CHEST Guidelines-Gravity-vs Active-Aspiration-for-Thoracentesi (1)

Gravity-vs Active-Aspiration-for-Thoracentesi (1)

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The document consists of multiple correspondences regarding a study published in the journal CHEST that compares two techniques for performing thoracentesis: active aspiration and gravity drainage. The study, referred to as the GRAVITAS multicenter randomized controlled trial, concluded that both methods were comparable in terms of safety and discomfort, but active aspiration was faster. <br /><br />Dr. Hiroshi Sugimoto and colleagues from the Kobe Red Cross Hospital express concern over the lack of consideration of lung collapse duration in the study. They point out that reexpansion pulmonary edema (REPE), a rare but serious complication, is more likely if a lung has been collapsed for a longer duration, especially more than three days. As Lentz et al. did not address lung collapse duration, Sugimoto et al. suggest this should have been disclosed to ensure safety comparisons between the two methods are valid. <br /><br />Another correspondence from Dr. Manu Madan and colleagues from AIIMS, New Delhi, raises points about potential biases in the study. They note that the rate of fluid aspiration wasn't clearly defined, which could have affected the results if proceduralists were cautious of complications, thus using slower aspiration rates. They also discuss potential confounding factors like pleural malignancy rates that could affect the primary outcome of chest discomfort, suggesting a need for stratiﬁed randomization in future studies. Additionally, they question whether different equipment might affect the study's findings and note potential risks of developing hydropneumothorax if air enters the pleural cavity.<br /><br />In response, researchers from the original study acknowledge these points. They clarify that data on symptom duration weren't collected but believe most patients were symptomatic for over three days, making the results applicable. They recognize the potential variability in aspiration techniques between proceduralists and real-world conditions. Nonetheless, they argue their findings on safety remain valid given the design of the trial.

Keywords

thoracentesis

active aspiration

gravity drainage

GRAVITAS trial

reexpansion pulmonary edema

lung collapse duration

biases

fluid aspiration rate

pleural malignancy

hydropneumothorax