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Initial size of unilateral pleural effusion determines impact of thoracocentesis on oxygenation
  1. Stylianos A Michaelides1,
  2. George D Bablekos2,3,
  3. Antonis Analitis4,
  4. Avgerinos-Romanos Michailidis1,2,
  5. Konstantinos A Charalabopoulos3,
  6. Nikolaos Koulouris5
  1. 1Department of Occupational Lung Diseases and Tuberculosis, 'Sismanogleio – Amalia Fleming' General Hospital, Maroussi, Greece
  2. 2Departmentof Medical Laboratories, Technological Educational Institute (TEI) of Athens, Faculty of Health and Caring Professions, Athens, Greece
  3. 3Department of Physiology, Medical School, University of Ioannina, Ioannina, Greece
  4. 4Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
  5. 5First Department of Thoracic Medicine, Medical School, National and Kapodistrian University of Athens, Hospital for Diseases of the Chest (Sotiria), Athens, Greece
  1. Correspondence to Dr George D Bablekos, Thoracic Surgeon, Androu 16B Str, Melissia 15127, Athens, Greece; gbableko{at}otenet.gr

Abstract

Background There have been contradicting reports in the literature regarding the impact of pleural fluid aspiration on patients’ oxygenation. The aim of this study was to assess the role of the initial size of effusion on post-drainage oxygenation.

Methods We studied 122 patients, aged (mean±SD) 61.2±16.8 years, with unilateral pleural effusion and no remarkable parenchymal lesion, by determining PaO2, PaCO2 and [A−a] PaO2 just before thoracocentesis (T1), 30 min after its completion (T2) and 48 hours after the procedure (T3). Patients were divided into group A (75 patients) with small and moderate sized effusions and group B (47 patients) with large and massive effusions. The position of the meniscus line on the posteroanterior film, being arbitrarily set at just above the upper costal margin of the sixth anterior rib, was used to divide the two groups. Patients were studied at rest, breathing room air in the sitting position. Repeated measures ANOVA (related samples) and the Friedman test when the normality assumption was violated were used.

Results In group A, at T3, PaO2(mm Hg) showed a statistically significant increase versus T1 (p<0.001) and T2 (p=0.002), while [A-a] PaO2 displayed a statistically significant decrease compared with T1 (p<0.001) and T2 (p=0.001). In group B, at T2, PaO2 presented significant decrease versus T1 (p<0.001) and T3 (p<0.001), while [A-a] PO2 was found to be significantly increased compared with both T1 and T3 (p<0.001).

Conclusion Patients with smaller effusions showed a small improvement in their oxygenation 48 hours post-thoracocentesis (T3). Patients with larger effusions exhibited a transient reduction in their oxygenation immediately after fluid removal (T2).

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Footnotes

  • Contributors SAM: acquisition of the data, draft of the manuscript, medical interpretation of the data, writing of the manuscript, and revision and final approval.

    GDB: acquisition of the data, draft of the manuscript, medical interpretation of the data, writing of the manuscript, and revision and final approval.

    AA: draft of the manuscript, medical statistics, writing of the manuscript, and revision and final approval.

    A-RM: draft of the manuscript, medical interpretation of the data, writing of the manuscript, and revision and final approval.

    KAC: draft of the manuscript, medical interpretation of the data, writing of the manuscript, and revision and final approval.

    NK: draft of the manuscript, medical interpretation of the data, writing of the manuscript, and revision and final approval.

  • Competing interests None declared.

  • Ethics approval The study was approved by the ethics committee of Sismanogleion General Hospital, Maroussi, Athens, Greece, and the National and Kapodistrian University of Athens, Greece.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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