TY - JOUR
T1 - The Impact of Gravity vs Suction-driven Therapeutic Thoracentesis on Pressure-related Complications
T2 - The GRAVITAS Multicenter Randomized Controlled Trial
AU - Interventional Pulmonary Outcomes Group
AU - Lentz, Robert J.
AU - Shojaee, Samira
AU - Grosu, Horiana B.
AU - Rickman, Otis B.
AU - Roller, Lance
AU - Pannu, Jasleen K.
AU - DePew, Zachary S.
AU - Debiane, Labib G.
AU - Cicenia, Joseph C.
AU - Akulian, Jason
AU - Walston, Charla
AU - Sanchez, Trinidad M.
AU - Davidson, Kevin R.
AU - Jagan, Nikhil
AU - Ahmad, Sahar
AU - Gilbert, Christopher
AU - Huggins, John T.
AU - Chen, Heidi
AU - Light, Richard W.
AU - Yarmus, Lonny
AU - Feller-Kopman, David
AU - Lee, Hans
AU - Rahman, Najib M.
AU - Maldonado, Fabien
N1 - Publisher Copyright:
© 2019 American College of Chest Physicians
PY - 2020/3
Y1 - 2020/3
N2 - Background: Thoracentesis can be accomplished by active aspiration or drainage with gravity. This trial investigated whether gravity drainage could protect against negative pressure-related complications such as chest discomfort, re-expansion pulmonary edema, or pneumothorax compared with active aspiration. Methods: This prospective, multicenter, single-blind, randomized controlled trial allocated patients with large free-flowing effusions estimated ≥ 500 mL 1:1 to undergo active aspiration or gravity drainage. Patients rated chest discomfort on 100-mm visual analog scales prior to, during, and following drainage. Thoracentesis was halted at complete evacuation or for persistent chest discomfort, intractable cough, or other complication. The primary outcome was overall procedural chest discomfort scored 5 min following the procedure. Secondary outcomes included measures of discomfort and breathlessness through 48 h postprocedure. Results: A total of 142 patients were randomized to undergo treatment, with 140 in the final analysis. Groups did not differ for the primary outcome (mean visual analog scale score difference, 5.3 mm; 95% CI, –2.4 to 13.0; P =.17). Secondary outcomes of discomfort and dyspnea did not differ between groups. Comparable volumes were drained in both groups, but the procedure duration was significantly longer in the gravity arm (mean difference, 7.4 min; 95% CI, 10.2 to 4.6; P <.001). There were no serious complications. Conclusions: Thoracentesis via active aspiration and gravity drainage are both safe and result in comparable levels of procedural comfort and dyspnea improvement. Active aspiration requires less total procedural time. Trial Registry: ClinicalTrials.gov; No.: NCT03591952; URL: www.clinicaltrials.gov.
AB - Background: Thoracentesis can be accomplished by active aspiration or drainage with gravity. This trial investigated whether gravity drainage could protect against negative pressure-related complications such as chest discomfort, re-expansion pulmonary edema, or pneumothorax compared with active aspiration. Methods: This prospective, multicenter, single-blind, randomized controlled trial allocated patients with large free-flowing effusions estimated ≥ 500 mL 1:1 to undergo active aspiration or gravity drainage. Patients rated chest discomfort on 100-mm visual analog scales prior to, during, and following drainage. Thoracentesis was halted at complete evacuation or for persistent chest discomfort, intractable cough, or other complication. The primary outcome was overall procedural chest discomfort scored 5 min following the procedure. Secondary outcomes included measures of discomfort and breathlessness through 48 h postprocedure. Results: A total of 142 patients were randomized to undergo treatment, with 140 in the final analysis. Groups did not differ for the primary outcome (mean visual analog scale score difference, 5.3 mm; 95% CI, –2.4 to 13.0; P =.17). Secondary outcomes of discomfort and dyspnea did not differ between groups. Comparable volumes were drained in both groups, but the procedure duration was significantly longer in the gravity arm (mean difference, 7.4 min; 95% CI, 10.2 to 4.6; P <.001). There were no serious complications. Conclusions: Thoracentesis via active aspiration and gravity drainage are both safe and result in comparable levels of procedural comfort and dyspnea improvement. Active aspiration requires less total procedural time. Trial Registry: ClinicalTrials.gov; No.: NCT03591952; URL: www.clinicaltrials.gov.
KW - gravity
KW - pleural effusion
KW - suction
KW - thoracentesis
UR - http://www.scopus.com/inward/record.url?scp=85079856638&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85079856638&partnerID=8YFLogxK
U2 - 10.1016/j.chest.2019.10.025
DO - 10.1016/j.chest.2019.10.025
M3 - Article
C2 - 31711990
AN - SCOPUS:85079856638
SN - 0012-3692
VL - 157
SP - 702
EP - 711
JO - CHEST
JF - CHEST
IS - 3
ER -