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

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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