title: Can ultrasound guidance reduce the risk of pneumothorax following thoracentesis? .
abstract: OBJECTIVE
  Thoracentesis is one of the bedside procedures most commonly associated with iatrogenic complications, particularly pneumothorax. Various risk factors for complications associated with thoracentesis have recently been identified, including an inexperienced operator; an inadequate or inexperienced support team; the lack of a standardized protocol; and the lack of ultrasound guidance. We sought to determine whether ultrasound-guided thoracentesis can reduce the risk of pneumothorax and improve outcomes (fewer procedures without fluid removal and greater volumes of fluid removed during the procedures). In our comparison of thoracentesis with and without ultrasound guidance, all procedures were performed by a team of expert pulmonologists, using the same standardized protocol in both conditions.
  
  
  METHODS
  A total of 160 participants were randomly allocated to undergo thoracentesis with or without ultrasound guidance (n = 80 per group). The primary outcome was pneumothorax following thoracentesis. Secondary outcomes included the number of procedures without fluid removal and the volume of fluid drained during the procedure.
  
  
  RESULTS
  Pneumothorax occurred in 1 of the 80 patients who underwent ultrasound-guided thoracentesis and in 10 of the 80 patients who underwent thoracentesis without ultrasound guidance, the difference being statistically significant (p = 0.009). Fluid was removed in 79 of the 80 procedures performed with ultrasound guidance and in 72 of the 80 procedures performed without it. The mean volume of fluid drained was larger during the former than during the latter (960 ± 500 mL vs. 770 ± 480 mL), the difference being statistically significant (p = 0.03).
  
  
  CONCLUSIONS
  Ultrasound guidance increases the yield of thoracentesis and reduces the risk of post-procedure pneumothorax. (Chinese Clinical Trial Registry identifier: ChiCTR-TRC-12002174 [http://www.chictr.org/en/]).
authors.affiliation: Sestri Levante General Hospital, Department of Respiratory Diseases, Sestri Levante, Italy, Physician. Department of Respiratory Diseases, Sestri Levante General Hospital, Sestri Levante, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Perazzo
authors.affiliation: Sestri Levante General Hospital, Department of Respiratory Diseases, Sestri Levante, Italy, Physician. Department of Respiratory Diseases, Sestri Levante General Hospital, Sestri Levante, Italy.
authors.forename: Piergiorgio
authors.initials: P
authors.lastname: Gatto
authors.affiliation: ASL4, Department of Forensic Medicine, Chiavarese, Italy, Physician. Department of Forensic Medicine, ASL4, Chiavarese, Italy.
authors.forename: Cornelius
authors.initials: C
authors.lastname: Barlascini
authors.affiliation: ASL4, Department of Public Health, Chiavarese, Italy, Physician. Department of Public Health, ASL4, Chiavarese, Italy.
authors.forename: Maura
authors.initials: M
authors.lastname: Ferrari-Bravo
authors.affiliation: Sestri Levante General Hospital, Department of Respiratory Diseases, Sestri Levante, Italy, Physician. Department of Respiratory Diseases, Sestri Levante General Hospital, Sestri Levante, Italy.
authors.forename: Antonello
authors.initials: A
authors.lastname: Nicolini
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004322:Drainage / Q000009:adverse effects; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010996:Pleural Effusion / Q000000981:diagnostic imaging* / Q000628:therapy*; D011030:Pneumothorax / Q000209:etiology / Q000517:prevention & control*; D011183:Postoperative Complications; D011446:Prospective Studies; D012307:Risk Factors; D019616:Thoracic Surgical Procedures / Q000009:adverse effects*; D018084:Ultrasonography, Interventional / Q000379:methods*