Physiology of breathlessness associated with pleural effusions

Rajesh Thomas; Susan Jenkins; Peter R. Eastwood; Y.C. Gary Lee; Bhajan Singh

doi:10.1097/MCP.0000000000000174

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Physiology of breathlessness associated with pleural effusions

Journal article

Open access

Physiology of breathlessness associated with pleural effusions

Rajesh Thomas, Susan Jenkins, Peter R. Eastwood, Y.C. Gary Lee and Bhajan Singh

Current opinion in pulmonary medicine, Vol.21(4), pp.338-345

2015

DOI: https://doi.org/10.1097/MCP.0000000000000174

PMCID: PMC5633324

PMID: 25978627

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Abstract

breathlessness

pathophysiology

pleural effusion

thoracentesis

Purpose of review Pleural effusions have a major impact on the cardiorespiratory system. This article reviews the pathophysiological effects of pleural effusions and pleural drainage, their relationship with breathlessness, and highlights key knowledge gaps. Recent findings The basis for breathlessness in pleural effusions and relief following thoracentesis is not well understood. Many existing studies on the pathophysiology of breathlessness in pleural effusions are limited by small sample sizes, heterogeneous design and a lack of direct measurements of respiratory muscle function. Gas exchange worsens with pleural effusions and improves after thoracentesis. Improvements in ventilatory capacity and lung volumes following pleural drainage are small, and correlate poorly with the volume of fluid drained and the severity of breathlessness. Rather than lung compression, expansion of the chest wall, including displacement of the diaphragm, appears to be the principle mechanism by which the effusion is accommodated. Deflation of the thoracic cage and restoration of diaphragmatic function after thoracentesis may improve diaphragm effectiveness and efficiency, and this may be an important mechanism by which breathlessness improves. Effusions do not usually lead to major hemodynamic changes, but large effusions may cause cardiac tamponade and ventricular diastolic collapse. Patients with effusions can have impaired exercise capacity and poor sleep quality and efficiency. Summary Pleural effusions are associated with abnormalities in gas exchange, respiratory mechanics, respiratory muscle function and hemodynamics, but the association between these abnormalities and breathlessness remains unclear. Prospective studies should aim to identify the key mechanisms of effusion-related breathlessness and predictors of improvement following pleural drainage.

Details

Title: Physiology of breathlessness associated with pleural effusions
Authors/Creators: Rajesh Thomas - The University of Western Australia
Susan Jenkins - Curtin University
Peter R. Eastwood - Curtin University
Y.C. Gary Lee - Curtin University
Bhajan Singh - Curtin University
Publication Details: Current opinion in pulmonary medicine, Vol.21(4), pp.338-345
Publisher: Lippincott Williams & Wilkins
Identifiers: 991005592646307891
Murdoch Affiliation: Vice Chancellery
Language: English
Resource Type: Journal article

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Collaboration types: Domestic collaboration
Citation topics: 1 Clinical & Life Sciences; 1.199 Lung Cancer; 1.199.1048 Pulmonary Ultrasound
Web Of Science research areas: Respiratory System
ESI research areas: Clinical Medicine