained through query of electronic medical records. Results CSMC performed 9320 inpatient thoracenteses on 4618 patients during the study period. There were 57 (0.61%) iatrogenic pneumothoraces, 10 (0.01%) incidents of REPE and 17 (0.18%) bleeding episodes. Iatrogenic pneumothorax was significantly associated with removal of >1500 mL fluid (p Conclusions Our series of thoracenteses had a very low complication rate. Current clinical guidelines and practice patterns may not reflect evidence-based best practices.
Jonathan Puchalski - One of the best experts on this subject based on the ideXlab platform.
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Physician Practice Patterns for Performing Thoracentesis in Patients Taking Anticoagulant Medications
Journal of bronchology & interventional pulmonology, 2020Co-Authors: Erin M Debiasi, Katy L. B. Araujo, Terrence E. Murphy, Margaret A. Pisani, Jonathan PuchalskiAbstract:Background Patients undergoing Thoracentesis often have comorbid conditions or take medications that potentially put them at higher bleeding risk. Direct oral anticoagulant (DOAC) use has also increased significantly. There are no published guidelines or consensus on when to perform Thoracentesis in patients on anticoagulants. Recent studies support the safety of a more liberal approach for Thoracentesis among patients with coagulopathy. Methods We conducted a survey to ascertain the practices of physicians regarding Thoracentesis in patients with increased bleeding risk. The survey was administered to the email distribution lists of the American Association of Bronchology and Interventional Pulmonology and of the American Thoracic Society. Results The survey was completed by 256 attending physicians. Most of them were general pulmonologists practicing at academic medical centers. Most of them would perform a Thoracentesis in patients receiving acetylsalicylic acid or prophylactic doses of unfractionated heparin or low molecular weight heparin (96%, 89%, and 88%, respectively). Half of the respondents would perform a Thoracentesis in patients on antiplatelet medications (clopidogrel and ticagrelor, 51%; ticlopidine, 53%). A minority would perform Thoracentesis in patients on direct oral anticoagulants or infused thrombin inhibitors (19% and 12%, respectively). The only subgroup that had a higher proclivity for performing Thoracentesis without holding medications were attending physicians practicing for under 10 years. Relative to noninterventional pulmonologists, there were no significant differences in the responses of interventional pulmonologists. Conclusion There was variation in the practice patterns of attending physicians in performing Thoracentesis in patients with elevated bleeding risk. Further data and guidelines regarding the safety of Thoracentesis in these patients are needed.
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safety and tolerability of vacuum versus manual drainage during Thoracentesis a randomized trial
Journal of bronchology & interventional pulmonology, 2019Co-Authors: Michal Senitko, Terrence E. Murphy, Katy L. B. Araujo, Margaret A. Pisani, Erin M Debiasi, Amrik S Ray, Kyle Bramley, Kelsey Cameron, Jonathan PuchalskiAbstract:Background:Pleural effusions may be aspirated manually or via vacuum during Thoracentesis. This study compares the safety, pain level, and time involved in these techniques.Methods:We randomized 100 patients receiving ultrasound-guided unilateral Thoracentesis in an academic medical center from Dece
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Thoracentesis: State-of-the-Art in Procedural Safety, Patient Outcomes, and Physiologic Impact
PLEURA, 2016Co-Authors: Erin M Debiasi, Jonathan PuchalskiAbstract:Pleural effusions are common and account for high morbidity and mortality in a range of patients. Thoracentesis can provide significant symptom relief and improvement in physiologic parameters including dyspnea, exercise, and sleep. Recent advances, including the use of ultrasound and dedicated procedural teams, have improved the safety of Thoracentesis. This has allowed Thoracentesis to be performed on higher-risk individuals including those with elevated bleeding risk and bilateral pleural effusions. This review will summarize recent advances in Thoracentesis procedural safety, symptom relief following Thoracentesis, and understanding of the physiologic basis for such improvements.
