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Sun L, Lu Y, Zhang Y, Jin C, Yuan Z, Xu R. Risk factors for enhanced recovery after surgery failure in patients undergoing lung cancer resection with concomitant cardiovascular disease: A single-center retrospective study. Asia Pac J Oncol Nurs 2024; 11:100532. [PMID: 39092140 PMCID: PMC11292427 DOI: 10.1016/j.apjon.2024.100532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Accepted: 06/02/2024] [Indexed: 08/04/2024] Open
Abstract
Objective Enhanced recovery after surgery (ERAS) has been widely used in patients with lung cancer, and its effectiveness has been confirmed; however, some lung cancers with poor clinical outcomes lead to ERAS failure after radical resection. This study aimed to analyze risk factors associated with ERAS failure after radical resection in patients with lung cancer and concomitant cardiovascular disease. Methods In total, 198 patients who underwent ERAS following radical lung cancer surgery for concomitant cardiovascular disease between January 2022 and September 2023 were enrolled in this retrospective study. The patients were categorized into two groups based on the definition of ERAS failure: ERAS success group (n = 152) and ERAS failure group (n = 46). Univariate and multivariate analyses were performed to investigate the risk factors of ERAS failure. Results Univariate analysis showed that gender, tumor location, operation time, estimated blood loss (EBL), suction drainage, and total cholesterol were associated with ERAS failure. Multivariate analysis showed that operation time (odds ratio [OR] = 1.015; P = 0.011) and suction drainage (OR = 3.343; P = 0.008) were independent risk factors for ERAS failure. Conclusions Operation time and suction drainage were independent risk factors for ERAS failure after radical resection of combined cardiovascular lung cancer. Therefore, improving surgical efficiency and postoperative chest drain management are important for successful ERAS.
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Affiliation(s)
- Lili Sun
- School of Nursing (School of Gerontology), Binzhou Medical University, Yantai, China
| | - Yutong Lu
- School of Nursing (School of Gerontology), Binzhou Medical University, Yantai, China
| | - Yanfang Zhang
- School of Nursing (School of Gerontology), Binzhou Medical University, Yantai, China
| | - Chan Jin
- School of Nursing (School of Gerontology), Binzhou Medical University, Yantai, China
| | - Zhenwei Yuan
- Library, Binzhou Medical University, Yantai, China
| | - Renhua Xu
- School of Nursing (School of Gerontology), Binzhou Medical University, Yantai, China
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Fjaellegaard K, Koefod Petersen J, Alstrup G, Skaarup S, Frost Clementsen P, Laursen CB, Bhatnagar R, Bodtger U. Ultrasound in predicting improvement in dyspnoea after therapeutic thoracentesis in patients with recurrent unilateral pleural effusion. Eur Clin Respir J 2024; 11:2337446. [PMID: 38711600 PMCID: PMC11073413 DOI: 10.1080/20018525.2024.2337446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 03/22/2024] [Indexed: 05/08/2024] Open
Abstract
Background In patients with recurrent pleural effusion, therapeutic thoracentesis is one way of relief. Correct prediction of which patients will experience relief following drainage may support the management of these patients. This study aimed to assess the association between ultrasound (US) characteristics and a relevant improvement in dyspnoea immediately following drainage. Methods In a prospective, observational study, patients with recurrent unilateral pleural effusion underwent US evaluation of effusion characteristics and diaphragm movement measured by M-mode and the Area method before and right after drainage. The level of dyspnoea was assessed using the modified Borg scale (MBS). A minimal important improvement in dyspnoea was defined as delta MBS ≥ 1. Results In the 104 patients included, 53% had a minimal important improvement in dyspnoea following thoracentesis. We found no association between US-characteristics, including diaphragm shape or movement (M-mode or the Area method), and a decrease in dyspnoea following drainage. Baseline MBS score ≥ 4 and a fully drained effusion were significant correlated with a minimal important improvement in dyspnoea (OR 3.86 (1.42-10.50), p = 0.01 and 2.86 (1.03-7.93), p = 0.04, respectively). Conclusions In our study population, US-characteristics including assessment of diaphragm movement or shape was not associated with a minimal important improvement in dyspnoea immediately following thoracentesis.
