CHEST Guidelines-Pleural-Manometry

Pleural-Manometry_chest

Pdf Summary

The discussion in the CHEST journal primarily revolves around the role of pleural manometry during thoracentesis. Drs. Khosla and Kistler engage in a debate with Drs. Maldonado and Mullon over whether pleural manometry should be routinely used. The former expresses curiosity about how the latter decides the necessity of pleural manometry and agrees with their notion that thoracentesis often stops prematurely due to symptoms like chest discomfort, which may indicate a significant drop in pleural pressure. However, Khosla and Kistler report that their data from 140 patients do not support this correlation. They advocate for pleural manometry's application but underscore the importance of paying attention to both symptoms and pleural pressures. They argue that establishing proven competency in diagnostic procedures, though important, shouldn't necessarily delay the adoption of pleural manometry given its potential benefits in patient management.<br /><br />In their response, Maldonado and Mullon appreciate the points raised by Khosla and Kistler, but disagree with the idea that changes in patient management should be the sole endpoint for using pleural manometry. They insist that while pleural manometry provides valuable insights, its routine use in all thoracenteses lacks sufficient evidence of meaningful outcomes, such as reducing pneumothorax rates. They suggest that without robust evidence, manometry should not be made a mandatory part of thoracentesis practice.<br /><br />Both parties discuss the need for more definitive studies on the topic, with Maldonado and Mullon emphasizing the potential relevance of alternatives such as ultrasonography. They highlight the importance of proper training to reduce procedure-associated risks, like iatrogenic pneumothorax, and propose closing pressure as a potentially more significant predictor compared to elastance, referencing limitations in existing studies. The dialogue illustrates the ongoing exploration of standards and best practices in pleural effusion management.

Keywords

pleural manometry

thoracentesis

pleural pressure

patient management

diagnostic procedures

pneumothorax

ultrasonography

pleural effusion

iatrogenic risks

closing pressure