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mortality among patients with pleural effusion undergoing Thoracentesis
European Respiratory Journal, 2015Co-Authors: Erin M Debiasi, Terrence E. Murphy, Katy L. B. Araujo, Margaret A. Pisani, Anna Kookoolis, Christine A Argento, Jonathan PuchalskiAbstract:Of the 1.5 million people diagnosed with pleural effusion in the USA annually, ∼178 000 undergo Thoracentesis. While it is known that malignant pleural effusion portends a poor prognosis, mortality of patients with nonmalignant effusions has not been well studied. This prospective cohort study evaluated 308 patients undergoing Thoracentesis. Chart review was performed to obtain baseline characteristics. The aetiology of the effusions was determined using standardised criteria. Mortality was determined at 30 days and 1 year. 247 unilateral and 61 bilateral thoracenteses were performed. Malignant effusion had the highest 30-day (37%) and 1-year (77%) mortality. There was substantial patient 30-day and 1-year mortality with effusions due to multiple benign aetiologies (29% and 55%), congestive heart failure (22% and 53%), and renal failure (14% and 57%, respectively). Patients with bilateral, relative to unilateral, pleural effusion were associated with higher risk of death at 30 days and 1 year (17% versus 47% (hazard ratio (HR) 2.58, 95% CI 1.44–4.63) and 36% versus 69% (HR 2.32, 95% CI 1.55–3.48), respectively). Patients undergoing Thoracentesis for pleural effusion have high short- and long-term mortality. Patients with malignant effusion had the highest mortality followed by multiple benign aetiologies, congestive heart failure and renal failure. Bilateral pleural effusion is distinctly associated with high mortality.
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The Safety of Thoracentesis in Patients with Uncorrected Bleeding Risk
Annals of the American Thoracic Society, 2013Co-Authors: Jonathan Puchalski, A. Christine Argento, Terrence E. Murphy, Katy L. B. Araujo, Margaret A. PisaniAbstract:Background: Thoracentesis is commonly performed to evaluate pleural effusions. Many medications (warfarin, heparin, clopidogrel) or physiological factors (elevated International Normalized Ratio [INR], thrombocytopenia, uremia) increase the risk for bleeding. Frequently these medications are withheld or transfusions are performed to normalize physiological parameters before a procedure. The safety of performing Thoracentesis without correction of these bleeding risks has not been prospectively evaluated.Methods: This prospective observational cohort study enrolled 312 patients who underwent Thoracentesis. All patients were evaluated for the presence of risk factors for bleeding. Hematocrit levels were obtained pre- and postprocedure, and the occurrence of postprocedural hemothorax was evaluated.Measurements and Main Results: Thoracenteses were performed in 312 patients, 42% of whom had a risk for bleeding. Elevated INR, secondary to liver disease or warfarin, and renal disease were the two most common eti...
Steven A. Sahn - One of the best experts on this subject based on the ideXlab platform.
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pathophysiology of pneumothorax following ultrasound guided Thoracentesis
Chest, 2006Co-Authors: Jay Heidecker, Steven A. Sahn, John T Huggins, Peter DoelkenAbstract:Study objectives Pneumothorax following ultrasound-guided Thoracentesis is rare. Our goal was to explain the mechanisms of pneumothorax following ultrasound-guided Thoracentesis in a setting where pleural manometry is routinely used. Methods We reviewed the patient records and procedure reports of 401 patients who underwent ultrasound-guided Thoracentesis. When manometry was performed, pleural space elastance was determined. A model assuming dependence of the pleural space elastic properties on respiratory system elastic properties was used to isolate cases with presumed normal pleural space elastance. Elastance outside mean ± SD × 2 of the isolated sample was considered abnormal. Four radiographic criteria of unexpandable lung were used: visceral pleural peel, lobar atelectasis, basilar pneumothorax, and pneumothorax with ipsilateral shift. Results There were 102 diagnostic thoracenteses, 192 therapeutic thoracenteses with pleural manometry, and 73 therapeutic thoracenteses without manometry. There was one pneumothorax that occurred from lung puncture and eight unintentional pneumothoraces, all of which showed radiographic evidence of unexpandable lung. Four of eight unintentional pneumothoraces had abnormal elastance; none had excessively negative pleural pressure ( 2 O). Conclusions Unintentional pneumothoraces cannot be prevented by monitoring for symptoms or excessively negative pressure. These pneumothoraces were drainage related rather than due to penetrating lung trauma or external air introduction. We speculate that unintentional pneumothoraces are caused by transient, parenchymal-pleural fistulae caused by nonuniform stress distribution over the visceral pleura that develop during large-volume drainage if the lung cannot conform to the shape of the thoracic cavity in some patients with unexpandable lung. These fistulae appear to be pressure dependent, and the resulting pneumothoraces rarely require treatment. Drainage-related pneumothorax is an unavoidable complication of ultrasound-guided Thoracentesis and appears to account for the vast majority of pneumothoraces occurring in a procedure service.
