Determine the Frequency of Pneumothorax in Patients Undergoing Large Volume Thoracentesis

Abstract

Background: Thoracentesis is a medical procedure used to remove excess fluid or air from the pleural space, the space between the lungs and the chest wall. Pleural effusion occurs when excess fluid collects in the pleural cavity, leading to symptoms such as difficulty breathing and chest discomfort. Large volume thoracentesis, which involves the removal of more than one liter of pleural fluid, can provide significant symptom relief. However, this procedure is associated with risks, including pneumothorax. Previous studies have reported varying incidence rates of pneumothorax following thoracentesis, highlighting the need for further investigation in different clinical settings.

Objective: To determine the frequency of pneumothorax in patients undergoing large volume thoracentesis.

Methods: This cross-sectional study was conducted at the Department of Pulmonology, Pakistan Emirates Military Hospital, Rawalpindi, from December 12, 2023, to June 12, 2024. A total of 120 patients, both male and female, aged 20-75 years, who required large volume thoracentesis due to pleural effusion were included. Patients with a history of pneumothorax, pre-existing pleural diseases, chronic lung diseases, coagulation disorders, or those who were pregnant were excluded. Non-probability consecutive sampling was used for recruitment. Informed consent was obtained from all participants. Each patient underwent a comprehensive clinical examination, followed by thoracentesis using a 16-gauge intravenous cannula. The volume of aspirated fluid was recorded. Post-procedure, an erect chest radiograph was performed to confirm pneumothorax. Data were analyzed using SPSS Version 26.

Results: The mean age of the patients was 49.68 ± 12.0 years, with ages ranging from 23 to 74 years. Among the patients, 71 (59.2%) were male and 49 (40.8%) were female. The majority of patients, 79 (65.8%), were in the 41-60 years age group. Pneumothorax was detected in 21 (17.5%) patients. Stratification of pneumothorax occurrence based on gender showed that 13 (18.3%) males and 8 (16.3%) females developed pneumothorax. Age group stratification revealed that 5 (31.3%) patients in the 20-40 years age group, 11 (13.9%) in the 41-60 years age group, and 5 (20.0%) in the >60 years age group developed pneumothorax. The P-values for gender and age group stratification were not statistically significant.

Conclusion: The study concluded that pneumothorax is a significant complication associated with large volume thoracentesis, occurring in 17.5% of patients. The findings underscore the need for careful procedural planning and consideration of techniques such as ultrasound guidance to reduce the risk of pneumothorax.