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Physiology of breathlessness associated with pleural effusions

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 breathles...

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Autores principales: Thomas, Rajesh, Jenkins, Susan, Eastwood, Peter R., Lee, Y.C. Gary, Singh, Bhajan
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Lippincott Williams & Wilkins 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5633324/
https://www.ncbi.nlm.nih.gov/pubmed/25978627
http://dx.doi.org/10.1097/MCP.0000000000000174
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author Thomas, Rajesh
Jenkins, Susan
Eastwood, Peter R.
Lee, Y.C. Gary
Singh, Bhajan
author_facet Thomas, Rajesh
Jenkins, Susan
Eastwood, Peter R.
Lee, Y.C. Gary
Singh, Bhajan
author_sort Thomas, Rajesh
collection PubMed
description 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.
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spelling pubmed-56333242017-10-17 Physiology of breathlessness associated with pleural effusions Thomas, Rajesh Jenkins, Susan Eastwood, Peter R. Lee, Y.C. Gary Singh, Bhajan Curr Opin Pulm Med DISEASES OF THE PLEURA: Edited by Richard W. Light 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. Lippincott Williams & Wilkins 2015-07 2015-05-27 /pmc/articles/PMC5633324/ /pubmed/25978627 http://dx.doi.org/10.1097/MCP.0000000000000174 Text en Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved. http://creativecommons.org/licenses/by-nc-nd/4.0 This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 License, where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially. http://creativecommons.org/licenses/by-nc-nd/4.0
spellingShingle DISEASES OF THE PLEURA: Edited by Richard W. Light
Thomas, Rajesh
Jenkins, Susan
Eastwood, Peter R.
Lee, Y.C. Gary
Singh, Bhajan
Physiology of breathlessness associated with pleural effusions
title Physiology of breathlessness associated with pleural effusions
title_full Physiology of breathlessness associated with pleural effusions
title_fullStr Physiology of breathlessness associated with pleural effusions
title_full_unstemmed Physiology of breathlessness associated with pleural effusions
title_short Physiology of breathlessness associated with pleural effusions
title_sort physiology of breathlessness associated with pleural effusions
topic DISEASES OF THE PLEURA: Edited by Richard W. Light
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5633324/
https://www.ncbi.nlm.nih.gov/pubmed/25978627
http://dx.doi.org/10.1097/MCP.0000000000000174
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