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Safety and Tolerability of Vacuum Versus Manual Drainage During Thoracentesis

A Randomized Trial

Senitko, Michal MD*,†; Ray, Amrik S. MD; Murphy, Terrence E. PhD; Araujo, Katy L.B. MPH; Bramley, Kyle MD; DeBiasi, Erin M. MD; Pisani, Margaret A. MD, MPH; Cameron, Kelsey PA-C; Puchalski, Jonathan T. MD, MEd

Journal of Bronchology & Interventional Pulmonology: July 2019 - Volume 26 - Issue 3 - p 166–171
doi: 10.1097/LBR.0000000000000556
Original Investigations

Background: Pleural effusions may be aspirated manually or via vacuum during thoracentesis. This study compares the safety, pain level, and time involved in these techniques.

Methods: We randomized 100 patients receiving ultrasound-guided unilateral thoracentesis in an academic medical center from December 2015 through September 2017 to either vacuum or manual drainage. Without using pleural manometry, the effusion was drained completely or until the development of refractory symptoms. Measurements included self-reported pain before and during the procedure (from 0 to 10), time for completion of drainage, and volume removed. Primary outcomes were rates of all-cause complications and of early termination of the procedure with secondary outcomes of change in pain score, drainage time, volume removed, and inverse rate of removal.

Results: Patient characteristics in the manual (n=49) and vacuum (n=51) groups were similar. Rate of all-cause complications was higher in the vacuum group (5 vs. 0; P=0.03): pneumothorax (n=3), surgically treated hemothorax with subsequent death (n=1) and reexpansion pulmonary edema causing respiratory failure (n=1), as was rate of early termination (8 vs. 1; P=0.018). The vacuum group exhibited greater pain during drainage (P<0.05), shorter drainage time (P<0.01), no association with volume removed (P>0.05), and lower inverse rate of removal (P≤0.01).

Conclusion: Despite requiring less time, vacuum aspiration during thoracentesis was associated with higher rates of complication and of early termination of the procedure and greater pain. Although larger studies are needed, this pilot study suggests that manual aspiration provides greater safety and patient comfort.

*Division of Pulmonary, Critical Care and Sleep Medicine, University of Mississippi Medical Center School of Medicine, Jackson, MS

Division of Pulmonary, Critical Care and Sleep Medicine, Yale University School of Medicine

Claude D. Pepper Older Americans Independence Center at Yale, Program on Aging, Yale School of Medicine, New Haven, CT

M.S. and A.S.R. contributed equally.

M.S., A.S.R., and J.T.P.: had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. M.S., A.S.R., T.E.M., K.B., E.M.D., M.A.P., and J.T.P.: contributed equally and substantially to the study design, data analysis and interpretation, and the writing of the manuscript. K.L.B.A.: contributed to data analysis, figures, and writing of the manuscript. K.C.: contributed to study design, data collection, and writing of the manuscript.

K.L.B.A. and T.E.M. were supported by Yale Program on Aging/Claude D. Pepper Older Americans Independence Center (P30 AG021342).

Clinical Trail Registration: US National Library of Medicine,, NCT03496987.

Disclosure: There is no conflict of interest or other disclosures.

Reprints: Michal Senitko, MD, University of Mississippi Medical Center, 2500 N State St., Jackson, MS 39216-4505 (e-mail:

Received June 4, 2018

Accepted October 15, 2018

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