No difference in chest discomfort (mean difference 2.4 mm on a visual analogue scale, 95% CI -5.7 to 10.5, p=0.56). Asymptomatic pneumothorax ex vacuo occurred in 6 of 62 (10%) controls and none of the manometry group (p=0.01).
Secondary endpoints
Pneumothorax ex vacuo, volume drained, complications
Measurement of pleural pressure by manometry during large-volume thoracentesis does not alter procedure-related chest discomfort. Our findings do not support the routine use of this approach.
The trial authors, in the published abstract
How it has aged
A useful negative: symptom-limited drainage is as good as pressure-guided drainage for comfort. The reduction in asymptomatic pneumothorax ex vacuo is real but clinically inconsequential, which is exactly why the authors declined to recommend routine use.
Publications
Routine monitoring with pleural manometry during therapeutic large-volume thoracentesis to prevent pleural-pressure-related complications: a multicentre, single-blind randomised controlled trial
Lentz RJ, Lerner AD, Pannu JK, et al. Routine monitoring with pleural manometry during therapeutic large-volume thoracentesis to prevent pleural-pressure-related complications: a multicentre, single-blind randomised controlled trial. Lancet Respir Med 2019 May;7(5):447-455.
No difference in procedure-related chest discomfort
Fewer asymptomatic pneumothoraces ex vacuo, of no clinical consequence