Large-Volume Thoracentesis and the Risk of Reexpansion Pulmonary Edema

David Feller-Kopman, David Berkowitz, Phillip Boiselle, Armin Ernst

Research output: Contribution to journalArticle

Abstract

Background: To avoid reexpansion pulmonary edema (RPE), thoracenteses are often limited to draining no more than 1 L. There are, however, significant clinical benefits to removing more than 1 L of fluid. The purpose of this study was to define the incidence of RPE among patients undergoing large-volume (≥1 L) thoracentesis. Methods: One hundred eighty-five patients undergoing large-volume thoracentesis were included in this study. The volume of fluid removed, absolute pleural pressure, pleural elastance, and symptoms during thoracentesis were compared in patients who did and did not experience RPE. Results: Of the 185 patients, 98 (53%) had between 1 L and 1.5 L withdrawn, 40 (22%) had between 1.5 L and 2 L withdrawn, 38 (20%) had between 2 L and 3 L withdrawn, and 9 (5%) had more than 3 L withdrawn. Only 1 patient (0.5%, 95% confidence interval: 0.01% to 3%) experienced clinical RPE. Four patients (2.2%, 95% confidence interval: 0.06% to 5.4%) had radiographic RPE (diagnosed only on postprocedure imaging without clinical symptoms). The incidence of RPE was not associated with the absolute change in pleural pressure, pleural elastance, or symptoms during thoracentesis. Conclusions: Clinical and radiographic RPE after large-volume thoracentesis is rare and independent of the volume of fluid removed, pleural pressures, and pleural elastance. The recommendation to terminate thoracentesis after removing 1 L of fluid needs to be reconsidered: large effusions can, and should, be drained completely as long as chest discomfort or end-expiratory pleural pressure less than -20 cm H2O does not develop.

Original languageEnglish (US)
Pages (from-to)1656-1661
Number of pages6
JournalAnnals of Thoracic Surgery
Volume84
Issue number5
DOIs
StatePublished - Nov 2007
Externally publishedYes

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Pulmonary Edema
Pressure
Confidence Intervals
Incidence
Thoracentesis
Thorax

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Large-Volume Thoracentesis and the Risk of Reexpansion Pulmonary Edema. / Feller-Kopman, David; Berkowitz, David; Boiselle, Phillip; Ernst, Armin.

In: Annals of Thoracic Surgery, Vol. 84, No. 5, 11.2007, p. 1656-1661.

Research output: Contribution to journalArticle

Feller-Kopman, David ; Berkowitz, David ; Boiselle, Phillip ; Ernst, Armin. / Large-Volume Thoracentesis and the Risk of Reexpansion Pulmonary Edema. In: Annals of Thoracic Surgery. 2007 ; Vol. 84, No. 5. pp. 1656-1661.
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title = "Large-Volume Thoracentesis and the Risk of Reexpansion Pulmonary Edema",
abstract = "Background: To avoid reexpansion pulmonary edema (RPE), thoracenteses are often limited to draining no more than 1 L. There are, however, significant clinical benefits to removing more than 1 L of fluid. The purpose of this study was to define the incidence of RPE among patients undergoing large-volume (≥1 L) thoracentesis. Methods: One hundred eighty-five patients undergoing large-volume thoracentesis were included in this study. The volume of fluid removed, absolute pleural pressure, pleural elastance, and symptoms during thoracentesis were compared in patients who did and did not experience RPE. Results: Of the 185 patients, 98 (53{\%}) had between 1 L and 1.5 L withdrawn, 40 (22{\%}) had between 1.5 L and 2 L withdrawn, 38 (20{\%}) had between 2 L and 3 L withdrawn, and 9 (5{\%}) had more than 3 L withdrawn. Only 1 patient (0.5{\%}, 95{\%} confidence interval: 0.01{\%} to 3{\%}) experienced clinical RPE. Four patients (2.2{\%}, 95{\%} confidence interval: 0.06{\%} to 5.4{\%}) had radiographic RPE (diagnosed only on postprocedure imaging without clinical symptoms). The incidence of RPE was not associated with the absolute change in pleural pressure, pleural elastance, or symptoms during thoracentesis. Conclusions: Clinical and radiographic RPE after large-volume thoracentesis is rare and independent of the volume of fluid removed, pleural pressures, and pleural elastance. The recommendation to terminate thoracentesis after removing 1 L of fluid needs to be reconsidered: large effusions can, and should, be drained completely as long as chest discomfort or end-expiratory pleural pressure less than -20 cm H2O does not develop.",
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N2 - Background: To avoid reexpansion pulmonary edema (RPE), thoracenteses are often limited to draining no more than 1 L. There are, however, significant clinical benefits to removing more than 1 L of fluid. The purpose of this study was to define the incidence of RPE among patients undergoing large-volume (≥1 L) thoracentesis. Methods: One hundred eighty-five patients undergoing large-volume thoracentesis were included in this study. The volume of fluid removed, absolute pleural pressure, pleural elastance, and symptoms during thoracentesis were compared in patients who did and did not experience RPE. Results: Of the 185 patients, 98 (53%) had between 1 L and 1.5 L withdrawn, 40 (22%) had between 1.5 L and 2 L withdrawn, 38 (20%) had between 2 L and 3 L withdrawn, and 9 (5%) had more than 3 L withdrawn. Only 1 patient (0.5%, 95% confidence interval: 0.01% to 3%) experienced clinical RPE. Four patients (2.2%, 95% confidence interval: 0.06% to 5.4%) had radiographic RPE (diagnosed only on postprocedure imaging without clinical symptoms). The incidence of RPE was not associated with the absolute change in pleural pressure, pleural elastance, or symptoms during thoracentesis. Conclusions: Clinical and radiographic RPE after large-volume thoracentesis is rare and independent of the volume of fluid removed, pleural pressures, and pleural elastance. The recommendation to terminate thoracentesis after removing 1 L of fluid needs to be reconsidered: large effusions can, and should, be drained completely as long as chest discomfort or end-expiratory pleural pressure less than -20 cm H2O does not develop.

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