Impact of Therapeutic Pleurocentesis on Pulmonary Function and Diaphragmatic Excursion in Pleural Effusions of Various Etiologies: A Prospective Pre–Post Study
Main Article Content
Abstract
Background:
Pleural effusion constitutes a significant mechanical disorder of the respiratory system. It compromises vascular perfusion, alters pleural pressure, and restricts diaphragmatic motion, resulting in significant respiratory morbidity. While therapeutic pleurocentesis is widely performed, comprehensive physiological evaluations of its impact across diverse etiologies—particularly in high-burden settings—remain scarce.
Methods:
This hospital-based, prospective observational study enrolled 85 adult patients presenting with symptomatic pleural effusion requiring therapeutic pleurocentesis. The study was conducted over 12 months at a tertiary care centre. Baseline clinical assessments, chest radiography, and biochemical analyses of pleural fluid were performed. Pulmonary function tests (FVC, FEV1, FEV1/FVC) and M-mode ultrasonography for diaphragmatic excursion were recorded prior to and following the procedure.
Results:
The mean age of the participants was 34.7 years, with a male predominance of 70.6%. Exudative effusions constituted 83.5% of the cases, with tuberculosis being the foremost etiological factor (42.4%), followed by parapneumonic effusions (21.2%). Baseline spirometry indicated a restrictive ventilatory defect with a mean FVC of 2.51 L and FEV1 of 2.00 L. Post-pleurocentesis, significant functional improvements were observed: FVC increased to 3.10 L (p<0.001) and FEV1 to 2.51 L (p=0.032). Mean diaphragmatic excursion improved from 1.03 cm pre-procedure to 2.05 cm post-procedure. Post-pleurocentesis diaphragmatic excursion improved in both groups, with mean excursion increasing from 1.20 cm to 2.10 cm in transudative effusions and from 0.99 cm to 2.04 cm in exudative effusions.
Conclusion:
Therapeutic pleurocentesis significantly improves pulmonary function and diaphragmatic mechanics in pleural effusion. While both transudative and exudative effusions showed substantial improvement, transudative effusions demonstrated slightly better baseline and post-procedure diaphragmatic excursion. Exudative effusions, likely due to inflammation-induced pleural thickening, early septation, and reduced diaphragmatic compliance, tend to have relatively restricted excursion. Despite this, significant functional recovery is still achieved following fluid removal. Integration of bedside ultrasonography with spirometry provides an objective and clinically valuable tool for assessing physiological recovery.