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Effect of Thoracentesis on Respiratory Mechanics and Gas Exchange in the Patient Receiving Mechanical Ventilation
Chest, 2006Co-Authors: Peter Doelken, Steven A. Sahn, Ricardo Abreu, Paul H. MayoAbstract:Background This study reports the effect of Thoracentesis on respiratory mechanics and gas exchange in patients receiving mechanical ventilation. Study design Prospective. Setting University hospital. Patients Eight patient receiving mechanical ventilation with unilateral (n = 7) or bilateral (n = 1) large pleural effusions. Intervention Therapeutic Thoracentesis (n = 9). Measurements Resistances of the respiratory system measured with the constant inspiratory flow interrupter method measuring peak pressure and plateau pressure, effective static compliance of the respiratory system (Cst,rs), work performed by the ventilator (Wv), arterial blood gases, mixed exhaled P co 2 , and pleural liquid pressure (Pliq). Results Thoracentesis resulted in a significant decrease in Wv and Pliq. Thoracentesis had no significant effect on dynamic compliance of the respiratory system; Cst,rs; effective interrupter resistance of the respiratory system, or its subcomponents, ohmic resistance of the respiratory system and additional (non-ohmic) resistance of the respiratory system; or intrinsic positive end-expiratory pressure (PEEPi). Indices of gas exchange were not significantly changed by Thoracentesis. Conclusions Thoracentesis in patients receiving mechanical ventilatory support results in significant reductions of Pliq and Wv. These changes were not accompanied by significant changes of resistance or compliance or by significant changes in gas exchange immediately after Thoracentesis. The reduction of Wv after Thoracentesis in patients receiving mechanical ventilation is not accompanied by predictable changes in inspiratory resistance and static compliance measured with routine clinical methods. The benefit of Thoracentesis may be most pronounced in patients with high levels of PEEPi.
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Safety and Value of Thoracentesis in Medical ICU Patients
Journal of Intensive Care Medicine, 1998Co-Authors: Gregory P. Le Mense, Steven A. SahnAbstract:The objective of this study was to determine the safety and value of Thoracentesis in an ICU, Thoracentesis is a safe procedure for critically ill patients, even those on mechanical ventilators, and usually confirms the suspected diagnosis. However, Thoracentesis revealed an unexpected diagnosis that changed management in 12% of patients. Repeat or contralateral Thoracentesis is indicated when either the clinical course is inconsistent or may represent a complication of the original diagnosis.
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Thoracentesis: a safe procedure in mechanically ventilated patients.
Annals of internal medicine, 1990Co-Authors: Jeffrey E. Godwin, Steven A. SahnAbstract:Thoracentesis has contributed to the diagnosis and management of patients with pleural effusions for almost 150 years (1). More than 90% of thoracenteses provide clinically useful information (2), ...
Peter Doelken - One of the best experts on this subject based on the ideXlab platform.
