title: Impact of pleural manometry on the development of chest discomfort during thoracentesis: a symptom-based study.
abstract: BACKGROUND
  Routine manometry is recommended to prevent complications during therapeutic thoracentesis, but has not definitively been shown to prevent pneumothorax or reexpansion pulmonary edema. As chest discomfort correlates with negative pleural pressures, we aimed to determine whether the use of manometry could anticipate the development of chest discomfort during therapeutic thoracentesis.
  
  
  METHODS
  A retrospective chart review of 214 consecutive adults who underwent outpatient therapeutic thoracentesis at our institution between January 1, 2011 and June 30, 2013 was performed. We compared preprocedural to postprocedural discomfort (using a linear analog scale from 0 to 10) in patients undergoing thoracentesis with or without manometry. We used a multivariate model to adjust for possible confounders. Changes of dyspnea scores were also analyzed.
  
  
  RESULTS
  Manometry was performed in 82/214 patients (38%). On univariate and multivariate analyses, neither the change in chest discomfort nor dyspnea scores was significantly different in the manometry versus the control group (P=0.12 and 0.24, respectively). Similar results were also found in the subgroup of large-volume thoracentesis (P=0.32 for discomfort, P=1.0 for dyspnea).
  
  
  CONCLUSIONS
  In our retrospective study, the use of manometry did not appear to anticipate the development of chest discomfort during therapeutic thoracentesis. Prospective studies are needed to confirm these findings.
authors.affiliation: Divisions of *Pulmonary and Critical Care Medicine †Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN.
authors.forename: Jasleen
authors.initials: J
authors.lastname: Pannu
authors.forename: Zachary S
authors.initials: ZS
authors.lastname: DePew
authors.forename: John J
authors.initials: JJ
authors.lastname: Mullon
authors.forename: Craig E
authors.initials: CE
authors.lastname: Daniels
authors.forename: Clinton E
authors.initials: CE
authors.lastname: Hagen
authors.forename: Fabien
authors.initials: F
authors.lastname: Maldonado
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002637:Chest Pain / Q000209:etiology* / Q000517:prevention & control*; D015331:Cohort Studies; D004322:Drainage / Q000379:methods; D004417:Dyspnea / Q000209:etiology / Q000517:prevention & control; D005260:Female; D006801:Humans; D016014:Linear Models; D008297:Male; D008365:Manometry / Q000379:methods*; D008875:Middle Aged; D019152:Paracentesis / Q000009:adverse effects / Q000379:methods*; D010996:Pleural Effusion / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D011030:Pneumothorax / Q000209:etiology / Q000517:prevention & control; D011312:Pressure; D011654:Pulmonary Edema / Q000209:etiology / Q000517:prevention & control; D012189:Retrospective Studies; D019616:Thoracic Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D014463:Ultrasonography