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Affiliation(s)
- Katrine Fjaellegaard
- Pulmonary Research Unit Zealand, PLUZ, Department of Respiratory Medicine, Zealand University Hospital, Roskilde and Næstved, Denmark
- Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
- Department of Internal Medicine, Zealand University Hospital, Roskilde, Denmark
| | - Jesper Koefod Petersen
- Pulmonary Research Unit Zealand, PLUZ, Department of Respiratory Medicine, Zealand University Hospital, Roskilde and Næstved, Denmark
- Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
- Department of Internal Medicine, Zealand University Hospital, Roskilde, Denmark
| | - Gitte Alstrup
- Pulmonary Research Unit Zealand, PLUZ, Department of Respiratory Medicine, Zealand University Hospital, Roskilde and Næstved, Denmark
- Department of Internal Medicine, Zealand University Hospital, Roskilde, Denmark
| | - Søren Skaarup
- Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
| | - Paul Frost Clementsen
- Copenhagen Academy for Medical Education and Simulation (CAMES), Rigshospitalet, Denmark
| | - Christian B. Laursen
- Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark
- Odense Respiratory Research Unit (ODIN), Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Rahul Bhatnagar
- Odense Respiratory Research Unit (ODIN), Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Academic Respiratory Unit, University of Bristol, Bristol, UK
- Department of Respiratory Medicine, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Uffe Bodtger
- Pulmonary Research Unit Zealand, PLUZ, Department of Respiratory Medicine, Zealand University Hospital, Roskilde and Næstved, Denmark
- Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
- Department of Internal Medicine, Zealand University Hospital, Roskilde, Denmark
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Skaarup SH, Juhl-Olsen P, Grundahl AS, Løgstrup BB. Replacement of fluoroscopy by ultrasonography in the evaluation of hemidiaphragm function, an exploratory prospective study. Ultrasound J 2024; 16:1. [PMID: 38189895 PMCID: PMC10774234 DOI: 10.1186/s13089-023-00355-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 12/18/2023] [Indexed: 01/09/2024] Open
Abstract
INTRODUCTION Dysfunction of the diaphragm may ultimately lead to respiratory insufficiency and compromise patient outcome. Evaluation of diaphragm function is cumbersome. Fluoroscopy has been the gold standard to measure diaphragmatic excursion. Ultrasonography can visualize diaphragm excursion and holds many advantages such as no radiation exposure, increased portability and accessibility. However, correlation between fluoroscopy and ultrasonography has never been studied. We aimed to compare fluoroscopic and ultrasound measures of diaphragm excursion to determine if ultrasonography can replace fluoroscopy. METHODS We performed ultrasound and fluoroscopy simultaneously during sniff inspiration and at total inspiratory capacity in patients with chronic obstructive pulmonary disease, heart failure and in healthy volunteers. Cranio-caudal excursion was measured by fluoroscopy and compared directly to M-mode excursion, B-mode excursion, area change, resting thickness, thickening fraction and contraction velocity measured by ultrasonography. RESULTS Forty-two participants were included. The Pearson correlation between M-mode and fluoroscopy excursion was 0.61. The slope was 0.9 (90%CI 0.76-1.04) in a regression analysis. Using the Bland-Altman method, the bias was - 0.39 cm (95% CI - 1.04-0.26), p = 0.24. The Pearson correlation between fluoroscopy and B-mode and area change ultrasonography was high; low for thickness and fraction. All correlations were lower during sniff inspiration compared with inspiratory capacity breathing. CONCLUSION Ultrasonography has an acceptable correlation and bias compared to fluoroscopy and can thus be used as the primary tool to evaluate diaphragm excursion.
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Affiliation(s)
- Søren Helbo Skaarup
- Department of Respiratory Medicine and Allergy, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus, Denmark.
| | - Peter Juhl-Olsen
- Department of Cardiothoracic and Vascular Surgery, Anaesthesia Section, Aarhus University Hospital, Aarhus, Denmark
| | - Anne Sofie Grundahl
- Department of Emergency Medicine, Randers Regional Hospital, Randers, Denmark
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Schenesse D, Mouillot P, Rabec C, Barnestein R, Tankere P, Giboulot M, Bonniaud P, Georges M. [Diaphragmatic ultrasonography for the pulmonologist: Technique and clinical use]. Rev Mal Respir 2024; 41:1-17. [PMID: 37980184 DOI: 10.1016/j.rmr.2023.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 09/29/2023] [Indexed: 11/20/2023]
Abstract
INTRODUCTION Ultrasonography is an emerging tool that helps to assess diaphragmatic function. It is now widely used in ICUs to predict weaning from mechanical ventilation. Ultrasonography is readily available, harmless (no radiation), and repeatable with good interoperator reproducibility. Over the past few years, ultrasonography has seen increasing use in patients with chronic pulmonary pathologies. STATE OF THE ART The aim of this review is (1) to describe the ultrasound techniques used to assess diaphragmatic excursion and thickening, (2) to indicate the expected, normal values in healthy patients, and (3) to summarize the main findings and clinical applications in treatment of chronic respiratory disorders. CONCLUSIONS Chronic pulmonary diseases are associated with diaphragmatic dysfunction that can be assessed with ultrasound. Diaphragmatic dysfunction is primary in neuromuscular disorders and secondary to respiratory disease in other chronic pulmonary conditions (COPD, ILD). Ultrasound is correlated with the severity of the underlying disease (functional and clinical parameters). PERSPECTIVES The prognostic interest of diaphragm ultrasonography remains to be established, after which its utilization should become routine.