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pathophysiology of pneumothorax following ultrasound guided Thoracentesis
Chest, 2006Co-Authors: Jay Heidecker, Steven A. Sahn, John T Huggins, Peter DoelkenAbstract:Study objectives Pneumothorax following ultrasound-guided Thoracentesis is rare. Our goal was to explain the mechanisms of pneumothorax following ultrasound-guided Thoracentesis in a setting where pleural manometry is routinely used. Methods We reviewed the patient records and procedure reports of 401 patients who underwent ultrasound-guided Thoracentesis. When manometry was performed, pleural space elastance was determined. A model assuming dependence of the pleural space elastic properties on respiratory system elastic properties was used to isolate cases with presumed normal pleural space elastance. Elastance outside mean ± SD × 2 of the isolated sample was considered abnormal. Four radiographic criteria of unexpandable lung were used: visceral pleural peel, lobar atelectasis, basilar pneumothorax, and pneumothorax with ipsilateral shift. Results There were 102 diagnostic thoracenteses, 192 therapeutic thoracenteses with pleural manometry, and 73 therapeutic thoracenteses without manometry. There was one pneumothorax that occurred from lung puncture and eight unintentional pneumothoraces, all of which showed radiographic evidence of unexpandable lung. Four of eight unintentional pneumothoraces had abnormal elastance; none had excessively negative pleural pressure ( 2 O). Conclusions Unintentional pneumothoraces cannot be prevented by monitoring for symptoms or excessively negative pressure. These pneumothoraces were drainage related rather than due to penetrating lung trauma or external air introduction. We speculate that unintentional pneumothoraces are caused by transient, parenchymal-pleural fistulae caused by nonuniform stress distribution over the visceral pleura that develop during large-volume drainage if the lung cannot conform to the shape of the thoracic cavity in some patients with unexpandable lung. These fistulae appear to be pressure dependent, and the resulting pneumothoraces rarely require treatment. Drainage-related pneumothorax is an unavoidable complication of ultrasound-guided Thoracentesis and appears to account for the vast majority of pneumothoraces occurring in a procedure service.
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Effect of Thoracentesis on Respiratory Mechanics and Gas Exchange in the Patient Receiving Mechanical Ventilation
Chest, 2006Co-Authors: Peter Doelken, Steven A. Sahn, Ricardo Abreu, Paul H. MayoAbstract:Background This study reports the effect of Thoracentesis on respiratory mechanics and gas exchange in patients receiving mechanical ventilation. Study design Prospective. Setting University hospital. Patients Eight patient receiving mechanical ventilation with unilateral (n = 7) or bilateral (n = 1) large pleural effusions. Intervention Therapeutic Thoracentesis (n = 9). Measurements Resistances of the respiratory system measured with the constant inspiratory flow interrupter method measuring peak pressure and plateau pressure, effective static compliance of the respiratory system (Cst,rs), work performed by the ventilator (Wv), arterial blood gases, mixed exhaled P co 2 , and pleural liquid pressure (Pliq). Results Thoracentesis resulted in a significant decrease in Wv and Pliq. Thoracentesis had no significant effect on dynamic compliance of the respiratory system; Cst,rs; effective interrupter resistance of the respiratory system, or its subcomponents, ohmic resistance of the respiratory system and additional (non-ohmic) resistance of the respiratory system; or intrinsic positive end-expiratory pressure (PEEPi). Indices of gas exchange were not significantly changed by Thoracentesis. Conclusions Thoracentesis in patients receiving mechanical ventilatory support results in significant reductions of Pliq and Wv. These changes were not accompanied by significant changes of resistance or compliance or by significant changes in gas exchange immediately after Thoracentesis. The reduction of Wv after Thoracentesis in patients receiving mechanical ventilation is not accompanied by predictable changes in inspiratory resistance and static compliance measured with routine clinical methods. The benefit of Thoracentesis may be most pronounced in patients with high levels of PEEPi.
Richard W. Light - One of the best experts on this subject based on the ideXlab platform.
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incidence and aetiology of eosinophilic pleural effusion
European Respiratory Journal, 2009Co-Authors: Rafał Krenke, Ryszarda Chazan, Jacek Nasilowski, Piotr Korczynski, Katarzyna Gorska, Tadeusz Przybylowski, Richard W. LightAbstract:Although eosinophilic pleural effusion (EPE) has been a subject of numerous studies, its clinical significance still remains unclear. The aim of our study was to evaluate: 1) the relative incidence and aetiology of EPE; 2) the predictors of malignancy in patients with EPE; and 3) the relationship between repeated Thoracentesis and pleural fluid eosinophilia. A retrospective analysis of 2,205 pleural fluid samples from 1,868 patients treated between 1995 and 2007 was performed. We identified 135 patients with EPE (7.2% of all patients with pleural effusion) and 153 EPE samples. The most common condition associated with EPE was malignancy (34.8%) followed by infectious (19.2%), unknown (14.1%), post-traumatic (8.9%) and miscellaneous (23.0%) pleural effusions. The incidence of malignancy was significantly higher in patients with a lower (≤40%) pleural fluid eosinophil percentage. 40 patients with EPE underwent a second Thoracentesis. In 16, eosinophilia was present in both pleural fluid samples, 14 revealed pleural fluid eosinophilia only after the second Thoracentesis and 10 had eosinophilia only in the first pleural fluid sample. Pleural fluid eosinophilia should not be regarded as a predictor of nonmalignant aetiology. Probability of malignancy is lower in effusions with a high eosinophil percentage. The incidence of EPE in patients undergoing second Thoracentesis is not different to that found during the first Thoracentesis.
