Pleural effusion decreases left ventricular pre-load and causes haemodynamic compromise: an experimental porcine study

Background Although pleural effusion is a common complication in critically ill patients, detailed knowledge is missing about the haemodynamic impact and the underlining mechanisms. The aim of this study was to evaluate the haemodynamic effect of incremental pleural effusion by means of invasive hae...

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Bibliographic Details
Published in:	Acta anaesthesiologica Scandinavica Vol. 56; no. 7; pp. 833 - 839
Main Authors:	WEMMELUND, K. B., LIE, R. H., JUHL-OLSEN, P., FREDERIKSEN, C. A., HERMANSEN, J. F., SLOTH, E.
Format:	Journal Article
Language:	English
Published:	Oxford Blackwell Publishing Ltd 01-08-2012 Blackwell Wiley Subscription Services, Inc
Subjects:	Anesthesia Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Animals Biological and medical sciences Blood pressure Cardiac Output Cardiac Tamponade - diagnostic imaging Cardiac Tamponade - physiopathology Echocardiography Heart Ventricles - diagnostic imaging Heart Ventricles - physiopathology Hemodynamics Medical sciences Pediatrics Pleural Effusion - complications Pleural Effusion - physiopathology Pulmonary Embolism - diagnostic imaging Pulmonary Embolism - physiopathology Random Allocation Single-Blind Method Stroke Volume Sus scrofa Swine Ventricular Dysfunction, Left - diagnostic imaging Ventricular Dysfunction, Left - etiology Ventricular Dysfunction, Left - physiopathology Vertebrata Mammalia Respiratory disease Pleurisy Pleural effusion Pleural disease Anesthesia Artiodactyla Experimental study Ungulata Left ventricle Pig
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Summary:	Background Although pleural effusion is a common complication in critically ill patients, detailed knowledge is missing about the haemodynamic impact and the underlining mechanisms. The aim of this study was to evaluate the haemodynamic effect of incremental pleural effusion by means of invasive haemodynamic parameters and transthoracic echocardiography. Methods This experimental interventional study was conducted using 22 female piglets (17.5–21.5 kg) randomized for right‐side (n = 9) and left‐side (n = 9) pleural effusion, or sham operation (n = 4). Pleural effusion was induced by infusing incremental volumes of saline into the pleural cavity. Invasive haemodynamic measurements and echocardiographical images were obtained at baseline, a volume of 45 ml/kg, a volume of 75 ml/kg and 45 min after drainage. Results No difference (all P > 0.147) was found between right‐ and left‐side pleural effusion, and the groups were thus pooled. At 45 ml/kg cardiac output, mean arterial pressure, stroke volume and mixed venous saturation decreased (all P < 0.003); central venous pressure and pulmonary arterial pressure increased (both P > 0.003) at this point. The changes accelerated at 75 ml/kg. At 45 ml/kg left ventricular pre‐load in terms of end‐diastolic area decreased significantly (P < 0.001). The effect on haemodynamics and cardiac dimensions changed dramatically at 75 ml/kg. Cardiac output, mean arterial pressure, central venous pressure and left ventricular end‐diastolic area returned to normal during a recovery period of 45 min (all P > 0.061). Conclusion Incremental volumes of unilateral pleural effusion induced a significant haemodynamic impact fully reversible after drainage. Pleural effusion causes a significant decrease of left ventricular pre‐load in a diverse picture of haemodynamic compromise.
Bibliography:	ark:/67375/WNG-LW8CWM4N-H ArticleID:AAS2678 istex:B31BE0D130B1BAC47C31A2B55185A26AC0CE7A12 ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0001-5172 1399-6576
DOI:	10.1111/j.1399-6576.2012.02678.x