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The optimal method for draining pleural fluid during large-volume thoracentesis is unclear. Drainage via gravity, manual aspiration by syringe, and wall-based or vacuum-bottle suction all are considered to be standard care. Each method applies negative pressure in various degrees to the pleural space; data suggests that higher negative pleural pressure can lead to more periprocedural chest discomfort and complications such as reexpansion pulmonary edema.
Researchers in the U.S. and Italy performed a multicenter, randomized trial in which 221 patients with free-flowing effusions of ≥500 mL who required thoracentesis were assigned to wall-suction (>200 mm Hg) or gravity drainage (<10 mm Hg). The primary endpoint of postprocedural chest pain at…