{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T22:29:24Z","timestamp":1790807364391,"version":"4.1.0"},"reference-count":31,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,4,11]],"date-time":"2025-04-11T00:00:00Z","timestamp":1744329600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004281","name":"Narodowe Centrum Nauki","doi-asserted-by":"publisher","award":["2019\/35\/B\/NZ5\/02531"],"award-info":[{"award-number":["2019\/35\/B\/NZ5\/02531"]}],"id":[{"id":"10.13039\/501100004281","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Physiol."],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>\n                      Computer simulations, enabling observations of variables inaccessible in living patients, provide a powerful approach to studying complex physiological phenomena. This\n                      <jats:italic>in silico<\/jats:italic>\n                      study presents the use of a virtual patient to investigate the impact of large pleural effusion (PE) and therapeutic thoracentesis (TT) on hemidiaphragm function and arterial blood gases.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Inspired by unexpected phenomena observed in living patients undergoing large-volume TT, we formulated four questions regarding this impact. To answer these questions, we simulated right-sided PE in our virtual patient and studied changes in the pleural pressure in the ipsilateral hemithorax (Ppli) and lung volume during the respiratory cycle (exemplified by Ppli-V loops, where V is the volume of both lungs), airflows in the main bronchi, and alveolar O2 (PAO2) and CO2 (PACO2) partial pressures.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Simulations highlighted that: (a) mediastinal compliance critically affects hemidiaphragm work; (b) the 8-shaped Ppli-V loops are associated with hemidiaphragm inversion, where exhalation from the ipsilateral lung occurs during a part of both the inspiratory and expiratory phases, and vice versa; (c) pre-TT PAO2 may be elevated due to reduction of the tidal volume to end-expiratory lung volume ratio; and (d) pre-TT Ppli amplitudes during respiration can exceed post-TT values when mediastinal compliance is high.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Our findings emphasize the significance of mediastinal compliance in pleural effusion physiology and suggest insignificant influence of the ipsilateral hemidiaphragm inverted due to large PE on arterial gas tensions. This study underscores the utility of virtual patient models for elucidating unexpected physiological behaviors and optimizing clinical interventions.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fphys.2025.1539781","type":"journal-article","created":{"date-parts":[[2025,4,11]],"date-time":"2025-04-11T00:10:39Z","timestamp":1744330239000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":3,"title":["Hemidiaphragm work in large pleural effusion and its insignificant impact on blood gases: a new insight based on in silico study"],"prefix":"10.3389","volume":"16","author":[{"given":"Tomasz","family":"G\u00f3lczewski","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna M.","family":"Stecka","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"El\u017cbieta M.","family":"Grabczak","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcin","family":"Michnikowski","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monika","family":"Zieli\u0144ska-Krawczyk","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rafa\u0142","family":"Krenke","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,4,11]]},"reference":[{"key":"B1","volume-title":"Pleural disease","author":"Bodtger","year":"2020"},{"key":"B2","doi-asserted-by":"publisher","first-page":"e127","DOI":"10.1016\/j.chest.2022.04.015","article-title":"A 57-year-old man with a large left pleural effusion","volume":"162","author":"Cho","year":"2022","journal-title":"Chest"},{"key":"B3","doi-asserted-by":"publisher","first-page":"421","DOI":"10.1016\/j.chest.2019.08.1920","article-title":"The relationship of pleural manometry with postthoracentesis chest radiographic findings in malignant pleural effusion","volume":"157","author":"Chopra","year":"2020","journal-title":"Chest"},{"key":"B4","doi-asserted-by":"publisher","first-page":"305","DOI":"10.1055\/s-0039-1693648","article-title":"Physiologic basis of symptoms in pleural disease","volume":"40","author":"DeBiasi","year":"2019","journal-title":"Semin. Respir. Crit. Care Med."