Sagar Ala Eddin S, Landaeta Maria F, Adrianza Andres M, Aldana Grecia L, Pozo Leonardo, Armas-Villalba Aristides, Toquica Christian C, Larson Andrew J, Vial Macarena R, Grosu Horiana B, Ost David E, Eapen George A, Sheshadri Ajay, Morice Rodolfo C, Shannon Vickie R, Bashoura Lara, Balachandran Diwakar D, Almeida Francisco A, Uzbeck Mateen H, Casal Roberto F, Faiz Saadia A, Jimenez Carlos A
Dept of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA.
Eur Respir J. 2020 Nov 19;56(5). doi: 10.1183/13993003.02356-2019. Print 2020 Nov.
Thoracentesis using suction is perceived to have increased risk of complications, including pneumothorax and re-expansion pulmonary oedema (REPO). Current guidelines recommend limiting drainage to 1.5 L to avoid REPO. Our purpose was to examine the incidence of complications with symptom-limited drainage of pleural fluid using suction and identify risk factors for REPO.
A retrospective cohort study of all adult patients who underwent symptom-limited thoracentesis using suction at our institution between January 1, 2004 and August 31, 2018 was performed, and a total of 10 344 thoracenteses were included.
Pleural fluid ≥1.5 L was removed in 19% of the procedures. Thoracentesis was stopped due to chest discomfort (39%), complete drainage of fluid (37%) and persistent cough (13%). Pneumothorax based on chest radiography was detected in 3.98%, but only 0.28% required intervention. The incidence of REPO was 0.08%. The incidence of REPO increased with Eastern Cooperative Oncology Group performance status (ECOG PS) ≥3 compounded with ≥1.5 L (0.04-0.54%; 95% CI 0.13-2.06 L). Thoracentesis in those with ipsilateral mediastinal shift did not increase complications, but less fluid was removed (p<0.01).
Symptom-limited thoracentesis using suction is safe even with large volumes. Pneumothorax requiring intervention and REPO are both rare. There were no increased procedural complications in those with ipsilateral mediastinal shift. REPO increased with poor ECOG PS and drainage ≥1.5 L. Symptom-limited drainage using suction without pleural manometry is safe.
采用抽吸法进行胸腔穿刺被认为会增加并发症风险，包括气胸和复张性肺水肿（REPO）。当前指南建议将引流量限制在1.5升以内以避免复张性肺水肿。我们的目的是研究采用抽吸法进行症状限制性胸腔积液引流时并发症的发生率，并确定复张性肺水肿的危险因素。
对2004年1月1日至2018年8月31日期间在我院接受症状限制性抽吸胸腔穿刺术的所有成年患者进行回顾性队列研究，共纳入10344例胸腔穿刺术。
19%的操作中抽出的胸腔积液≥1.5升。胸腔穿刺术因胸部不适（39%）、液体完全引流（37%）和持续性咳嗽（13%）而停止。胸部X线检查发现气胸的比例为3.98%，但仅0.28%需要干预。复张性肺水肿的发生率为0.08%。复张性肺水肿的发生率随着东部肿瘤协作组体能状态（ECOG PS）≥3且引流量≥1.5升而增加（0.04 - 0.54%；95%可信区间0.13 - 2.06升）。同侧纵隔移位患者进行胸腔穿刺术并未增加并发症，但抽出的液体较少（p<0.01）。
即使引流量大，采用抽吸法进行症状限制性胸腔穿刺术也是安全的。需要干预的气胸和复张性肺水肿都很罕见。同侧纵隔移位患者的操作并发症并未增加。复张性肺水肿随着ECOG PS差和引流量≥1.5升而增加。不使用胸腔测压法进行抽吸的症状限制性引流是安全的。
