EVALUATION OF CHANGES IN SPIROMETRY & EXERCISE TOLERANCE

FOLLOWING THERAPEUTIC THORACENTESIS

DR. JINEESH JOSEPH , RESIDENT, DEPARTMENT OF PULMONARY MEDICINE, IPGME&R
PROF.DR. S.KUNDU, IPGME&R
INTRODUCTION OBJECTIVE OF THIS STUDY
•Pleural effusion –excess fluid production and/or decreased absorption. This clinico-physiological study is undertaken to evaluate changes in
 FVC  FEV1
•Always abnormal and indicates the presence of underlying disease.
 6minute walk distance  Pleural pressure
•Thoracentesis result in relief of dyspnoea and improvement of pulmonary  Dyspnoea score after Thoracentesis.
function but studies show dyspnoea or its improvement poorly correlates with To assess any correlation between changes in FEV1, FVC, 6minute walk test,
pulmonary function. pleural pressure, change in severity of Dyspnoea& the amount of fluid
aspirated.

METHODOLOGY The null hypothesis is that

– Design: Prospective hospital based study. 1) There is no change in FEV1, FVC, pleural pressure and 6-minute walk distance following
Thoracentesis.
– Time period: One and half year (Feb 2013- Aug 2014).
2) There is no direct or indirect relation between dyspnoea score, FEV1, FVC, pleural pressure
– Sample size: 48 Cases and 6-minute walk test pre and post Thoracentesis.

•INCLUSION CRITERIA: •EXCLUSION CRITERIA:

– Patients with symptomatic pleural effusion who didn’t have previous aspiration during this – Patients who couldn’t perform a spirometry and/or 6-minute walk test.
episode of illness – Patients with clinical evidence of cardiac, renal or liver failure & patients with loco motor
– Age 18years and above disabilities.
– Patients who are severely dyspnoeic.
– Patients who in whom less than 7ml/kg fluid was aspirated or patients with encysted
effusion.
– Patients in whom pus /blood was aspirated during thoracentesis.
– Lack of informed consent

PROCEDURE
Pleural effusion was confirmed by Chest x-ray PA view.
↓
Patient was then asked to score his Dyspnoea as per modified Borg scale at rest.
↓
Spirometry and Six-minute Walk Test was done as per ATS guidelines. PLEURAL
↓ MANOMETRY
Then aspiration & pleural Manometry was done.
(Maximum of 15ml/kg of pleural fluid was aspirated )
↓
Post aspiration spirometry, dyspnoea scoring and six-minute walk test was done 24 hours after
aspiration.

Patient was kept on follow up till the diagnostic work up was completed.
Doelken P, Huggins JT, Pastis NJ, Sahn SA. Pleural manometry: technique and clincal implications. Chest. 2004; 126(6):1764-1769

RESULTS
PREASPIRATION PLEURAL PRESSURE VS DYSPNOEA AMOUNT OF PLEURAL FLUID ASPIRATED VS CHANGE POST ASPIRATION CHANGE IN PLEURAL PRESSURE VS
SCORE IN FVC IN LITRES CHANGE IN DYSPNOEA SCORE
9 0.7
6

0.6
PREASPIRATION DYSPNOEA SCORE

POST ASPIRATION DYSPNOEA SCORE

8 5
CHANGE IN FVC IN LITRES

0.5
7 4
0.4
6 3
0.3
5 2
0.2
4 1
0.1
3 0
-10 -5 0 5 10 0
0 5 10 15 20
PREASPIRATION PLEURAL PRESSURE 400 450 500 550 600 650 700 750
POST ASPIRATION PLEURAL PRESSURE
AMOUNT OF PLEURAL FLUID ASPIRATED IN mL

CORRELATION COEFFICIENT-0.738 P VALUE-<0.01 CORRELATION COEFFICIENT-0.49 P VALUE-<0.01 CORRELATION COEFFICIENT-0.451 P VALUE-<0.01

PARAMETER P Average SIGNIFIC PARAMETERS CORRELATION P CONCLUSION

VALUE change ANCT OR
NOT
COEFFICIENT VALUE • THERAPEUTIC PLEURAL ASPIRATION IS INDICTED IN PATIENTS WITH LARGE
NOT PLEURAL EFFUSION.
FVC <0.01 0.37 SD±0.112
litres PLEURAL FLUID • STUDY SHOWS SIGNIFICANT IMPROVEMENT IN PULMONARY FUNCTION,
0.18 0.19
FORCED EXPIRATORY <0.01 0.23 ±SD 0.11 ASPIRATED AND CHANGE DYSPNOEA AND TOLERANCE TO EXERCISE FOLLOWING THORACENTESIS.
SIGNIFICANT

VOLUME IN 1 SECOND IN DYSPNOE SCORE

CHANGE IN DYSPNOEA <0.01
SCORE
2.75±SD 1.19 YES • THE STUDY SHOWS SIGNIFICANT CORRELATION BETWEEN PREASPIRATION
PLEURAL FLUID 0.009 0.94 PLEURAL PRESSURE & DYSPNOEA SCORE ,CHANGE IN PLEURAL PRESSURE
CHANGE IN 6MINUTE <0.01 78.02 ±SD 55.20 ASPIRATED AND CHANGE &DYSPNOEA SCORE FOLLOWING THORACENTESIS AND CHANGE IN FVC
WALK DISTANCE meters IN 6MINUTE WALK WITH AMOUNT OF FLUID ASPIRATED.
PLEURAL PRESSURE <0.01 7.60 ±SD 2.66 cm DISTANCE
CHANGE IN FVC AND 0.10 0.498 • THE IMPROVEMENT IN DYSPNOEA MAY BE DUE TO IMPROVED
PRE AND POST 6MINUTE 0.394
WALK TEST SPO2 NO CHANGE IN DYSPNOEA INSPIRATORY MUSCLE FUNCTION DUE TO DECREASED PLEURAL PRESSURE
SCORE RATHER THAN IMPROVEMENT IN PULMONARY FUNCTION.

REFERENCES
• Diaz-Guzman E, Dweik RA. Diagnosis and management of pleural effusions: a practical approach. Compr Ther. Winter 2007;33(4):237-46
• Sahn SA. State of the art-the pleura. Am Rev Respirat Dis 1988;138:184-234.
• M. L. Mayse, “Non-malignant pleural effusions,” in Fishman’s Pulmonary Diseases and Disorders, A. P. Fishman, J. A. Elias, M. A. Grippi, R. M. Senior, and A.I.Pack, Eds., pp.1487–1504, Mcgrow-Hill, New York, NY, USA, 4th edition, 2008
• Froudarakis ME. Diagnostic work-up of pleural effusions. Respiration. 2008;75(1):4-13
• Sahn SA. Pleural effusions of extravascular origin. Clin Chest Med. Jun 2006;27(2):285-308.
• Light RW. The undiagnosed pleural effusion. Clin Chest Med. Jun 2006;27(2):309-19