},{"key":"B5","doi-asserted-by":"publisher","first-page":"882","DOI":"10.1111\/resp.14307","article-title":"Ipsilateral and contralateral hemidiaphragm dynamics in symptomatic pleural effusion: the 2nd pleural effusion and symptom evaluation (PLEASE-2) study","volume":"27","author":"Fitzgerald","year":"2022","journal-title":"Respirology"},{"key":"B6","doi-asserted-by":"publisher","first-page":"2337446","DOI":"10.1080\/20018525.2024.2337446","article-title":"Ultrasound in predicting improvement in dyspnoea after therapeutic thoracentesis in patients with recurrent unilateral pleural effusion","volume":"11","author":"Fjaellegaard","year":"2024","journal-title":"Eur. Clin. Respir. J."},{"key":"B7","doi-asserted-by":"publisher","first-page":"690","DOI":"10.5301\/ijao.5000636","article-title":"The use of a virtual patient to follow pleural pressure changes associated with therapeutic thoracentesis","volume":"40","author":"G\u00f3lczewski","year":"2017","journal-title":"Int. J. Artif. Organs"},{"key":"B8","doi-asserted-by":"publisher","first-page":"47","DOI":"10.1186\/s12931-024-02684-7","article-title":"Malignant pleural effusion: current understanding and therapeutic approach","volume":"25","author":"Gonnelli","year":"2024","journal-title":"Respir. Res."},{"key":"B9","doi-asserted-by":"publisher","first-page":"39","DOI":"10.1007\/5584_2015_126","article-title":"Variability of transcutaneous oxygen and carbon dioxide pressure measurements associated with sensor location","volume":"858","author":"G\u00f3rska","year":"2015","journal-title":"Adv. Exp. Med. Biol."},{"key":"B10","doi-asserted-by":"publisher","first-page":"33","DOI":"10.29390\/cjrt-2022-047","article-title":"Pleural manometry during thoracocentesis in patients with malignant pleural effusion: a randomized controlled trial","volume":"59","author":"Hassaballa","year":"2023","journal-title":"Can. J. Respir. Ther."},{"key":"B11","doi-asserted-by":"publisher","first-page":"2759","DOI":"10.21037\/jtd.2020.04.04","article-title":"Pleural manometry: techniques, applications, and pitfalls","volume":"12","author":"Hu","year":"2020","journal-title":"J. Thorac. Dis."},{"key":"B12","doi-asserted-by":"publisher","first-page":"31","DOI":"10.2147\/OAEM.S29942","article-title":"Pleural effusion: diagnosis, treatment, and management","volume":"4","author":"Karkhanis","year":"2012","journal-title":"Open Access Emerg. Med."},{"key":"B31","first-page":"34","article-title":"Respiratory Clinics: Mediastinal shift: a sign of significant clinical and radiological importance in diagnosis of malignant pleural effusion","volume":"7","author":"Khajotia","year":"2012","journal-title":"Malays Fam Physician."},{"key":"B13","doi-asserted-by":"publisher","first-page":"447","DOI":"10.1016\/S2213-2600(18)30421-1","article-title":"Routine monitoring with pleural manometry during therapeutic large-volume thoracentesis to prevent pleural-pressure-related complications: a multicentre, single-blind randomised controlled trial","volume":"7","author":"Lentz","year":"2019","journal-title":"Lancet Respir. Med."},{"key":"B14","doi-asserted-by":"publisher","first-page":"999","DOI":"10.1152\/japplphysiol.00807.2003","article-title":"Mediastinal and chest wall limitations to asymmetry of lung inflation","volume":"96","author":"Lin","year":"2004","journal-title":"J. Appl. Physiol."},{"key":"B15","doi-asserted-by":"publisher","first-page":"49","DOI":"10.1016\/j.ejim.2018.02.004","article-title":"Pleural effusions in acute decompensated heart failure: prevalence and prognostic implications","volume":"52","author":"Morales-Rull","year":"2018","journal-title":"Eur. J. Intern Med."},{"key":"B16","doi-asserted-by":"publisher","first-page":"1080","DOI":"10.1148\/84.6.1080","article-title":"The effect of pleural fluid on the diaphragm","volume":"84","author":"Mulvey","year":"1965","journal-title":"Radiology"},{"key":"B17","doi-asserted-by":"publisher","first-page":"1900980","DOI":"10.1183\/13993003.00980-2019","article-title":"The Pleural Effusion and Symptom Evaluation (PLEASE) study of breathlessness in patients with a symptomatic pleural effusion","volume":"55","author":"Muruganandan","year":"2020","journal-title":"Eur. Respir. J."