Clinical Question 2014811JHOSPITALIST Network

811

NKDAADL

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1L/3010SpO2 85%(RA)

CXR CT

Clinical QuestionHospitalist

1.2. Re-expansion Pulmonary Edema: RPE

APTTPT25/mm3Cr6mg/dl

Transfusion.1991;31:164.

Table 3 Complications related to thoracentesisFirst author Year n

Complications (%)

CommentsPneumothorax

Pneumothoraxrequiringdrainage Pain Dyspnoea Cough

Vasovagalreaction Bleeding Haematoma

SymptomaticRPO Haemoptysis

Non-guidedRaptopoulos32 1991 154 18.0 7.0 ND ND ND ND ND ND ND ND US-guided significantly

safer than non-guidedAleman33 1999 506 3.6 1.8 3.0 1.8 1.2 ND ND ND ND ND NDCastellote34 2001 245 4.0 ND ND ND ND ND ND ND ND ND NDBarnes35 2005 145 10.3 4.1 ND ND ND ND ND ND ND ND US-guided significantly

safer than non-guided

US-guidedHarnsberger36 1983 110 0.0 0.0 ND ND ND ND ND ND ND ND NDRaptopoulos32 1991 188 3.0 2.0 ND ND ND ND ND ND ND ND US-guided significantly

safer than non-guidedColt37 1999 255 5.4 0.8 ND ND ND ND ND ND ND ND NDJones38 2003 941 2.6 ND 2.7 1.0 0.9 0.6 0.2 0.2 0.2 ND Incidence of

pneumothorax increasedwhen >1.1 L fluid removed

Mynarek39 2004 711 2.8 0.0 ND ND ND ND ND ND ND 0.1 NDPihlajamaa11 2004 264 4.2 0.4 ND ND ND ND ND ND ND ND No RPO although >1.5 L

taken in 29 patientsMayo40 2004 232 1.3 1.3 ND ND ND ND 0.0 ND ND ND Mechanically ventilated

patientsBarnes35 2005 305 4.9 0.7 ND ND ND ND ND ND ND ND US-guided significantly

safer than non-guidedHeidecker41 2006 367 2.5 ND 8.2 ND ND ND 1.6 0.3 0.3 ND NDFeller-Kopman10 2007 185 4.9 0.5 ND ND ND ND ND ND 0.5 ND At least 1 L aspirated,

some even more than 3 LJosephson42 2009 735 4.6 1.5 ND ND ND ND ND ND ND ND Compared with draining

0.81.2 L, odds ratio 3.8 ofdeveloping pneumothoraxfor 1.82.2 L drained andodds ratio 5.7 if 2.3 L orover drained

Rahman43 2009 362 0.0 0.0 ND ND ND ND 0.3 ND ND ND NDBass44 2005 100 7.0 ND ND ND ND ND 2.0 ND ND ND Group with

haematologicalmalignancy

Non-weighted average 4.7 1.5 4.6 1.4 1.1 0.6 0.8 0.3 0.3 0.1 ND

RPO, re-expansion pulmonary oedema, US, ultrasound.

Com

plicationsof

pleuralprocedures799

2009

TheA

uthorsJournalcom

pilation

2009A

sianPacific

Society

ofR

espirologyR

espirology(2009)

14,796807

RPO: re-expansion pulmonary oedemaUS: ultrasoundND: no data

Respirology.2009;14:796-807.

6%34.1%[OR 0.3; 95% CI 0.2-0.7]

246605Systematic reviewArch Intern Med.2010;170:322.

/2.7% 363

Chest.2009;135:1315.

02489

Am J Roentgenol.2010;195:846.

3 1

Ann Thorac Cardiovasc Surg. 2008;14:205.

RPE

Jpn J Clin Physiol 2000;32:105.

RPE0.2%605941

Chest. 2003;123:418.

RPE0.5%[95% CI 0.01-3%]RPE2.2%[95% CI 0.06-5.4%]

1851L16.55mean1.67

Ann Thorac Surg. 2007;84:1656.

2

RPE47 83%3 64%1 1 94% 6%(3)32

Ann Thorac Surg 1988;45:340.

RPE9 4

892 2483ml

Lancet 1970;1:1367.

20%

RPE47919

Ann Thorac Surg. 1988;45:340. RPE9 222%

Lancet 1970; 1: 13679.

24-48

CLINICS. 2010;65:1387.

CPAP

Thorax.2010;65 Suppl2:ii61.

3 20cmH2O10001500ml 1

Thorax.2010;65 Suppl 2:ii61.Ann Thorac Cardiovasc Surg.2008;14:205.

Take home message