PLEURAL MANOMETRY by Nick Mark MD ONE onepagericu.

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DEFINITION: PLEURAL PRESSURE MEASUREMENT:
Measurement of Intrapleural 1 Connect a MANOMETER 5
Pressures and Pleural Elastance
(WATER COLUMN, PRESSURE
during therapeutic thoracentesis 0
TRANSDUCER, or DIGITAL

Intrapleural Pressure
can be used to identify pleural MANOMETER) behind a 3-
pathologies such as trapped lung -5
way stopcock Normal lung re-expansion

(cmH2O)
and entrapped lung and to -10 steady slow decrease in IP
predict successful pleurodesis.
-15
It may also reduce the risk of re-
+5
expansion pulmonary edema. -20 Entrapped lung will
initially have a slow
-25
Trapped lung decrease in IP followed
by a rapid drop
2
INTERPRETATION: -30 rapid drop in IP
𝟏 ∆𝑷 Withdraw fluid using
Elastance = = using a SYRINGE and 0 500 1000 1500 2000
𝑪𝒐𝒎𝒑𝒍𝒊𝒂𝒏𝒄𝒆 ∆𝑽 COLLECTING BAG as
Consider stopping the
thoracentesis if pressure Volume Removed (mL)
• Normally Pleural Elastance is ≤ 14 you would normally drops < 20 cmH2O
cmH2O/L.
• Pleural elastance > 14.5cmH2O/L 3 Measure the INTRAPLEURAL PRESSURE at end-expiration
suggests trapped lung. intermittently (e.g. every 250cc) as fluid is removed by Normal re-expansion
occurs in the majority of cases
• Pleural elastance < 18 cmH2O/L thoracentesis and calculate PLEURAL ELASTANCE
predicts successful pleurodesis
15-20% of thoracentesis

Differentiate Entrapped Lung (partially 10-15% of cases

inflatable) and Trapped Lung (un-inflatable)
Pleural elastance < 18 cmH2O/L (after 500 mL
withdrawn) implies that the visceral and parietal
pleura are opposed, and suggesting a successful
response to pleurodesis in malignant effusions.
Entrapped Lung is an active Trapped Lung is a resolved inflammatory
PATHOLOGY inflammatory process. There is process with residual pleural fibrosis,
typically partial lung re-expansion which will prevent lung re-expansion
FLUID Exudative Transudatative (usually)

Bimodal pressure change (initially Linear pressure change

Avoid excessive negative pressure (<-20 cmH2O) MANOMETRY (rapid drop in pressure)
slow pressure change, then rapid
during thoracentesis, as this can cause re- FINDINGS drop)

v1.0 (2020-08-15)
expansion pulmonary edema. However, the Normal or increased elastance Increased elastance (>14.5 cmH2O/L)
utility of pleural manometry to predict re-
expansion pulmonary edema is controversial. TREATMENT Treat the cause; drain the effusion Remove the rind preventing lung
dry if possible expansion (decortication)