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Abstract

Purposes:

Some controversies exist on the effect of therapeutic thoracentesis (TT) on arterial blood oxygen tension. The aim of this study was to evaluate this issue using a previously developed virtual patient.

Methods:

The analysis was based and supported by clinical data collected during 36 TT. Pleural pressure and transcutaneous oxygen and carbon dioxide pressures (PtcO₂ and PtcCO₂) were measured during pleural fluid withdrawal. Arterial blood oxygen tension and arterial CO₂ tension (PaO₂ and PaCO₂) were analysed in simulations that mimicked TT. Minute ventilation was adjusted to maintain arterial CO₂ tension at a constant level unless arterial blood oxygen tension fell below 8 kPa. Specifically, the influence of hypoxic pulmonary vasoconstriction efficiency was tested.

Results:

In patients, PtcCO₂ remained at an approximately constant level (average amplitude: 0.63 ± 0.29 kPa), while some fluctuations of PtcO2 were observed (amplitude: (1.65 ± 1.18 kPa) were observed. In 42% of patients, TT was associated with decrease in PtcCO₂. Simulations showed the following: (a) there were similar PaO₂ fluctuations in the virtual patient; (b) the lower the hypoxic pulmonary vasoconstriction efficiency, the more pronounced the PaO₂ fall during fluid withdrawal; and (c) the lower the atelectatic lung areas recruitment rate, the slower the PaO₂ normalization. The decrease in PaO₂ was caused by an increase of pulmonary shunt.

Conclusion:

Therapeutic thoracentesis may cause both an increase and a decrease in PaO₂ during the procedure. Pleural pressure decrease, caused by pleural fluid withdrawal, improves the perfusion of atelectatic lung areas. If the rate of recruitment of these areas is low, a lack of ventilation causes the arterial blood oxygen tension to fall. Effective hypoxic pulmonary vasoconstriction may protect against the pulmonary shunt.

Keywords

Blood oxygenation hypoxic pulmonary vasoconstriction pleural effusion pleural pressure pulmonary shunt thoracentesis

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References

Brandstetter

Cohen

RP.

Hypoxemia after thoracentesis. A predictable and treatable condition. JAMA 1979; 242: 1060–1061.

Perpiñá

Benlloch

Marco

et al . Effect of thoracentesis on pulmonary gas exchange. Thorax 1983; 38: 747–750.

Agustí

Cardús

Roca

et al . Ventilation-perfusion mismatch in patients with pleural effusion: effects of thoracentesis. Am J Respir Crit Care Med 1997; 156: 1205–1209.

Doelken

Abreu

Sahn

et al . Effect of thoracentesis on respiratory mechanics and gas exchange in the patient receiving mechanical ventilation. Chest 2006; 130: 1354–1361.

Thomas

Jenkins

Eastwood

et al . Physiology of breathlessness associated with pleural effusions. Curr Opin Pulm Med 2015; 21: 338–345.

Chen

Chung

Hsiao

et al . Pleural space elastance and changes in oxygenation after therapeutic thoracentesis in ventilated patients with heart failure and transudative pleural effusions. Respirology 2010; 15: 1001–1008.

Zielinska-Krawczyk

Michnikowski

Grabczak

et al . Cough during therapeutic thoracentesis: friend or foe? Respirology 2015; 20: 166–168.

Gólczewski

Stecka

Michnikowski

et al . The use of a virtual patient to follow pleural pressure changes associated with therapeutic thoracentesis. Int J Artif Organs 2017; 40: 690–695.

Zielinska-Krawczyk

Grabczak

Michnikowski

et al . Patterns of pleural pressure amplitude and respiratory rate changes during therapeutic thoracentesis. BMC Pulm Med 2018; 18: 36.

10.

Krenke

Guć

Grabczak

et al . Development of an electronic manometer for intrapleural pressure monitoring. Respiration 2011; 82: 377–385.

11.

Zieliński

Stecka

Gólczewski

. VirRespir – an application for virtual pneumonological experimentation and clinical training. In: Lhotska

Sukupova

Lacković

et al (eds). World congress on medical physics and biomedical engineering 2018. IFMBE proceedings. Singapore: Springer, 2019, pp. 697–701.

12.

Gólczewski

Darowski

Virtual respiratory system for education and research: simulation of expiratory flow limitation for spirometry. Int J Artif Organs 2006; 29: 961–972.

13.

Gólczewski

Pałko

KJ.

A method for quantification of lung resistive and compliant properties for spirometry interpretation support – tests on a virtual patient. Biocybern Biomed Eng 2013; 33: 136–144.

14.

Gólczewski

Gas exchange in a virtual respiratory system-simulation of ventilation without lung movement. Int J Artif Organs 2007; 30: 1047–1056.

15.

Gólczewski

Zieliński

Ferrari

et al . Influence of ventilation mode on blood oxygenation – investigation with polish virtual lungs and Italian model of circulation. Biocybern Biomed Eng 2010; 30: 17–30.

16.

Ferrari

Kozarski

Zieliński

et al . A modular computational circulatory model applicable to VAD testing and training. J Artif Organs 2012; 15: 32–43.

17.

Suga

Sagawa

Shoukas

AA.

Load independence of the instantaneous pressure-volume ratio of the canine left ventricle and effects of epinephrine and heart rate on the ratio. Circ Res 1973; 32: 314–322.

18.

Gilbert

Glantz

SA.

Determinants of left ventricular filling and of the diastolic pressure-volume relation. Circ Res 1989; 64: 827–852.

19.

Hall

. Regulation of Respiration. In: Hall

(ed.) Guyton and Hall textbook of medical physiology. 12th ed. Philadelphia, PA: Elsevier/Saunders, 2010, pp. 505–513.

20.

Nishiyama

Nakamura

Yamashita

Effects of the electrode temperature of a new monitor, TCM4, on the measurement of transcutaneous oxygen and carbon dioxide tension. J Anesth 2006; 20: 331–334.

21.

Górska

Korczyński

Maskey-Warzęchowska

et al . Variability of transcutaneous oxygen and carbon dioxide pressure measurements associated with sensor location. Adv Exp Med Biol 2015; 858: 39–46.

22.

Ward

JPT

Aaronson

. Mechanisms of hypoxic pulmonary vasoconstriction: can anyone be right? Respir Physiol 1999; 115: 261–271.

23.

Dumas

Bardou

Goirand

et al . Hypoxic pulmonary vasoconstriction. Gen Pharmacol 1999; 33: 289–297.

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The use of a virtual patient to follow changes in arterial blood gases associated with therapeutic thoracentesis

Abstract

Purposes:

Methods:

Results:

Conclusion:

Keywords

Get full access to this article

References

Supplementary Material