Large volume thoracentesis
- John T Huggins, MD
John T Huggins, MD
- Associate Professor of Medicine
- Medical University of South Carolina
- Amit Chopra, MD
Amit Chopra, MD
- Assistant Professor of Medicine
- Division of Pulmonary and Critical Care, Albany Medical Center
Large volume thoracentesis refers to the removal of more than one liter of pleural fluid during a therapeutic thoracentesis. Large volume thoracentesis is performed to relieve dyspnea associated with a pleural effusion. Assessment of the initial pleural fluid pressure and the changes in pressure as fluid is removed (known as the pleural space elastance) can be used to guide fluid removal.
The technique for large volume thoracentesis will be reviewed here. The diagnostic evaluation of pleural fluid and the techniques for pleural manometry and diagnostic thoracentesis are discussed separately. (See "Measurement of pleural pressure" and "Diagnostic thoracentesis" and "Diagnostic evaluation of a pleural effusion in adults: Initial testing" and "Diagnostic evaluation of pleural effusion in adults: Additional tests for undetermined etiology".)
DEFINITIONS AND NORMAL VALUES
●Large volume thoracentesis refers to removal of more than 1 L of pleural fluid during a therapeutic thoracentesis.
●Pleural elastance is the change in pleural pressure with removal of a given volume of pleural fluid. It is calculated by dividing the change in pleural pressure by the volume removed. A normal pleural elastance is estimated to be <14.5 cm H2O/L . (See "Measurement of pleural pressure", section on 'Pleural elastance'.)
●The initial pleural pressure of a free-flowing pleural effusion with an expandable lung is typically slightly positive (pleural pressure in the absence of fluid is slightly negative) and changes minimally as fluid is withdrawn. (See "Measurement of pleural pressure", section on 'Interpretation of pleural pressures'.)
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- DEFINITIONS AND NORMAL VALUES
- INDICATIONS AND CONTRAINDICATIONS
- DETERMINING THE VOLUME OF FLUID TO BE REMOVED
- ASSESSMENT AFTER FLUID REMOVAL
- EFFECT ON PULMONARY FUNCTION
- Re-expansion pulmonary edema
- Post-procedure pneumothorax
- Pneumothorax ex vacuo
- SUMMARY AND RECOMMENDATIONS