CHEST Guidelines-Considering-the-Duration-of-Lung-Collapse-When-Com (1)

Considering-the-Duration-of-Lung-Collapse-When-Com (1)

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A recent issue of CHEST featured the GRAVITAS multicenter randomized controlled trial conducted by Lentz et al., which compared two techniques for therapeutic thoracentesis: active aspiration and gravity drainage. The study found both methods to be comparable in safety and chest discomfort, with active aspiration being faster. However, concerns are raised regarding the consideration of lung collapse duration, a potential risk factor for reexpansion pulmonary edema as noted by a literature review by Sohara. Reexpansion pulmonary edema, although rare, carries a significant mortality risk. The authors of the correspondence suggest that more information is needed on whether active aspiration maintains safety with long-term collapsed lungs.<br /><br />Another correspondence highlights the non-blinding of operators in the trial, suggesting they may have aspirated fluid at slower rates due to anticipated pressure-related complications. This poses questions about the relative safety of gravity-assisted aspiration if a faster rate of active aspiration was employed. The correspondence also notes an imbalance in the trial's baseline characteristics, with more cases of pleural malignancy and exudative effusions in the active aspiration group, potentially influencing discomfort levels.<br /><br />Both pieces of correspondence commend the authors for their contribution but underscore areas needing further exploration, such as potential biases due to non-blinding, the rate of fluid aspiration in active aspiration, and comprehensive safety data for collapsed lungs. These factors could impact the interpretation of the findings and the generalizability of the study's conclusions regarding thoracentesis techniques.

Keywords

GRAVITAS trial

therapeutic thoracentesis

active aspiration

gravity drainage

reexpansion pulmonary edema

lung collapse duration

non-blinding

pleural malignancy

exudative effusions

safety data