Unexpected Review Finding: Ultrasound Guided Thoracocentesis Does Not Reduce the Incidence of Pneumothoraces
Thoracocentesis is a procedure often used to further determine pleural effusions. This commonly performed procedure may lead to complications including the development of a pneumothorax. Wilcox et al. performed a systematic review in JAMA of current literature to answer following two questions: 1. What are the most accurate diagnostic indicators to diagnose an exsudate? and 2. What are the most common adverse side effects and factors affecting them?
48 studies were included to answer the first question, while 37 studies were used to approach question number 2.
- Light's criteria, pleural fluid cholesterol (<55 mg/dl) and pleural fluid LDH (>200 U/L) levels, and the pleural fluid cholesterol to serum cholesterol ratio (> 0.3) are the best diagnostic indicators for pleural exsudates
- Pneumothorax was the most common complication of thoracocetesis (incidence 6%). Chest tube placement was needed in 2% of all procedures. And most impressive: Ultrasound skin marking by a radiologist or ultrasound-guided thoracocentesis were not associated with a decrease in pneumothorax events.
... would you abandon the ultrasound?
Wilcox et al. JAMA, June 18, 2014, Vol 311, No. 23