Thoracentesis via wall suction as good as gravity drainage for procedural discomfort and dyspnea improvement, suggests study

Although previous studies showed no difference in procedural discomfort between manual aspiration and gravity drainage, the effect of wall suction drainage on chest discomfort has not been adequately addressed. This study aimed to bridge this gap by comparing wall suction with gravity drainage regarding procedural discomfort and related outcomes in patients with large free-flowing effusions.

This was a multicenter, single-blinded, randomized controlled trial that involved 228 patients, of whom 221 completed the study. Patients had large free-flowing pleural effusions of ≥ 500 mL and were randomly assigned at a 1:1 ratio to wall suction or gravity drainage.

• Wall suction drainage: The technique involved a suction system with vacuum pressure set at full vacuum.

• Gravity drainage: Carried out with a drainage bag located 100 cm caudal to the site of catheter insertion, connected via straight tubing.

Pain assessment was performed using a 100-mm VAS at preprocedure, during the procedure, and postprocedure. The main outcome measured was postprocedural chest pain at 5 minutes; other outcomes included pain, relief from dyspnea, procedure time, volume aspirated, and complications including pneumothorax and reexpansion pulmonary edema.

Key Findings

Chest Pain:

• Procedural chest discomfort at 5 minutes was not significantly different between the wall suction and gravity drainage groups (p=0.08).

Dyspnea Relief:

• No significant differences in dyspnea improvement were noted between the groups.

Procedure Time:

• Gravity drainage took approximately 3 minutes longer than wall suction.

Fluid Volume:

• Similar volumes of fluid were drained in both groups.

Safety:

• The rates of pneumothorax and reexpansion pulmonary edema were matched between the groups, giving no evidence that either poses additional risk.

Thoracentesis performed using wall suction or gravity drainage resulted in similar levels of procedural chest discomfort, dyspnea improvement, and complication rates. The findings highlight the equivalence of these methods, allowing clinicians to tailor procedural techniques to individual patient needs and clinical settings.

Reference:

Shojaee, S., Pannu, J., Yarmus, L., Fantin, A., MacRosty, C., Bassett, R., Jr, Debiane, L., DePew, Z. S., Faiz, S. A., Jimenez, C. A., Avasarala, S. K., Vakil, E., DeMaio, A., Bashoura, L., Keshava, K., Ferguson, T., Adachi, R., Eapen, G. A., Ost, D. E., … Grosu, H. B. (2024). Gravity- vs wall suction-driven large-volume thoracentesis. Chest, 166(6), 1573–1582. https://doi.org/10.1016/j.chest.2024.05.046