CHEST
Original Research: Disorders of the PleuraComparison of Pleural Pressure Measuring Instruments
Section snippets
Materials and Methods
The study was approved by the Johns Hopkins University institutional review board (NA0006941). All thoracentesis procedures were conducted in an endoscopy suite at the Johns Hopkins Hospital. All patients presenting for thoracentesis (inpatient and outpatient) were included in the study. Data were collected prospectively, and informed consent was obtained from all patients prior to inclusion into the study.
Thoracic ultrasonography was performed to identify a safe site for pleural entry.11, 12
Results
There were a total of 594 Ppl measurements performed in 30 patients using the three different manometers. Thirty of 33 patients had a sufficient amount of effusion and underwent a successful thoracentesis with adequate pleural fluid removal to measure Ppl at two volumes, allowing for measurement of pleural elastance. The mean age was 65.7 years, and the most common cause was malignant effusions (Table 1).
There was a strong correlation between Ppl random effects for slope for DM and ET (R2 =
Discussion
Despite the arguable benefits of pleural manometry, its widespread adoption has not occurred.8 A potential reason is the perceived additional time requirement and difficulty in setup of an ET manometer and no studies demonstrating a direct correlation for the benefits of pleural manometry to predict reexpansion pulmonary edema. Using an undamped UT is easily accessible since the tubing required is a part of most standard thoracentesis kits, but because of various techniques it has not been well
Conclusions
The DM provided a valid method to measure Ppl during thoracentesis. Future studies are needed to assess the usefulness of this device in selecting appropriate patients for pleurodesis and in preventing complications of thoracentesis, such as reexpansion pulmonary edema.
Acknowledgments
Author contributions: H. J. L. is the guarantor of the entire manuscript. H. J. L., D. K., J. A., C. G., and D. F.-K. contributed to the planning, data collection/analysis, and manuscript preparation; L. Y. contributed to the planning, data analysis, and manuscript preparation; R. E. T. contributed to the data analysis and manuscript preparation; R. O. A. and S. A. contributed to data collection and manuscript preparation; and A. H. contributed to planning, data collection, and manuscript
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The Feasibility of Gastroesophageal Manometry for Continuously Evaluating the Degree of Expiratory Effort During Successful Crescendo Phonation
2023, Journal of VoiceCitation Excerpt :First, we did not compare the measurements of the intra-thoracic-esophageal and intra-gastric pressures between GEM and other instruments, which can measure the actual intra-thoracic and intra-abdominal pressures, in the present study. Generally, the most accurate method for estimating the intra-thoracic pressure is direct measurement on thoracentesis.62 In addition, the intra-bladder pressure measurement has been used as an alternative to be indirect method of predicting the intra-abdominal pressure, principally in intensive and critical care settings.63
Malignant Pleural Effusions
2021, Clinics in Chest MedicineAnatomy and Applied Physiology of the Pleural Space
2021, Clinics in Chest MedicineCitation Excerpt :Owing to the hydrostatic pressure of the fluid column, this pressure is not equally distributed within the pleural space; rather, there is a vertical gradient of 1 cm H2O/cm height, with more basilar areas having a higher pleural pressure than more apical regions.15,49 Various methods can be used to measure pleural pressure and have led to a greater understanding of pleural elastance, or the change in pleural pressure at a given change in pleural volume.50–56 Using a simple U-tube manometer, Light and coworkers54 were the first to describe 3 characteristic pleural elastance curves: normal, trapped, and entrapped (Fig. 4).
Pleural Interventions: Manometry
2021, Encyclopedia of Respiratory Medicine, Second EditionPleural manometry and thoracentesis—is the issue resolved?
2019, The Lancet Respiratory MedicineRoutine monitoring with pleural manometry during therapeutic large-volume thoracentesis to prevent pleural-pressure-related complications: a multicentre, single-blind randomised controlled trial
2019, The Lancet Respiratory MedicineCitation Excerpt :This threshold was based on early animal models in which the lowest risk of complications was seen at pressures greater than −20 mm Hg (−27 cm H2O).8,9 Pleural manometry monitoring to mitigate these pressure-related procedural risks during thoracentesis has become widely used.1,3,5–7,10,12–17 Evidence before this study
Drs Lee and Yarmus are primary coauthors.
FUNDING/SUPPORT: The authors have reported to CHEST that no funding was received for this study.
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