ABSTRACT
This work aimed to evaluate the effect of thoracocentesis on the haemodynamic and ventilatory functions in patients with massive pleural effusion [PE]. The study entailed 20 patients with massive pleural effusion divided into two equal groups, each of 10 cases. Group I: patients with right PE, Group II: patients with left PE. All patients underwent basal assessment protocol including plain X-ray chest, computed tomography when needed, chest ultrasonography, pulmonary function tests, arterial blood gases and echocardiography. Thoracocentesis was carried out repeatedly until nearly complete evacuation of pleural effusion was reached, this was followed up and guided by X-ray chest and chest ultrasonography. The previously mentioned assessment protocol was repeated after PE evacuation. Patients with massive pleural effusions in both groups I and II demonstrated restrictive pattern of pulmonary function tests [PFTs] together with evidence of small airway obstruction FEF[25-75%] [51.2 +/- 13.2], arterial hypoxemia PaO[2] [65.2 +/- 11.3 mmHg], echocardiographic study demonstrated high mean values of pulmonary artery pressure [mPAP] 47.3 +/- 5.7 mmHg together with evidence of both right and left ventricular diastolic dysfunctions of relaxation pattern [E/A<1]. No significant difference was found between patients with right and left effusions. Thoracocentesis produced significant improvement in PFTs, arterial PaO[2] and biventricular diastolic dysfunction [E/A >1], as well as decrease in mPAP. Correlation study revealed significant relationship between total volume of aspirated pleural fluid and% change in PFTs, PaO[2] and mPAP. Our data provide circumstantial evidence that massive pleural effusion produce detrimental effects on the ventilatory function, gas exchange as well as on cardiac function. This occur irrespective to the side affected. Thoracocentesis induced significant improvement in cardiac and pulmonary functions that is proportional to the volume aspirated. Thoracocentesis can lead to rapid improvement of the haemodynamic profile