Large pleural effusions

PulmCrit 

Large volume thora: Can we drain ‘em dry?

PulmCrit - August 12, 2019 - By Josh Farkas

"Summary The Bullet:

• Large pleural effusions can generally be drained entirely (although the procedure should be stopped if the patient develops vague central chest discomfort).
• Pleural manometry has not been shown to reduce discomfort or re-expansion pulmonary edema during large volume thoracentesis.
• The rate of re-expansion pulmonary edema is low, even in large-volume thoracentesis (<1%). When it occurs, this can generally be treated with conservative measures (e.g. supplemental oxygen or noninvasive ventilation).
• Using multiple small-volume thoracenteses to avoid large-volume thoracentesis is probably a misguided strategy. Multiple small-volume thoracenteses may cause an overall increase in the risk of procedural complications (due to increases in the risk of bleeding, infection, or lung laceration with multiple procedures)."