الفهرس 
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Abstract
Patients with pleural effusion usually present with dyspnea, chest pain and cough that intensify with effort and interfere with the continuation of their daily activities. Thoracentesis relieves dyspnea, improves mechanical function of the chest and pulmonary functions. Exercise tests; the 6MWT and the SCT are regarded as simple economical global tests, capable of uncovering pathophysiologic abnormalities in the cardiopulmonary system response at level of submaximal exercise or more stressful. Thus, they represent most of the activities of daily life and can be useful in analyzing the impact of thoracentesis on patients’ quality of life.
The aim of the present study was to evaluate the improvements in pulmonary functions, emphasizing exercise tolerance in the 6MWT and the SCT 48 hours after thoracentesis.
The present study was conducted on 25 patients from whom full history taking, clinical examination, routine laboratory investigation and the biochemical analysis of the pleural effusion was done. Radiological evaluation included plain chest radiographs, ultrasound of the chest for evaluation of the degree of diaphragmatic excursion and the amount of pleural effusion pre-and post-thoracentesis using the simplified formula: V (ml)= 20 x Sep (mm) as V is volume and Sep is the maximal separation distance between the parietal and visceral pleura and computed tomography of the chest if indicated. Cardiorespiratory evaluation included the 6MWT and the SCT. The SpO2 and the heart rate were documented using a pulse oximeter before and after the test, plus the respiratory rate counting and evaluation of dyspnea at the beginning and end of the test using the BDS. Spirometry was performed to measure FVC and FEV1.
Among the 25 patients evaluated, there were 15 males (60%) and 10 females (40%). The mean ± SD of their age was 56.96 ± 15.79 years and 40% of patients were smokers. Comorbidities included COPD, hypertension, diabetes mellitus and presence of a previous malignancy. In 20 patients (80%), the pleural fluid drained was an exudate, (15 were para malignant and 5 were para-pneumonic) and the transudate in 5 patients were due to metabolic causes as liver and kidney failure.
The mean ± SD of actual fluid drained was 1424.0 ± 362.03 ml. The mean ± SD amount of pleural fluid calculated post-thoracentesis was significantly lower than the calculated amount pre-thoracentesis (p<0.001). There was a positive significant correlation (r=0.435, p=0.03) between the actual amount of fluid drained and the evaluation of the pleural fluid by sonography pre-thoracentesis.
Post-thoracentesis, the ultrasonograhic mean diaphragmatic excursion, the 6-min walked distance and number of stairs climbed (with its corresponding distance) in the SCT increased significantly (p<0.001). Similarly, the values of FVC and FEV1 increased significantly (p=0.001 and p=0.019 respectively). The BDS and the respiratory rate decreased significantly (p<0.001). While, the heart rate and the SpO2 didn’t show that same significant change after fluid removal.
Significant correlations were found between the distance walked in the 6MWT post-thoracentesis and the values of FVC (r=0.548, p=0.005) and FEV1 (r=0.568, p=0.003). Similarly, significant correlations were found between the climbed distance in the SCT and values of FVC (r=0.730, p<0.001) and FEV1 (r=0.793, p<0.001). Significant correlations were also observed between the deltas (prethoracentesis-postthoracentesis) of the distance walked during the 6MWT or the change of the distance climbed during the SCT with the percentage of variation of FVC (Δ6MWT; r=0.325, p=0.013 and ΔSCT; r=0.571, p=0.003) and FEV1 (Δ6MWT; r=0.288, p=0.043 and ΔSCT; r=0.586, p=0.002) in relation to the actual amount of the fluid drained.
However, no significant correlation was observed between the mean diaphragmatic excursion and the values of FVC and FEV1 post drainage (r=0.376, p=0.064 and r=0.366, p=0.072 respectively), nor between the change in the mean diaphragmatic excursion with the percentage of variation of FVC or FEV1 in relation to the actual amount of the fluid drained (r=-0.021, p=0.922 and r=0.071, p=0.737 respectively).