Gravity-Based IPC for Pleural Effusion

Therapy is individualized based on the specific patient and in accordance with the patient's wishes and preferences. Treatment may include specific therapy including thoracentesis, chest tube insertion, diuretics, corticosteroids, antibiotics. If pleural effusion persists, antibiotics, antitubercular medications and repeat procedures are used at the appropriate interval. If symptoms persist and effusion continues to grow, patients are switched from pleurodesis alone to thoracentesis with the removal of effusion followed by pleurodesis.

Pleural effusion and pleuronectin may result from two separate but related processes. They are associated with the inflammation and malignant transformation of cells in the pleura; thus, they may have the same etiology in the pleural space. (J Am Geriat Assoc 2001;57:837-849).

Pleural effusions were found in almost half of hospitalized patients in this study. The most common cause of pleural effusions was congestive heart failure. A restrictive filling pattern on the chest x-rays was the most significant predictor of pleural effusions in patients with congestive heart failure. Diagnosing and assessing pleural effusions remain an important task in the emergency room.

Pleural effusion presents as the sudden development of abdominal fullness and is the presence of an effused fluid between the lungs and the surface of the chest wall. The most common signs of pleural effusion are spontaneous breath sounds heard over the pneumothorax. In addition, pleural effusions can have a negative x-ray, as they appear similar to congestive heart failure and pneumonia, respectively.

Pleural effusion cannot be cured. However, thanks to its quick and relatively non-performed relief and improvement in symptoms, it deserves to be considered a therapeutic option.

Data from a recent study indicates that pleural effusion occurs relatively frequently in the USA. The prevalence in men is markedly higher than in women. Age-related changes over the life span are not consistent with the pattern of overall incidence of pleural effusion.

This is a very important point in our approach to pleural effusion, because if we get the correct diagnosis, we'll get the proper management and follow-up. This can save our patient a lot of pain.\n\nIn the following table, some of the more common indications and their associated prognoses are described.\n\n- Parenteral nutrition\n- Total parenteral nutrition\n- Parenteral lipid"

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There are multiple causes for pleural effusion, including diseases of the heart, kidneys, liver, and lungs, and diseases of connective tissues such as pleurisy. The primary cause is most often due to lung disease. Other causes are infections such as pneumonia, TB, and empyema. Complications of lung disease that also lead to pleural effusions include heart failure, lung cancer, fluid in the abdomen (ascites), or blood in the pleura (hemorrhage or hematogenous contamination). Certain drugs or drugs that contain arsenic or arsenic oxide can lead to the condition of pleural effusion.

We conclude that, in an initial treatment scenario, the combination of gravity IPC and chest tube drainage can provide significant reductions of both pleural volumes and the total number of treatments, thus reducing both the cost and the risk of complications to the patients. We consider IPC alone a rational first line therapy for a plethic effusion (see figure 4), without an adjunctive chest tube drainage (see table 1). In an IPC and chest tube drainage scenario, the chest tubes can be safely left in place for several months until symptomatic resolution, and the patients can be safely discharged from hospital. This approach may also apply to other conditions in which gravity IPC is a common first line therapy.

A substantial portion of new treatments for PE are used off-label, without the benefit of randomized controlled trials. As the clinical trials on PE would mostly enroll people with mild to moderate severity of disease (or have little effect on the length of hospital stay), there is a much-needed opportunity for new therapies with the potential to improve morbidity and mortality when and where it occurs, in patients with the most severe disease. As PE affects approximately 40 million people worldwide each year, the potential public health benefit is substantial.

Patients experience at least one side effect in 70% of their gravity-based ipc treatments. The most commonly reported side effects reported were nausea, vomiting, headache, sore throat, itching, sweating, and chills; however, side effects are manageable and do not preclude patients from treatment. There was no relationship between any of the adverse events and age group.