Suction pressures generated during thoracentesis using wall suction-based automated drainage: an in vitro and in vivo analysis
Equipoise exists regarding the optimal method to drain pleural fluid during thoracentesis. While several institutions use wall-based automated suction, others point to the risk of excessively high suction pressures and therefore elevated barotrauma risk as a reason to avoid it. We first performed i...
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PAGEPress Publications
2025-07-01
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| Series: | Monaldi Archives for Chest Disease |
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| Online Access: | https://www.monaldi-archives.org/macd/article/view/3484 |
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| author | Abdias Rodriguez Anuradha Ramaswamy Aravind A. Menon Noah Belkhayat Victoria E. Forth Scott L. Schissel Majid Shafiq |
| author_facet | Abdias Rodriguez Anuradha Ramaswamy Aravind A. Menon Noah Belkhayat Victoria E. Forth Scott L. Schissel Majid Shafiq |
| author_sort | Abdias Rodriguez |
| collection | DOAJ |
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Equipoise exists regarding the optimal method to drain pleural fluid during thoracentesis. While several institutions use wall-based automated suction, others point to the risk of excessively high suction pressures and therefore elevated barotrauma risk as a reason to avoid it. We first performed in vitro experiments involving drainage of a 1-liter saline bag using standard thoracentesis apparatus, a digital manometer, and either manual drainage (using a 60 mL syringe) or automated drainage (using wall suction at the maximum setting). The proceduralist was blinded to measurements during manual aspiration. Separately, in a clinical setting involving consecutive hospitalized adults undergoing thoracentesis, dynamic suction pressures were similarly measured during automated drainage. Total aspirated volume, time-to-evacuation, patient discomfort, and complications were also recorded. In vitro experiments showed that compared to manual aspiration, automated drainage using wall suction resulted in shorter average time-to-evacuation (230 sec vs. 365 sec), lower suction pressures (average maximum: -361±4.5 cmH2O vs. -496±5.1 cmH2O, p<0.0001), and less pressure variation (95% of values within a 20 cmH2O range vs. swings between 0 and -500 cmH2O). Twenty hospitalized adults undergoing thoracentesis via automated drainage (mean aspirated volume: 1649.5±685.5 mL) experienced similar suction pressures to those measured in in vitro experiments using automated drainage (average maximum: -350±59.2 cmH2O) and limited pressure variations (mean interquartile range: 19.3 cmH2O). There were no complications, including pneumothorax, hemothorax, or re-expansion pulmonary edema. Thoracentesis using automated wall suction does not generate excessively high suction pressures and reduces pressure swings. It appears safe and effective and may reduce the time-to-evacuation of a pleural effusion.
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| format | Article |
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| institution | DOAJ |
| issn | 1122-0643 2532-5264 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | PAGEPress Publications |
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| series | Monaldi Archives for Chest Disease |
| spelling | doaj-art-b48e800dde9648389aa6af3826ea39ed2025-08-20T02:56:47ZengPAGEPress PublicationsMonaldi Archives for Chest Disease1122-06432532-52642025-07-0110.4081/monaldi.2025.3484Suction pressures generated during thoracentesis using wall suction-based automated drainage: an in vitro and in vivo analysisAbdias Rodriguez0Anuradha Ramaswamy1Aravind A. Menon2Noah Belkhayat3Victoria E. Forth4Scott L. Schissel5Majid Shafiq6Harvard Medical School, Boston, MADivision of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MADivision of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MADivision of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MADivision of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MADivision of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MADivision of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA Equipoise exists regarding the optimal method to drain pleural fluid during thoracentesis. While several institutions use wall-based automated suction, others point to the risk of excessively high suction pressures and therefore elevated barotrauma risk as a reason to avoid it. We first performed in vitro experiments involving drainage of a 1-liter saline bag using standard thoracentesis apparatus, a digital manometer, and either manual drainage (using a 60 mL syringe) or automated drainage (using wall suction at the maximum setting). The proceduralist was blinded to measurements during manual aspiration. Separately, in a clinical setting involving consecutive hospitalized adults undergoing thoracentesis, dynamic suction pressures were similarly measured during automated drainage. Total aspirated volume, time-to-evacuation, patient discomfort, and complications were also recorded. In vitro experiments showed that compared to manual aspiration, automated drainage using wall suction resulted in shorter average time-to-evacuation (230 sec vs. 365 sec), lower suction pressures (average maximum: -361±4.5 cmH2O vs. -496±5.1 cmH2O, p<0.0001), and less pressure variation (95% of values within a 20 cmH2O range vs. swings between 0 and -500 cmH2O). Twenty hospitalized adults undergoing thoracentesis via automated drainage (mean aspirated volume: 1649.5±685.5 mL) experienced similar suction pressures to those measured in in vitro experiments using automated drainage (average maximum: -350±59.2 cmH2O) and limited pressure variations (mean interquartile range: 19.3 cmH2O). There were no complications, including pneumothorax, hemothorax, or re-expansion pulmonary edema. Thoracentesis using automated wall suction does not generate excessively high suction pressures and reduces pressure swings. It appears safe and effective and may reduce the time-to-evacuation of a pleural effusion. https://www.monaldi-archives.org/macd/article/view/3484Thoracentesispleural pressuremanual aspirationwall suction |
| spellingShingle | Abdias Rodriguez Anuradha Ramaswamy Aravind A. Menon Noah Belkhayat Victoria E. Forth Scott L. Schissel Majid Shafiq Suction pressures generated during thoracentesis using wall suction-based automated drainage: an in vitro and in vivo analysis Monaldi Archives for Chest Disease Thoracentesis pleural pressure manual aspiration wall suction |
| title | Suction pressures generated during thoracentesis using wall suction-based automated drainage: an in vitro and in vivo analysis |
| title_full | Suction pressures generated during thoracentesis using wall suction-based automated drainage: an in vitro and in vivo analysis |
| title_fullStr | Suction pressures generated during thoracentesis using wall suction-based automated drainage: an in vitro and in vivo analysis |
| title_full_unstemmed | Suction pressures generated during thoracentesis using wall suction-based automated drainage: an in vitro and in vivo analysis |
| title_short | Suction pressures generated during thoracentesis using wall suction-based automated drainage: an in vitro and in vivo analysis |
| title_sort | suction pressures generated during thoracentesis using wall suction based automated drainage an in vitro and in vivo analysis |
| topic | Thoracentesis pleural pressure manual aspiration wall suction |
| url | https://www.monaldi-archives.org/macd/article/view/3484 |
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