Failed pleurodesis

Q: Failed pleurodesis can be predicted by pleural manometry if pleural elastance is? (select one)

A) ≥5 cm H2O per liter of fluid
B) ≥10 cm H2O per liter of fluid
C) ≥15 cm H2O per liter of fluid
D)  ≥20 cm H2O per liter of fluid
E) ≥25 cm H2O per liter of fluid


Answer: D

Pleurodesis requires contact between two layers of a lung to be successful i.e., the visceral and parietal pleurae. Failed pleurodesis is a term applied if a lung failed to fully expand to the chest wall. Various causes include "trapped lung", interstitial pulmonary fibrosis (IPF) or any kind of endobronchial obstruction. In such cases, failed pleurodesis appears as pneumothorax after the procedure. One of the way to predict a failed pleurodesis is using pleural manometry pressure during thoracentesis. Pleural pressure changes is a good surrogate of pleural elastance. A final value for pleural elastance ≥19-20 cm H2O per liter of fluid removed predicts a high likelihood of a failed pleurodesis.

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#procedures


References:

1. Doelken P, Huggins JT, Pastis NJ, Sahn SA. Pleural manometry: technique and clinical implications. Chest 2004; 126:1764. 

2. Feller-Kopman D, Parker MJ, Schwartzstein RM. Assessment of pleural pressure in the evaluation of pleural effusions. Chest 2009; 135:201.