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Affiliation(s)
- D Schenesse
- Service de pneumologie et soins intensifs respiratoires, centre de référence des maladies pulmonaires rares de l'adulte, CHU Dijon-Bourgogne, 14, rue Paul-Gaffarel, 21000 Dijon, France
| | - P Mouillot
- Service de pneumologie et soins intensifs respiratoires, centre de référence des maladies pulmonaires rares de l'adulte, CHU Dijon-Bourgogne, 14, rue Paul-Gaffarel, 21000 Dijon, France
| | - C Rabec
- Service de pneumologie et soins intensifs respiratoires, centre de référence des maladies pulmonaires rares de l'adulte, CHU Dijon-Bourgogne, 14, rue Paul-Gaffarel, 21000 Dijon, France
| | - R Barnestein
- Service de pneumologie et soins intensifs respiratoires, centre de référence des maladies pulmonaires rares de l'adulte, CHU Dijon-Bourgogne, 14, rue Paul-Gaffarel, 21000 Dijon, France
| | - P Tankere
- Service de pneumologie et soins intensifs respiratoires, centre de référence des maladies pulmonaires rares de l'adulte, CHU Dijon-Bourgogne, 14, rue Paul-Gaffarel, 21000 Dijon, France
| | - M Giboulot
- Service de pneumologie et soins intensifs respiratoires, centre de référence des maladies pulmonaires rares de l'adulte, CHU Dijon-Bourgogne, 14, rue Paul-Gaffarel, 21000 Dijon, France
| | - P Bonniaud
- Service de pneumologie et soins intensifs respiratoires, centre de référence des maladies pulmonaires rares de l'adulte, CHU Dijon-Bourgogne, 14, rue Paul-Gaffarel, 21000 Dijon, France; Inserm, LNC UMR 1231, LipSTIC LabEx Team, Dijon, France
| | - M Georges
- Service de pneumologie et soins intensifs respiratoires, centre de référence des maladies pulmonaires rares de l'adulte, CHU Dijon-Bourgogne, 14, rue Paul-Gaffarel, 21000 Dijon, France; UMR 6265 CNRS 1234 INRA, centre des sciences du goût et de l'alimentation, université Bourgogne-Franche-Comté, Dijon, France.
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Trindade AJ, Lentz RJ, Gannon WD, Rickman OB, Shojaee S, Vandervest K, Schwartz G, Li GW, Kumar A, Garcha PS, Seeley EJ, Gesthalter YB, Mueller S, Egan JP, DeMaio AJ, Yarmus LB, Josan ES, Pannu JK, Wayne MT, DeCardenas JL, Bacchetta MD, Maldonado F. Safety and utility of indwelling pleural catheters in lung transplant recipients. Clin Transplant 2023; 37:e15056. [PMID: 37354125 DOI: 10.1111/ctr.15056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 05/21/2023] [Accepted: 06/12/2023] [Indexed: 06/26/2023]
Abstract
INTRODUCTION The safety and efficacy of indwelling pleural catheters (IPCs) in lung allograft recipients is under-reported. METHODS We performed a multicenter, retrospective analysis between 1/1/2010 and 6/1/2022 of consecutive IPCs placed in lung transplant recipients. Outcomes included incidence of infectious and non-infectious complications and rate of auto-pleurodesis. RESULTS Seventy-one IPCs placed in 61 lung transplant patients at eight centers were included. The most common indication for IPC placement was recurrent post-operative effusion. IPCs were placed at a median of 59 days (IQR 40-203) post-transplant and remained for 43 days (IQR 25-88). There was a total of eight (11%) complications. Infection occurred in five patients (7%); four had empyema and one had a catheter tract infection. IPCs did not cause death or critical illness in our cohort. Auto-pleurodesis leading to the removal of the IPC occurred in 63 (89%) instances. None of the patients in this cohort required subsequent surgical decortication. CONCLUSIONS The use of IPCs in lung transplant patients was associated with an infectious complication rate comparable to other populations previously studied. A high rate of auto-pleurodesis was observed. This work suggests that IPCs may be considered for the management of recurrent pleural effusions in lung allograft recipients.
