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

• 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
• DOI: 10.1111/j.1399-6576.2012.02678.x
• EISSN: 1399-6576
• ISSN: 0001-5172

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.