},{"key":"B18","doi-asserted-by":"publisher","first-page":"230145","DOI":"10.1183\/20734735.0145-2023","article-title":"Malignant pleural disease","volume":"19","author":"Piggott","year":"2023","journal-title":"Breathe"},{"key":"B19","doi-asserted-by":"publisher","first-page":"e43040","DOI":"10.7759\/cureus.43040","article-title":"Massive myelomatous pleural effusion with contralateral mediastinal shift: a unique presentation of extramedullary myeloma","volume":"15","author":"Polski","year":"2023","journal-title":"Cureus"},{"key":"B20","doi-asserted-by":"publisher","first-page":"172","DOI":"10.1097\/LBR.0000000000000627","article-title":"Ultrasound evaluation of hemidiaphragm function following thoracentesis: a study on mechanisms of dyspnea related to pleural effusion","volume":"27","author":"Skaarup","year":"2020","journal-title":"J. Bronchology Interv. Pulmonol."},{"key":"B21","doi-asserted-by":"publisher","first-page":"690","DOI":"10.1177\/0391398818793354","article-title":"The use of a virtual patient to follow changes in arterial blood gases associated with therapeutic thoracentesis","volume":"41","author":"Stecka","year":"2018","journal-title":"Int. J. Artif. Organs"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.21203\/rs.3.rs-3873696\/v1","article-title":"A virtual patient in interpretation of massive pleural effusion impact on hemidiaphragm work and an insignificant influence on blood oxygenation","author":"Stecka","year":"2024","journal-title":"Prepr. Res. Square"},{"key":"B23","doi-asserted-by":"publisher","first-page":"192","DOI":"10.1097\/LBR.0000000000000747","article-title":"The impact of thoracentesis on postprocedure pulse oximetry","volume":"28","author":"Taylor","year":"2021","journal-title":"J. Bronchol Interv. Pulmonol."},{"key":"B24","volume-title":"Pleural disease","author":"Thomas","year":"2020"},{"key":"B25","doi-asserted-by":"publisher","first-page":"36","DOI":"10.1183\/09059180.00010715","article-title":"Virtual respiratory system for interactive e-learning of spirometry","volume":"17","author":"Tomalak","year":"2008","journal-title":"Eur. Respir. Rev."},{"key":"B26","doi-asserted-by":"publisher","first-page":"97623","DOI":"10.18632\/oncotarget.18824","article-title":"Thoracic radiation-induced pleural effusion and risk factors in patients with lung cancer","volume":"8","author":"Zhao","year":"2017","journal-title":"Oncotarget"},{"key":"B27","doi-asserted-by":"publisher","first-page":"36","DOI":"10.1186\/s12890-018-0595-7","article-title":"Patterns of pleural pressure amplitude and respiratory rate changes during therapeutic thoracentesis","volume":"18","author":"Zieli\u0144ska-Krawczyk","year":"2018","journal-title":"BMC Pulm. Med."},{"key":"B28","doi-asserted-by":"publisher","first-page":"16185","DOI":"10.20452\/pamw.16185","article-title":"Impact of therapeutic thoracentesis and pleural pressure changes on breathing pattern, dyspnea, lung function, and arterial blood gases","volume":"132","author":"Zieli\u0144ska-Krawczyk","year":"2022","journal-title":"Pol. Arch. Intern Med."},{"key":"B29","doi-asserted-by":"publisher","first-page":"548","DOI":"10.3390\/membranes12060548","article-title":"Virtual and artificial cardiorespiratory patients in medicine and biomedical engineering","volume":"12","author":"Zieli\u0144ski","year":"2022","journal-title":"Membranes"},{"key":"B30","doi-asserted-by":"publisher","first-page":"697","DOI":"10.1007\/978-981-10-9035-6_129","article-title":"VirRespir\u2014an application for virtual pneumonological experimentation and clinical training","author":"Zieli\u0144ski","year":"2018","journal-title":"Proc. IFMBE"}],"container-title":["Frontiers in Physiology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fphys.2025.1539781\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,4,11]],"date-time":"2025-04-11T00:10:40Z","timestamp":1744330240000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fphys.2025.1539781\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4,11]]},"references-count":31,"alternative-id":["10.3389\/fphys.2025.1539781"],"URL":"https:\/\/doi.org\/10.3389\/fphys.2025.1539781","relation":{"has-preprint":[{"id-type":"doi","id":"10.21203\/rs.3.rs-3873696\/v1","asserted-by":"object"}]},"ISSN":["1664-042X"],"issn-type":[{"value":"1664-042X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,4,11]]},"article-number":"1539781"}}