Section of Interventional Pulmonology, Cooper Medical School at Rowan University, Camden, New Jersey, USA,
Division of Pulmonary, Critical Care and Sleep Medicine, Palmetto Health-USC Medical Group, Columbia, South Carolina, USA.
Respiration. 2019;98(1):55-59. doi: 10.1159/000496610. Epub 2019 Apr 17.
Excessive drop of pleural pressure (Ppl) during therapeutic thoracentesis may be related to adverse events and/or to repeated procedures due to incomplete drainage.
This was a pilot study of the impact of the application of continuous positive airway pressure (CPAP) at +5 cm H2O upon the Ppl profile during thoracentesis.
This was a prospective, controlled study of 49 consecutive adults who underwent thoracentesis. Enrollment was via alternation on a one-to-one basis. Pleural manometry was used to compare serial Ppl in patients using CPAP at +5 cm H2O (CPAP group) with Ppl in patients without CPAP (control group).
Mean volumes drained were comparable between CPAP and control groups (1,380 vs. 1,396 mL). Patients in the CPAP group had a significantly greater change in volume per centimeter water column pressure (p = 0.0231, 95% confidence interval 6.41-82.61). No patient in the CPAP group had a Ppl less than -20 cm H2O at termination of the procedure, while 8 (33%) control group patients developed a pressure lower than -20. No patient in either group developed re-expansion pulmonary edema.
The application of CPAP at +5 cm H2O mitigates the decreases in Ppl caused by thoracentesis via an increase in pleural compliance. The clinical implications of this finding merit study.
治疗性胸腔穿刺术中胸膜压力（Ppl）的过度下降可能与不良事件和/或由于引流不完全而导致的重复操作有关。
这是一项关于在胸腔穿刺术期间应用 5cmH2O 持续气道正压通气（CPAP）对 Ppl 曲线影响的初步研究。
这是一项连续 49 例成人进行胸腔穿刺术的前瞻性、对照研究。通过一对一的交替方式进行入组。使用胸膜测压法比较使用 5cmH2O CPAP（CPAP 组）和未使用 CPAP（对照组）患者的连续 Ppl。
CPAP 组和对照组的引流量相似（1380 与 1396mL）。CPAP 组患者每厘米水柱压力的容积变化明显更大（p = 0.0231，95%置信区间 6.41-82.61）。CPAP 组患者在操作结束时无一例 Ppl 低于-20cmH2O，而对照组 8 例（33%）患者出现压力低于-20cmH2O。两组患者均未发生复张性肺水肿。
CPAP 应用于+5cmH2O 通过增加胸膜顺应性来减轻胸腔穿刺术引起的 Ppl 下降。这一发现的临床意义值得进一步研究。