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Ultrasound-guided Thoracentesis: is it a safer method?
Chest, 2003Co-Authors: Phillip W. Jones, J. Phillip Moyers, Jeffrey T. Rogers, R. Michael Rodriguez, Y. C. Gary Lee, Richard W. LightAbstract:Study objectives: The objectives of this study are as follows: (1) to determine the incidence of complications from Thoracentesis performed under ultrasound guidance by interventional radiologists in a tertiary referral teaching hospital; (2) to evaluate the incidence of vasovagal events without the use of atropine prior to Thoracentesis; and (3) to evaluate patient or radiographic factors that may contribute to, or be predictive of, the development of re-expansion pulmonary edema after ultrasound-guided Thoracentesis. Design: Prospective descriptive study. Setting: Saint Thomas Hospital, a tertiary referral teaching hospital in Nashville, TN. Patients: All patients referred to interventional radiology for diagnostic and/or therapeutic ultrasound-guided Thoracentesis between August 1997 and September 2000. Results: A total of 941 thoracenteses in 605 patients were performed during the study period. The following complications were recorded: pain (n = 25; 2.7%), pneumothorax (n = 24; 2.5%), shortness of breath (n = 9; 1.0%), cough (n = 8; 0.8%), vasovagal reaction (n = 6; 0.6%), bleeding (n = 2; 0.2%), hematoma (n = 2; 0.2%), and re-expansion pulmonary edema (n = 2; 0.2%). Eight patients with pneumothorax received tube thoracostomies (0.8%). When > 1,100 mL of fluid were removed, the incidence of pneumothorax requiring tube thoracostomy and pain was increased (p 1,000 mL of pleural fluid were removed. Conclusions: The complication rate with Thoracentesis performed by interventional radiologists under ultrasound guidance is lower than that reported for non–image-guided Thoracentesis. Premedication with atropine is unnecessary given the low incidence of vasovagal reactions. Re-expansion pulmonary edema is uncommon even when > 1,000 mL of pleural fluid are removed, as long as the procedure is stopped when symptoms develop.
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The Utility of Daily Therapeutic Thoracentesis for the Treatment of Early Empyema
Chest, 1999Co-Authors: Scott A. Sasse, Tan Nguyen, Lisete R. Teixeira, Richard W. LightAbstract:Study objectives: To determine if therapeutic Thoracentesis is as effective as early chest tube placement or no drainage procedure in the treatment of early empyema in rabbits. Design and interventions: An empyema, as evidenced by gross pleural pus and a decreased pleural fluid pH and glucose level, was induced in 49 rabbits. The rabbits were divided into three groups: 16 underwent daily therapeutic Thoracentesis starting at 48 h, 14 underwent chest tube placement at 48 h, and 19 served as controls. Results: The mortality rate in the therapeutic Thoracentesis group (0/16) did not differ significantly from that in the chest tube group (3/14) or that in the control group (6/19). At autopsy at 10 days, the gross empyema score in the therapeutic Thoracentesis group (2.1 6 0.3) was significantly lower (p < 0.05) than that in the chest tube group (2.8 6 0.3) or the control group (3.5 6 0.2). The mean pleural peel score of 5.8 6 1.1 in the therapeutic Thoracentesis group was significantly less (p < 0.05) than the score for the nonintervention control group (13.4 6 1.6). Conclusions: From this study, we conclude that therapeutic Thoracentesis is at least as effective as early chest tube placement for the treatment of early empyema using our rabbit model of empyema. (CHEST 1999; 116:1703‐1708)
