CRIT CLOUD

  • Summaries & Reviews
    • Airway
    • Cardiovascular
    • Controversies
    • Endocrinology
    • Fluids
    • Guidelines
    • Infections
    • Neurology
    • Nutrition
    • Pharmacology
    • Procedures
    • Radiology
    • Renal
    • Resuscitiation
    • Respiratory
    • Sedation
    • Sepsis
    • Transfusion
  • World of Foam
  • FOAM.education
  • Education
    • ACLS Training ICU Lindenhofspital
    • Download Presentations
    • Download CME Galway Clinic 🔒
    • Download CME Lindenhof Hospital 🔒
    • Echo 🔒
    • Presentations🔒
    • Multimedia
  • About Us
    • Contact
  • Summaries & Reviews
    • Airway
    • Cardiovascular
    • Controversies
    • Endocrinology
    • Fluids
    • Guidelines
    • Infections
    • Neurology
    • Nutrition
    • Pharmacology
    • Procedures
    • Radiology
    • Renal
    • Resuscitiation
    • Respiratory
    • Sedation
    • Sepsis
    • Transfusion
  • World of Foam
  • FOAM.education
  • Education
    • ACLS Training ICU Lindenhofspital
    • Download Presentations
    • Download CME Galway Clinic 🔒
    • Download CME Lindenhof Hospital 🔒
    • Echo 🔒
    • Presentations🔒
    • Multimedia
  • About Us
    • Contact

FOAM Bits

Yes, it is Safe to Drain More than 1500ml of Pleural Effusion!

14/8/2019

0 Comments

 
Picture

​Most Swiss Guidelines recommend never to drain more than 1500ml of pleural fluid when performing a thoracocentesis. The reason is that excessive drainage might cause re-expansion pleural effusion (e.g. www.medstandards.ch). There is not much literature on the safe amount of fluid one can drain, but a clinical practice article on pleural effusions in the New England Journal of Medicine also states that "...in which case therapeutic thoracentesis to remove up to 1500 ml of fluid is indicated." (N Engl J Med 2002; 346:1971-1977).
​
Interestingly there is no evidence supporting this recommendation. Some data suggests that the risk of re-expansion pulmonary oedema might correlate with the baseline size of the effusion, rather than the volume of fluid removed.​

However, the first results from research start giving us some answers and indicate that removing more than 1500ml of fluids is safe and feasible.


Ault M et al. (Thorax. 2015;70(2):127-132.) looked at 9320 patients during 11 years who underwent thoracocentesis and recorded the incidence of adverse events. They were able to show that:

  • The occurrence of re-expansion pulmonary oedema is rare, also when large amounts of fluids are drained
 
  • No patient died due to this intervention


Lentz RJ et al. (Lancet Respir Med. 2019;7(5):447-455.) showed that

  • The use of manometry during thoracocentesis does not influence patient outcome.


All the details and lots of background information are very nicely summarized in this fabulous post on emcrit.org:

PulmCrit - Large volume thora: Can we drain 'em dry?

0 Comments



Leave a Reply.

    Search

    Translate

    Select your language above. Beware: Google Translate is often imprecise and might result in incorrect phrases!


    ​Categories

    All
    Airway
    Antibiotics
    Cardiology
    Education
    Evidence Based Medicine
    Procedures
    Q And A
    Sonography

    Archives

    January 2021
    March 2020
    August 2019
    January 2019
    June 2018
    February 2017
    October 2016
    February 2016
    August 2015
    May 2015
    March 2015

    Author

    Collecting FOAM pearls and sharing them in the World of FOAM.

    Welcome to the site where posts on the net are the author themselves!

    RSS Feed

ABOUT US

The Crit ☁​ supports free access medical education. The content of this website can be used and reproduced by stating a reference to our site.
Read our statements here

SEARCH US

CONTACT US

If you have any interesting article or news to be posted on this website, please contact us here
​

FOLLOW US

TRUST US

TWEET US

This website is certified by Health On the Net Foundation. Click to verify. This site complies with the HONcode standard for trustworthy health information:
verify here.

Picture
Follow @BIJCorg

DISCOVER THE WORLD OF #FOAMed HERE
Picture