Pulmonary ventilation activity, gas exchange rates and the reaction of the circulatory system in the conditions of intrapleural pressure changes caused by therapeutic pleural puncture

The study design includes eight research hypotheses and 8 corresponding study objectives. The most important goals are outlined below. • Analysis of changes in lung ventilation indices and changes in gas exchange indices depending on the volume of fluid removed and changes in intrapleural pressure. • Examination of changes in the compliance of the lungs and chest walls and the related changes in the scope of respiratory work occurring during therapeutic pleural puncture and fluid evacuation. • Analysis of the relationship between changes in intrapleural pressure, dimensions and heart function assessed by echocardiography, and changes in blood concentration of type A natriuretic peptide and type B natriuretic peptide. pressure and ventilation measurements taken during the procedure. The examination will be performed in 60 patients with pleural fluid requiring therapeutic pleural puncture. Research before toracentesis. bodyplethysmography, spirometry, carbon monoxide diffusion capacity (DLCO), arterial blood gas testing, six-minute gait test, echocardiography, blood natriuretic peptide concentration.Assessment during thoracentesis: constant measurement of tidal volume and respiration rate, measurement of pleural effusion volume, measurement of pleural pressure, percutaneous monitoring of O2 and CO2 partial pressures. A catheter will remain in the pleural cavity to allow the fluid to drain and periodically measure the intrapleural pressure after the procedure is completed. Monitoring during 48 hours after surgery. In two groups of patients (undergoing physiotherapy aimed at accelerating the aeration of the lung and those who will not be subjected to physiotherapy), the tests before pleural puncture will be repeated at appropriate intervals. Pleural pressure measurements will be taken up to 48 hours after surgery. Thereafter, the catheter will be removed. Analysis. The signal analysis and visual multidimensional analysis of the relationship between parameters carried out with the use of proprietary computer programs will be an introduction to the formulation of physiological, medical and statistical hypotheses, and will also suggest possible modifications to the analysis and previously parameterized signals. The results of the study will allow to characterize the relationship between lung function indices, gas exchange indices and cardiac function, and changes in intrapulmonary pressure. Some of the studied relationships have never been studied before. The results of the study may change the standard of care during therapeutic pleural puncture and in the early period after its performance.