CHEST Guidelines-Gravity-vs Active-Aspiration-for-Thoracentesi

Gravity-vs Active-Aspiration-for-Thoracentesi

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The correspondence section of the journal CHEST features letters regarding a recent study by Lentz et al., which compared thoracentesis techniques—active aspiration and gravity drainage—for treating pleural effusions. The study concluded that both techniques were safe and comparable regarding patient comfort, although active aspiration was faster. However, this summary sparked concerns from several medical professionals.<br /><br />Dr. Hiroshi Sugimoto and colleagues from Japan highlighted the study's omission of data on the duration of lung collapse, a notable variable since prolonged lung collapse (>3 days) can contribute significantly to reexpansion pulmonary edema—a potentially fatal complication. Concerns were raised regarding whether the quicker active aspiration method remains comparably safe for patients with extended lung collapse durations.<br /><br />Additionally, Dr. Manu Madan and colleagues from India noted that the study’s operators were not blinded, potentially affecting the fluid aspiration speed in the active aspiration group due to fear of pressure-related complications. The greater number of subjects with pleural malignancy in the active aspiration group could have skewed pain evaluations, as these patients started with higher baseline discomfort levels. Suggestions included employing a stratified randomization sequence in future studies to alleviate baseline discrepancies.<br /><br />In response to these critiques, the study’s authors acknowledged the absence of data on the symptom duration before the procedure, asserting that most participants likely experienced symptoms for over three days. They speculated that the effusion volume drained rather than symptom duration could be more critical to the development of reexpansion pulmonary edema. The authors agreed that while their study demonstrated the feasibility of safe active aspiration, variability in real-world settings might result in different patient experiences, depending on the operator's skill and attentiveness. This underscores the necessity for caution and specialized technique assessments in performing thoracentesis.

Keywords

thoracentesis

pleural effusions

active aspiration

gravity drainage

reexpansion pulmonary edema

lung collapse

pleural malignancy

stratified randomization

patient safety

operator skill