Drainage of large pleural effusions increases left ventricular preload.

OBJECTIVES: The aim of the study was to investigate if pleurocentesis in patients with pleural effusion would lead to changes in systolic and diastolic function of the left ventricle. DESIGN: The study was descriptive, and patients were their own controls. SETTING: The setting was a single-center university hospital. PARTICIPANTS: Patients with pleural effusion requiring pleurocentesis were eligible for inclusion. INTERVENTIONS: The participants who had pleurocentesis performed were available for analysis. MEASUREMENTS AND MAIN RESULTS: Prior to pleurocentesis and approximately 1 hour after, patients were examined primarily with transthoracic echocardiography. The examination included measurements of left ventricular volumes and measures of diastolic function assessed by Doppler echocardiography. Thirty-five patients were included, and 11 later were excluded, yielding a study population of 24. Preload, expressed as left ventricular end-diastolic volume, increased significantly from before to after pleurocentesis (p=0.014). None of the diastolic parameters showed significant results. Significant changes were observed for heart rate, supplementary O2, respiratory frequency, and saturation. CONCLUSIONS: Pleurocentesis increased left ventricular preload and improved respiratory function.

Ultrasound of the inferior vena cava does not predict hemodynamic response to early hemorrhage.

BACKGROUND: Ultrasonographic evaluation of the inferior vena cava (IVC) provides information on central hemodynamics and predicts fluid responsiveness during positive pressure ventilation. In spontaneously breathing patients, the correlations between IVC dynamics and the hemodynamic response to volume shifts remain to be described. OBJECTIVES: We aimed to describe the correlation between IVC dynamics and the changes in cardiac output (CO) caused by controlled hemorrhage. METHODS: Healthy donors from the blood bank were eligible for inclusion. Measurements of the IVC and CO were performed before and immediately after blood donation using ultrasound methods. A control group served to evaluate the effect of resting. RESULTS: Thirty-seven participants completed the study. IVC collapsibility index (IVC-CI) and IVC end expiratory diameter (IVCe) both changed significantly after blood donation (p < 0.001). The baseline IVC-CI and IVCe did not correlate with the change in CO (p-values ≥ 0.40). The alterations in IVC-CI and IVCe induced by blood donation also did not correlate with the change in CO (p ≥ 0.71). The sensitivities of IVC-CI or IVCe, defined as an increase in IVC-CI and a decrease in IVCe, for picking up any decrease in CO were 81.3% and 84.4%, respectively. In the control group, no effect was seen between measurements. CONCLUSION: IVC-CI and IVCe did not correlate with the magnitude of hemodynamic response to early hemorrhage. The sensitivity of serial IVC measurements was approximately 80% for detecting early blood loss.