Pleural effusion is a frequent med...

Pleural effusion is a frequent medical condition that usually proceeds in the performance of thoracentesis to determine its etiology. Complications from thoracentesis may appear and the more common commons include pain, pneumothorax, shortness of breath, vasovagal reaction, and cough More serious complications from thoracentesis can come to one's mind but are less common. In greatest in number cases, thoracentesis is performed based upon the results of physical examination or chest radiography. These, however, can be misleading.

A safer approach to this operation is the use of ultrasound-guided thoracentesis. This technique allows for better identification of the pleural fluid and assists in ruling without other potential causes for the appearance of fluid forward physical examination or radiography. Although the complication rates of bedside thoracentesis are well documented, the incidence of complications in the ultrasound-guided technique is les well documented. Jone and colleagues studied the incidence of complications from ultrasound-guided thoracentesis, evaluated the incidence of vasovagal results without the use of atropine before the act and evaluated the factors that may lead to re-expansion pulmonary edema after the procedure

The prospective, descriptive cogitation involved patients at a tertiary referral hospital who were referr to interventional radiology for diagnostic or therapeutic ultrasound-guided thoracentesis. The decision to commit to radiology for ultrasound-guided thoracentesis was made by dint of each patient's physician. Patient symptoms and complications from the proceeding were recorded. The procedure was performed using ultrasonography to determine the location of the fluid and to guide the physician to where the pleural space should be jot downed There was no limitation in succession the amount of fluid withdrawn, and the manner of proceeding ended when one of the following ends occurred: no more fluid could be withdrawn, pain, excessive cough vasovagal consequences shortness of breath, or excessive bleeding at the ingress site. Patients received pre- and post-procedure chest radiography. If a small pneumothorax was discovered, radiography was repeated each six to eight hours for 24 hours.

During the research period, 941 ultrasound-guided thoracentesis conducts were performed. Complication rates ranged from 02 percent for bleeding at the ingress site to 2.7 percent for pain (see accompanying table). barely eight of the 24 patients with post-procedure pneumothorax received chest tubes to re-expand their lung If more than 1100 mL of fluid was remov the patients were often more likely to develop a pneumothorax that required a chest tube and to complain of pain during the practice The incidence of vasovagal reactions was depressed during the procedure, despite the fact that patients were not premedicated with atropine. In addition, the incidence of re-expansion edema was 02 percent which occurr in patients who had more than 1000 mL of fluid withdrawn.

The authors close that there are fewer complications of thoracentesis when the action is performed using ultrasound-guided technique than when using a non-image-guided technique. Premedication with atropine is not necessary given the depressed incidence of vasovagal reactions. In addition, re-expansion edema is unlikely to meet the eye even when more than 1000 mL of pleural fluid is withdrawn.

Jone PW et al. Ultrasound-guided thoracentesis: is it a safer method? Chest February 2003;123:418-23

COPYRIGHT 2003 American Academy of Family Physicians

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