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Affiliation(s)
- Anil J Trindade
- Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Robert J Lentz
- Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Whitney D Gannon
- Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Otis B Rickman
- Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Samira Shojaee
- Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Katherine Vandervest
- Centers for Advanced Lung Disease and Thoracic Surgery, Baylor University Medical Center, Dallas, Texas, USA
| | - Gary Schwartz
- Centers for Advanced Lung Disease and Thoracic Surgery, Baylor University Medical Center, Dallas, Texas, USA
| | - Gloria W Li
- Pulmonary, Critical Care, and Sleep Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Anupam Kumar
- Pulmonary, Critical Care, and Sleep Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Puneet S Garcha
- Pulmonary, Critical Care, and Sleep Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Eric J Seeley
- Pulmonary and Critical Care Medicine, University California San Francisco, San Francisco, California, USA
| | - Yaron B Gesthalter
- Pulmonary and Critical Care Medicine, University California San Francisco, San Francisco, California, USA
| | - Stephanie Mueller
- Pulmonary and Critical Care, Spectrum Health, Grand Rapids, Michigan, USA
| | - John P Egan
- Pulmonary and Critical Care, Spectrum Health, Grand Rapids, Michigan, USA
| | - Andrew J DeMaio
- Pulmonary and Critical Care Medicine, The Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Lonny B Yarmus
- Pulmonary and Critical Care Medicine, The Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Enambir S Josan
- Pulmonary, Critical Care, and Sleep Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Jasleen K Pannu
- Pulmonary, Critical Care, and Sleep Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Max T Wayne
- Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Jose L DeCardenas
- Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Matthew D Bacchetta
- Department of Cardiac Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Biomedical Engineering, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Fabien Maldonado
- Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Muruganandan S, Mishra E, Singh B. Breathlessness with Pleural Effusion: What Do We Know? Semin Respir Crit Care Med 2023. [PMID: 37308113 DOI: 10.1055/s-0043-1769098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Breathlessness is the most common symptom in individuals with pleural effusion and is often disabling. The pathophysiology of breathlessness associated with pleural effusion is complex. The severity of breathlessness correlates weakly with the size of the effusion. Improvements in ventilatory capacity following pleural drainage are small and correlate poorly with the volume of fluid drained and improvements in breathlessness. Impaired hemidiaphragm function and a compensatory increase in respiratory drive to maintain ventilation appear to be an important mechanism of breathlessness associated with pleural effusion. Thoracocentesis reduces diaphragm distortion and improves its movement; these changes appear to reduce respiratory drive and associated breathlessness by improving the neuromechanical efficiency of the diaphragm.
