title: Impact of large-volume thoracentesis on transpulmonary thermodilution-derived extravascular lung water in medical intensive care unit patients.
abstract: OBJECTIVE
  The purpose of this study was to investigate the impact of large-volume thoracentesis (>1000 mL) on transpulmonary thermodilution (TPTD)-derived cardiopulmonary parameters with special regard to extravascular lung water index (EVLWI).
  
  
  METHODS
  Retrospective analysis of a prospectively maintained database including TPTD measurements of patients treated in a medical intensive care unit of a German university hospital between January 2009 and September 2010. Data of 17 patients treated with large-volume thoracentesis were analyzed.
  
  
  RESULTS
  A median of 1350 (25%-75% interquartile range [IQR], 1200-1590) mL of pleural fluid was removed. Extravascular lung water index was statistically significantly higher after thoracentesis compared with baseline (9.0 [IQR, 8.0-13.0] vs 8.0 [IQR, 7.0-13.0] mL/kg) (P = .039). Pulmonary vascular permeability index (PVPI) also increased significantly after thoracentesis (1.7 [IQR, 1.3-2.4] vs 1.4 [IQR, 1.1-2.1]) (P = .019). When determined 2 and 6 hours after thoracentesis, EVLWI and PVPI even further increased. Six hours after removal of pleural fluid, we observed a median EVLWI of 11.0 (IQR, 8.0-15.0) mL/kg (P = .048 compared with baseline) and a median PVPI of 2.0 (IQR, 1.5-2.7) (P = .040 compared with baseline).
  
  
  CONCLUSIONS
  Large-volume thoracentesis results in a statistically significant increase in TPTD-derived EVLWI. Because EVLWI was higher after removal of pleural fluid, we conclude that pleural effusions do not take part in single-indicator TPTD as a part of the pulmonary thermovolume and do not increase TPTD-derived EVLWI.
authors: II. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Strasse 22, 81675 München, Germany. bcs.muc@gmx.de
authors: Bernd
authors: B
authors: Saugel
authors: Veit
authors: V
authors: Phillip
authors: Christina
authors: C
authors: Ernesti
authors: Marlena
authors: M
authors: Messer
authors: Agnes S
authors: AS
authors: Meidert
authors: Roland M
authors: RM
authors: Schmid
authors: Wolfgang
authors: W
authors: Huber
mesh_terms: D000368:Aged; D015633:Extravascular Lung Water / Q000502:physiology*; D005260:Female; D006439:Hemodynamics; D006785:Hospitals, University; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D010996:Pleural Effusion / Q000503:physiopathology; D011652:Pulmonary Circulation / Q000502:physiology; D012189:Retrospective Studies; D013815:Thermodilution / Q000379:methods