CHEST
Volume 146, Issue 4, October 2014, Pages 1007-1012
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Original Research: Disorders of the Pleura
Comparison of Pleural Pressure Measuring Instruments

https://doi.org/10.1378/chest.13-3004Get rights and content

OBJECTIVE

The objective of this study was to compare the accuracy of a handheld digital manometer (DM) and U-tube (UT) manometer with an electronic transducer (ET) manometer during thoracentesis.

METHODS

Thirty-three consecutive patients undergoing thoracentesis were enrolled in the study. Pleural pressure (Ppl) measurements were made using a handheld DM (Compass; Mirador Biomedical), a UT water manometer, and an ET (reference instrument). End-expiratory Ppl was recorded after catheter insertion, after each aspiration of 240 mL, and prior to catheter removal. Volume of fluid removed, symptoms during thoracentesis, pleural elastance, and pleural fluid chemistry were also evaluated.

RESULTS

A total of 594 Ppl measurements were made in 30 patients during their thoracenteses. There was a strong linear correlation coefficient between elastance for the DM and ET (r = 0.9582, P < .001). Correlation was poor between the UT and ET (r = 0.0448, P = .84). Among the 15 patients who developed cough, recorded ET pressures ranged from −9 to +9 cm H2O at the time of symptom development, with a mean (SD) of −2.93 (4.89) cm H2O. ET and DM measurements among those patients with cough had a low correlation between these measurements (R2 = 0.104, P = .24). Nine patients developed chest discomfort and had ET pressures that ranged from −26 to +6 cm H2O, with a mean (SD) of −7.89 (9.97) cm H2O.

CONCLUSIONS

The handheld DM provided a valid and easy-to-use method to measure Ppl during thoracentesis. Future studies are needed to investigate its usefulness in predicting clinically meaningful outcomes.

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

References (15)

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Drs Lee and Yarmus are primary coauthors.

FUNDING/SUPPORT: The authors have reported to CHEST that no funding was received for this study.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.

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