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Affiliation(s)
- Sanjeevan Muruganandan
- Department of Respiratory Medicine, The Northern Hospital, Melbourne, Australia
- School of Medicine, Health Sciences, Dentistry, University of Melbourne, Melbourne, Australia
| | - Eleanor Mishra
- Norwice Medical School, University of East Anglia, Norwich, Norfolk, United Kingdom
- Norwice Medical School, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, Norfolk, United Kingdom
| | - Bhajan Singh
- Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital, Perth, Australia
- School of Human Sciences, University of Western Australia, Perth, Australia
- West Australian Sleep Disorders Research Institute, Perth, Australia
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7
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Rezk S, Azab N, El-Habashy M, El-Helbawy R, Habib R. Ultrasound assessment of the relation between the quantity of pleural effusion and diaphragmatic functions. EGYPTIAN JOURNAL OF CHEST DISEASES AND TUBERCULOSIS 2023. [DOI: 10.4103/ecdt.ecdt_26_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023] Open
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Fitzgerald DB, Muruganandan S, Peddle-McIntyre CJ, Lee YCG, Singh B. Ipsilateral and contralateral hemidiaphragm dynamics in symptomatic pleural effusion: The 2nd PLeural Effusion And Symptom Evaluation (PLEASE-2) Study. Respirology 2022; 27:882-889. [PMID: 35672271 DOI: 10.1111/resp.14307] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 05/05/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND AND OBJECTIVE The pathophysiology of breathlessness in pleural effusion is unclear. In the PLEASE-1 study, abnormal ipsilateral hemidiaphragm shape and movement, assessed qualitatively, were independently associated with breathlessness relief after pleural drainage. Effects of pleural effusion on contralateral hemidiaphragm function are unknown. PLEASE-2, a prospective exploratory pilot study, assessed the effects of unilateral effusion and drainage on both hemidiaphragms using advanced quantitative bedside ultrasonography. METHODS Individuals with symptomatic unilateral pleural effusion undergoing therapeutic drainage were included. Measurements pre- and post-drainage included severity of breathlessness (visual analogue scale) and ultrasound measurements of diaphragm excursion and thickness, in addition to shape and movement. Diaphragm measurements were compared to published reference values. RESULTS Twenty participants were recruited (mean age 68.9 [SD 12.8] years, 12 females). During tidal breathing, contralateral hemidiaphragm excursion exceeded ipsilateral excursion and reference values (all p ≤ 0.001). Contralateral excursion was greatest in participants with abnormal ipsilateral hemidiaphragm movement and was inversely correlated with ipsilateral tidal excursion (r = -0.676, p = 0.001). Following drainage (mean volume 2121 [SD = 1206] ml), abnormal shape (n = 12) and paradoxical movement (n = 9) of the ipsilateral hemidiaphragm resolved in all participants, and tidal excursion of the contralateral hemidiaphragm normalized. Relief of breathlessness post-drainage correlated with improvement in ipsilateral hemidiaphragm excursion (r = 0.556, p = 0.031). CONCLUSION This pilot study suggests, for the first time, that unilateral pleural effusion not only impairs ipsilateral hemidiaphragm function but also causes compensatory hyperactivity of the contralateral hemidiaphragm, which resolves post-drainage. These findings provide a basis for detailed studies of diaphragmatic function and ventilatory drive in patients with symptomatic pleural effusion.
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Affiliation(s)
- Deirdre B Fitzgerald
- Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.,Pleural Medicine Unit, Institute for Respiratory Health, Perth, Western Australia, Australia.,Medical School, University of Western Australia, Perth, Western Australia, Australia
| | | | - Carolyn J Peddle-McIntyre
- Pleural Medicine Unit, Institute for Respiratory Health, Perth, Western Australia, Australia.,Exercise Medicine Research Institute, Edith Cowan University, Perth, Western Australia, Australia.,School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Y C Gary Lee
- Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.,Pleural Medicine Unit, Institute for Respiratory Health, Perth, Western Australia, Australia.,Medical School, University of Western Australia, Perth, Western Australia, Australia
| | - Bhajan Singh
- Department of Pulmonary Physiology & Sleep Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.,School of Human Sciences, University of Western Australia, Perth, Western Australia, Australia.,West Australian Sleep Disorders Research Institute, Perth, Western Australia, Australia
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DeBiasi EM, Feller-Kopman D. Anatomy and Applied Physiology of the Pleural Space. Clin Chest Med 2021; 42:567-576. [PMID: 34774165 DOI: 10.1016/j.ccm.2021.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The unique anatomy and physiology of the pleural space provides tight regulation of liquid within the space under normal physiologic conditions. When this balance is disrupted and pleural effusions develop, there can be significant impacts on the respiratory system. Drainage of effusions can lead to meaningful improvement in symptoms, primarily owing to improvement in the length-tension relationship of the respiratory muscles. Ultrasound examination to evaluate the movement and function of the diaphragm, as well as pleural manometry, have provided a greater understanding of the impact of pleural effusion and thoracentesis.
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Affiliation(s)
- Erin M DeBiasi
- Division of Pulmonary, Critical Care and Sleep Medicine, Yale University School of Medicine, New Haven, CT 06510, USA.
| | - David Feller-Kopman
- Division of Pulmonary and Critical Care Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
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10
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Porcel JM. PLEASE, take a deep breath. Eur Respir J 2020; 55:55/5/2000501. [PMID: 32409425 DOI: 10.1183/13993003.00501-2020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Accepted: 02/29/2020] [Indexed: 11/05/2022]
Affiliation(s)
- José M Porcel
- Pleural Medicine Unit, Dept of Internal Medicine, Arnau de Vilanova University Hospital, IRBLleida, University of Lleida, Lleida, Spain
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