Pleural space elastance and changes in oxygenation after therapeutic thoracentesis in ventilated patients with heart failure and transudative pleural effusions.
OBJECTIVE
Therapeutic thoracentesis (TT) is required in patients with refractory pleural effusions and impaired oxygenation. In this study, the relationship between pleural space elastance (PE) and changes in oxygenation after TT was investigated in ventilated patients with heart failure and transudative pleural effusions.


METHODS
Twenty-six mechanically ventilated patients with heart failure and significant transudative effusions, who were undergoing TT, were studied. The effusion was drained as completely as possible, with monitoring of pleural liquid pressure (Pliq) and chest symptoms. The volume of effusion removed, the changes in Pliq during TT, PE and arterial blood gases before and after TT were recorded.


RESULTS
The mean volume of effusion removed was 1011.9 +/- 58.2 mL. The mean Pliq decreased from 14.5 +/- 1.0 to 0.1 +/- 1.5 cm H(2)O after TT, and the mean PE was 15.3 +/- 1.8 cm H(2)O/L. TT significantly increased the mean ratio of PaO(2)/fraction of inspired oxygen (FiO(2)) from 243.2 +/- 19.9 to 336.0 +/- 17.8 mm Hg (P < 0.0001). The changes in PaO(2)/FiO(2) ratio after TT were inversely correlated with PE (r = -0.803, P < 0.0001). The 14 patients (54%) with normal PE (<or=14.5 cm H(2)O/L) had significantly greater increases in PaO(2)/FiO(2) ratio after TT than did the 12 patients with abnormal PE (>14.5 cm H(2)O/L).


CONCLUSIONS
Measurement of PE during TT may be valuable for predicting improvement in oxygenation in ventilated patients with heart failure and pleural effusions. Patients with lower PE showed greater improvement in oxygenation after TT.
Chen
Wei-Lin
WL
Institute of Emergency and Critical Care Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
Chung
Chi-Li
CL
Hsiao
Shih-Hsin
SH
Chang
Shi-Chuan
SC
D000368:Aged; D000369:Aged, 80 and over; D005122:Exudates and Transudates; D005260:Female; D006333:Heart Failure / Q000628:therapy*; D006801:Humans; D008297:Male; D010100:Oxygen / Q000097:blood*; D019152:Paracentesis; D035422:Pleural Cavity / Q000503:physiopathology*; D010996:Pleural Effusion / Q000628:therapy*; D012121:Respiration, Artificial
D010100:Oxygen