TY - JOUR
T1 - Gravity- vs Wall Suction-Driven Large-Volume Thoracentesis
T2 - A Randomized Controlled Study
AU - Shojaee, Samira
AU - Pannu, Jasleen
AU - Yarmus, Lonny
AU - Fantin, Alberto
AU - MacRosty, Christina
AU - Bassett, Roland
AU - Debiane, Labib
AU - DePew, Zachary S.
AU - Faiz, Saadia A.
AU - Jimenez, Carlos A.
AU - Avasarala, Sameer K.
AU - Vakil, Erik
AU - DeMaio, Andrew
AU - Bashoura, Lara
AU - Keshava, Keerthana
AU - Ferguson, Travis
AU - Adachi, Roberto
AU - Eapen, George A.
AU - Ost, David E.
AU - Bashour, Sami
AU - Khan, Asad
AU - Shannon, Vickie
AU - Sheshadri, Ajay
AU - Casal, Roberto F.
AU - Evans, Scott E.
AU - Pew, Krystle
AU - Castaldo, Nadia
AU - Balachandran, Diwakar D.
AU - Patruno, Vincenzo
AU - Lentz, Robert
AU - Pai, Cheryl
AU - Maldonado, Fabien
AU - Roller, Lance
AU - Ma, Junsheng
AU - Zaveri, Jhankruti
AU - Los, Jenna
AU - Vaquero, Luis
AU - Ordonez, Eva
AU - Yermakhanova, Gulmira
AU - Akulian, Jason
AU - Burks, Cole
AU - Almario, Roel Rolando
AU - Sauve, Marie
AU - Pettee, Jackson
AU - Noor, Laila Z.
AU - Arain, Muhammad H.
AU - Grosu, Horiana B.
N1 - Publisher Copyright:
© 2024 American College of Chest Physicians
PY - 2024/12
Y1 - 2024/12
N2 - Background: Prior studies have found no differences in procedural chest discomfort for patients undergoing manual syringe aspiration or drainage with gravity after thoracentesis. However, whether gravity drainage could protect against chest pain due to the larger negative-pressure gradient generated by wall suction has not been investigated. Research Question: Does wall suction drainage result in more chest discomfort compared with gravity drainage in patients undergoing large-volume thoracentesis? Study Design and Methods: In this multicenter, single-blinded, randomized controlled trial, patients with large free-flowing effusions of ≥ 500 mL were assigned at a 1:1 ratio to wall suction or gravity drainage. Wall suction was performed with a suction system attached to the suction tubing and with vacuum pressure adjusted to full vacuum. Gravity drainage was performed with a drainage bag placed 100 cm below the catheter insertion site and connected via straight tubing. Patients rated chest discomfort on a 100-mm visual analog scale before, during, and after drainage. The primary outcome was postprocedural chest discomfort at 5 minutes. Secondary outcomes included measures of postprocedure chest discomfort, breathlessness, procedure time, volume of fluid drained, and complication rates. Results: Of the 228 patients initially randomized, 221 were included in the final analysis. The primary outcome of procedural chest discomfort did not differ significantly between the groups (P = .08), nor did the secondary outcomes of postprocedural discomfort and dyspnea. Similar volumes were drained in both groups, but the procedure duration was longer in the gravity arm by approximately 3 minutes. No differences in rate of pneumothorax or reexpansion pulmonary edema were noted between the two groups. Interpretation: Thoracentesis via wall suction and gravity drainage results in similar levels of procedural discomfort and dyspnea improvement. Clinical Trial Registry: ClinicalTrials.gov; No.: NCT05131945; URL: www.clinicaltrials.gov
AB - Background: Prior studies have found no differences in procedural chest discomfort for patients undergoing manual syringe aspiration or drainage with gravity after thoracentesis. However, whether gravity drainage could protect against chest pain due to the larger negative-pressure gradient generated by wall suction has not been investigated. Research Question: Does wall suction drainage result in more chest discomfort compared with gravity drainage in patients undergoing large-volume thoracentesis? Study Design and Methods: In this multicenter, single-blinded, randomized controlled trial, patients with large free-flowing effusions of ≥ 500 mL were assigned at a 1:1 ratio to wall suction or gravity drainage. Wall suction was performed with a suction system attached to the suction tubing and with vacuum pressure adjusted to full vacuum. Gravity drainage was performed with a drainage bag placed 100 cm below the catheter insertion site and connected via straight tubing. Patients rated chest discomfort on a 100-mm visual analog scale before, during, and after drainage. The primary outcome was postprocedural chest discomfort at 5 minutes. Secondary outcomes included measures of postprocedure chest discomfort, breathlessness, procedure time, volume of fluid drained, and complication rates. Results: Of the 228 patients initially randomized, 221 were included in the final analysis. The primary outcome of procedural chest discomfort did not differ significantly between the groups (P = .08), nor did the secondary outcomes of postprocedural discomfort and dyspnea. Similar volumes were drained in both groups, but the procedure duration was longer in the gravity arm by approximately 3 minutes. No differences in rate of pneumothorax or reexpansion pulmonary edema were noted between the two groups. Interpretation: Thoracentesis via wall suction and gravity drainage results in similar levels of procedural discomfort and dyspnea improvement. Clinical Trial Registry: ClinicalTrials.gov; No.: NCT05131945; URL: www.clinicaltrials.gov
KW - complications
KW - pleural effusion
KW - suction
KW - thoracentesis
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U2 - 10.1016/j.chest.2024.05.046
DO - 10.1016/j.chest.2024.05.046
M3 - Article
C2 - 39029784
AN - SCOPUS:85206642368
SN - 0012-3692
VL - 166
SP - 1573
EP - 1582
JO - Chest
JF - Chest
IS - 6
ER -