الفهرس 
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Abstract
Summary
Large volume therapeutic thoracentesis may be
associated with Re-expansion pulmonary edema (REP).
Without the use of pleural manometry, this limits the amount of
fluid drained. We investigated whether monitoring pleural
pressure with manometry during thoracentesis would avoid
REP or allow larger volume drainage. We wanted to see if
using manometry to measure pleural pressure during
thoracentesis may help minimize REP or allow for more
volume drainage.
Patients and Methods
We did a randomized controlled trial involving 110
patients with large malignant pleural effusions. Patients were
randomly allocated to obtain thoracentesis with or without
pleural manometry. The primary objective was to measure
the incidence of REP symptoms. The secondary objectives
were to measure the total fluid aspirated and pleural
pressures during thoracocentesis. This trial is listed on
ClinicalTrials.gov as NCT04420663
Results
The mean amount of total thoracocentesis fluid
withdrawn from the control group was 945.4±78.9(ml) and
1690.9±681.0(ml) from the Intervention group (p<0.001).
clinical signs of REP appeared in (n=20) (36.3%) of patients Summary
86
in the Intervention group while no signs of REP appeared in
controls (p-value<0.001). opening pleural pressure was
13.4±12.7 cm H2O in the non-REP cluster vs 23.5±5.7 cm
H2O in the REP cluster (p-value=0.002). The difference
between opening and closing pressures between the non-REP
and REP cluster was (32.8±15.6 vs 42.2±13) respectively. (pvalue=0.02). Total fluid withdrawn from non-REP was
1828.5±505ml in comparison to 1450±875ml in the REP
cluster (p-value=0.04).
Conclusion:
Pleural manometry can be used to increase the volume of
fluid removed on each occasion in patients with malignant
pleural effusion. In our study, pleural manometry was
associated with a larger number of REP but the association
doesn’t -always- imply causation. We believe that manometry
may be a useful tool to not exceed a 17 cm H2O gradient in
pleural pressure which should be avoided to prevent REP. Our
conclusion does support the adoption of pleural manometry
whenever larg