{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,2]],"date-time":"2025-08-02T19:25:06Z","timestamp":1754162706439,"version":"3.41.2"},"reference-count":10,"publisher":"PAGEPress Publications","license":[{"start":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T00:00:00Z","timestamp":1753833600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Monaldi Arch Chest Dis"],"abstract":"<jats:p>Equipoise exists regarding the optimal method to drain pleural fluid during thoracentesis. While several institutions use wall-based automated suction, others point to the risk of excessively high suction pressures and therefore elevated barotrauma risk as a reason to avoid it. We first performed in vitro experiments involving drainage of a 1-liter saline bag using standard thoracentesis apparatus, a digital manometer, and either manual drainage (using a 60 mL syringe) or automated drainage (using wall suction at the maximum setting). The proceduralist was blinded to measurements during manual aspiration. Separately, in a clinical setting involving consecutive hospitalized adults undergoing thoracentesis, dynamic suction pressures were similarly measured during automated drainage. Total aspirated volume, time-to-evacuation, patient discomfort, and complications were also recorded. In vitro experiments showed that compared to manual aspiration, automated drainage using wall suction resulted in shorter average time-to-evacuation (230 sec vs. 365 sec), lower suction pressures (average maximum: -361\u00b14.5 cmH2O vs. -496\u00b15.1 cmH2O, p&lt;0.0001), and less pressure variation (95% of values within a 20 cmH2O range vs. swings between 0 and -500 cmH2O). Twenty hospitalized adults undergoing thoracentesis via automated drainage (mean aspirated volume: 1649.5\u00b1685.5 mL) experienced similar suction pressures to those measured in in vitro experiments using automated drainage (average maximum: -350\u00b159.2 cmH2O) and limited pressure variations (mean interquartile range: 19.3 cmH2O). There were no complications, including pneumothorax, hemothorax, or re-expansion pulmonary edema. Thoracentesis using automated wall suction does not generate excessively high suction pressures and reduces pressure swings. It appears safe and effective and may reduce the time-to-evacuation of a pleural effusion.<\/jats:p>","DOI":"10.4081\/monaldi.2025.3484","type":"journal-article","created":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T14:15:07Z","timestamp":1753884907000},"source":"Crossref","is-referenced-by-count":0,"title":["Suction pressures generated during thoracentesis using wall suction-based automated drainage: an &lt;i&gt;in vitro&lt;\/i&gt; and &lt;i&gt;in vivo&lt;\/i&gt; analysis"],"prefix":"10.4081","author":[{"given":"Abdias","family":"Rodriguez","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anuradha","family":"Ramaswamy","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aravind A.","family":"Menon","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Noah","family":"Belkhayat","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Victoria E.","family":"Forth","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Scott L.","family":"Schissel","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Majid","family":"Shafiq","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2549","published-online":{"date-parts":[[2025,7,30]]},"reference":[{"key":"60331","doi-asserted-by":"crossref","unstructured":"Light RW. Pleural diseases. Dis Mon 1992;38:266-331.","DOI":"10.1016\/0011-5029(92)90007-C"},{"key":"60332","doi-asserted-by":"crossref","unstructured":"Puchalski JT, Argento AC, Murphy TE, et al. The safety of thoracentesis in patients with uncorrected bleeding risk. Ann Am Thorac Soc 2013;10:336-41.","DOI":"10.1513\/AnnalsATS.201210-088OC"},{"key":"60333","doi-asserted-by":"crossref","unstructured":"Senitko M, Ray AS, Murphy TE, et al. Safety and tolerability of vacuum versus manual drainage during thoracentesis: a randomized trial. J Bronchology Interv Pulmonol 2019;26:166-71.","DOI":"10.1097\/LBR.0000000000000556"},{"key":"60334","doi-asserted-by":"crossref","unstructured":"Kim H, Shyn PB, Wu L, et al. Wall suction-assisted image-guided thoracentesis: a safe alternative to evacuated bottles. Clin Radiol 2017;72:898.e1-e5.","DOI":"10.1016\/j.crad.2017.05.001"},{"key":"60335","doi-asserted-by":"crossref","unstructured":"Kelil T, Shyn PB, Wu LE, et al. Wall suction-assisted image-guided therapeutic paracentesis: a safe and less expensive alternative to evacuated bottles. Abdom Radiol 2016;41:1333-7.","DOI":"10.1007\/s00261-016-0634-x"},{"key":"60336","doi-asserted-by":"crossref","unstructured":"Heidecker J, Huggins JT, Sahn SA, Doelken P. Pathophysiology of pneumothorax following ultrasound-guided thoracentesis. Chest 2006;130:1173-84.","DOI":"10.1016\/S0012-3692(15)51155-0"},{"key":"60337","doi-asserted-by":"crossref","unstructured":"Sagar AES, Landaeta MF, Adrianza AM, et al. Complications following symptom-limited thoracentesis using suction. Eur Respir J 2020;56:1902356.","DOI":"10.1183\/13993003.02356-2019"},{"key":"60338","unstructured":"Alraiyes AH, Kheir F, Harris K, Gildea TR. How much negative pressure are we generating during thoracentesis? Ochsner J. Summer 2017;17:138-40."},{"key":"60339","doi-asserted-by":"crossref","unstructured":"Gattinoni L, Caironi P, Cressoni M, et al. Lung recruitment in patients with the acute respiratory distress syndrome. N Engl J Med 2006;354:1775-86.","DOI":"10.1056\/NEJMoa052052"},{"key":"60340","doi-asserted-by":"crossref","unstructured":"Cipulli F, Vasques F, Duscio E, et al. Atelectrauma or volutrauma: the dilemma. J Thorac Dis Mar 2018;10:1258-64.","DOI":"10.21037\/jtd.2018.02.71"}],"container-title":["Monaldi Archives for Chest Disease"],"original-title":[],"link":[{"URL":"https:\/\/www.monaldi-archives.org\/macd\/article\/download\/3484\/2114","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.monaldi-archives.org\/macd\/article\/download\/3484\/2114","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T14:15:10Z","timestamp":1753884910000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.monaldi-archives.org\/macd\/article\/view\/3484"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,30]]},"references-count":10,"URL":"https:\/\/doi.org\/10.4081\/monaldi.2025.3484","relation":{},"ISSN":["2532-5264","1122-0643"],"issn-type":[{"type":"electronic","value":"2532-5264"},{"type":"print","value":"1122-0643"}],"subject":[],"published":{"date-parts":[[2025,7,30]]}}}