Chest
Volume 107, Issue 6, June 1995, Pages 1610-1614
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Clinical Investigations: The Pleura
Changes in Pulmonary Mechanics and Gas Exchange After Thoracentesis on Patients With Inversion of a Hemidiaphragm Secondary to Large Pleural Effusion

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The present study was designed to test whether there was a significant improvement in pulmonary function and arterial blood oxygenation after therapeutic thoracentesis on patients with inversion of a hemidiaphragm due to pleural effusion. In 21 patients with inversion of a hemidiaphragm because of a pleural effusion, we studied the changes in pulmonary mechanics and gas exchange that occurred in 24 h after removal of 600 to 2,700 mL of fluid by thoracentesis. There was a small but significant increase in the forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC) (p<0.001). The alveolar-arterial oxygen gradient (P[A-a]O2) and partial pressure of arterial oxygen (PaO2) showed a significant increase (p<0.001), but there was no change in partial pressure of arterial carbon dioxide (PaCO2). In the present study, all patients with a large pleural effusion had inversion of a hemidiaphragm documented by chest sonography, and that was an important factor to observe significant improvement in pulmonary mechanics and gas exchange.

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Materials and Methods

From February 1990 to March 1993, patients in the medical ward with dyspnea and large pleural effusion documented by chest radiograph were considered for chest sonography. Pleural effusion was classified as large degree when there was obliteration of more than half of the hemidiaphragm. Only patients who had inversion of a hemidiaphragm proved by chest sonography (Fig 1, top) and could cooperate satisfactorily for pulmonary function test and artery blood gas were included. At the time of

Results

A total of 21 patients (13 men and 8 women; mean age, 53 years; range, 26 to 74 years) completed the pulmonary function test and arterial blood gas procedures before and 24 h after thoracentesis. The underlying diseases were as follows: tuberculous pleurisy (five cases); liver cirrhosis (five); cardiac failure (four); bronchogenic carcinoma (three); bacterial pneumonia (two); metastatic carcinoma (one); and uremia (one). The reasons for stopping the thoracentesis were as follows: no more fluid

Discussion

As in previous studies, we had shown that pleural effusion was associated with restrictive ventilatory impairment and hypoxemia. In our patients, the increase in FVC and in FEV1 averaged 317 and 234 mL, respectively, contrasting with the average of 1,610 mL of fluid aspirated from the pleural space. There was no significant change in FEV1/FVC since pleural effusion was not associated with obstructive ventilatory impairment. Although the increase of PaO2 observed after thoracentesis was

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revision accepted October 5.

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