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    "titulo" => "Influence of the Method Used to Obtain Pleural Fluid on the Determination of the Acid-Base Balance"
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        "resumen" => "<span class="elsevierStyleSectionTitle">Objective</span><p class="elsevierStyleSimplePara elsevierViewall">To analyze the methods used in our hospital for obtaining pleural fluid to determine the acid-base balance and to evaluate the clinical repercussions of each method&#46;</p> <span class="elsevierStyleSectionTitle">Methods</span><p class="elsevierStyleSimplePara elsevierViewall">Initially we studied the methods used by physicians in our hospital to collect pleural fluid for determination of the acid-base balance&#46; In a second phase&#44; we performed a prospective&#44; descriptive&#44; comparative study with the participation of 71 patients with pleural effusions in order to compare the acid-base balance according to the technique used to obtain the fluid&#46;</p> <span class="elsevierStyleSectionTitle">Results</span><p class="elsevierStyleSimplePara elsevierViewall">Pleural fluid was obtained using 3 methods&#58; <span class="elsevierStyleItalic">a&#41;</span> direct extraction using a heparinized syringe &#40;group 1&#41;&#59; <span class="elsevierStyleItalic">b&#41;</span> extraction using a 20-mL syringe with subsequent aspiration from this syringe into a heparinized syringe &#40;group 2&#41;&#59; and <span class="elsevierStyleItalic">c&#41;</span> filling a heparinized syringe from the 20- mL syringe &#40;group 3&#41;&#46; The only significant differences between group 1 and groups 2 and 3 were an increase in the pleural PO<span class="elsevierStyleInf">2</span> and oxygen saturation&#46; The difference in the mean pH between groups 1 and 2 was 0&#46;009 &#40;95&#37; confidence interval&#58; &#8722;0&#46;39 to 0&#46;02&#59; <span class="elsevierStyleItalic">P</span>&#61;&#46;5&#41; and between groups 1 and 3 was 0&#46;007 &#40;95&#37; confidence interval&#58; &#8722;0&#46;38 to 0&#46;023&#59; <span class="elsevierStyleItalic">P</span>&#61;&#46;6&#41;&#46; The correlations between findings for PO<span class="elsevierStyleInf">2</span>&#44; pH&#44; and PCO<span class="elsevierStyleInf">2</span> obtained in the different groups were statistically significant&#44; with values superior to &#46;95 in the last 2 variables&#46;</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p class="elsevierStyleSimplePara elsevierViewall">Physicians who perform thoracentesis in our hospital use different methods for obtaining fluid to determine the pleural acid-base balance&#46; The 3 methods analyzed show no significant differences with regard to pH or PCO<span class="elsevierStyleInf">2</span>&#46; Pleural fluid may be obtained by a single puncture with a large-volume syringe&#44; subsequently transferring the fluid to a heparinized syringe without this significantly affecting the pH or PCO<span class="elsevierStyleInf">2</span>&#44; thus reducing the number of manipulations and the risk of complications&#46;</p>"
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        "resumen" => "<span class="elsevierStyleSectionTitle">Objetivo</span><p class="elsevierStyleSimplePara elsevierViewall">Analizar las formas de obtenci&#243;n del l&#237;quido para determinar el equilibrio &#225;cido-base pleural en nuestro medio y su influencia o relevancia cl&#237;nica&#46;</p> <span class="elsevierStyleSectionTitle">M&#233;todos</span><p class="elsevierStyleSimplePara elsevierViewall">En una primera fase se describieron las formas en que los m&#233;dicos de nuestro hospital obten&#237;an el l&#237;quido para determinar el equilibrio &#225;cido-base pleural&#46; En una segunda fase se realiz&#243; un estudio prospectivo&#44; descriptivo y comparativo de 71 pacientes con derrame para comparar el equilibrio &#225;cido-base pleural seg&#250;n las formas de obtenci&#243;n&#46;</p> <span class="elsevierStyleSectionTitle">Resultados</span><p class="elsevierStyleSimplePara elsevierViewall">El l&#237;quido pleural se obten&#237;a de 3 formas distintas&#58; <span class="elsevierStyleItalic">a&#41;</span> extracci&#243;n directa con jeringa heparinizada &#40;grupo I&#41;&#59; <span class="elsevierStyleItalic">b&#41;</span> extracci&#243;n con jeringa de 20 ml&#44; aspirando de esta jeringa con la jeringa heparinizada &#40;grupo II&#41;&#44; o <span class="elsevierStyleItalic">c&#41;</span> llenando la jeringa heparinizada con la jeringa de 20 ml &#40;grupo III&#41;&#46; Se observ&#243; un aumento significativo s&#243;lo en los valores de la presi&#243;n parcial &#40;PO<span class="elsevierStyleInf">2</span>&#41; y saturaci&#243;n de ox&#237;geno entre el grupo I y los grupos II o III&#46; La diferencia de las medias del pH entre los grupos I y II fue de 0&#44;009 &#40;intervalo de confianza del 95&#37;&#44; &#8722;0&#44;039 a 0&#44;02&#59; p &#61; 0&#44;5&#41;&#44; y entre los grupos I y III&#44; de 0&#44;007 &#40;intervalo de confianza del 95&#37;&#44; &#8722;0&#44;038 a 0&#44;023&#59; p &#61; 0&#44;6&#41;&#46; Las correlaciones entre los distintos grupos de la PO<span class="elsevierStyleInf">2</span>&#44; pH y presi&#243;n parcial de anh&#237;drido carb&#243;nico &#40;PCO<span class="elsevierStyleInf">2</span>&#41; fueron estad&#237;sticamente significativas y con valores superiores a 0&#44;95 en las 2 &#250;ltimas&#46;</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p class="elsevierStyleSimplePara elsevierViewall">Los m&#233;dicos que realizan las toracocentesis en nuestro hospital procesan de formas distintas el l&#237;quido para determinar el equilibrio &#225;cido-base pleural&#46; Las 3 formas analizadas no mostraron diferencias significativas en cuanto al pH y la PCO<span class="elsevierStyleInf">2</span>&#46; La obtenci&#243;n del l&#237;quido puede realizarse con una &#250;nica punci&#243;n con jeringas de mayor capacidad&#44; para posteriormente llenar la jeringa heparinizada&#44; sin que se modifiquen de forma significativa los valores del pH y la PCO<span class="elsevierStyleInf">2</span>&#44; y con una disminuci&#243;n del n&#250;mero de manipulaciones y el riesgo de complicaciones&#46;</p>"
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Vol. 44. Issue 8.
Pages 413-417 (January 2008)
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Vol. 44. Issue 8.
Pages 413-417 (January 2008)
Original Articles
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Influence of the Method Used to Obtain Pleural Fluid on the Determination of the Acid-Base Balance
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Manuel Haro-Estarriol
Corresponding author
mip.mharo@htrueta.scs.es

Correspondence: Dr M. Haro-Estarriol Servicio de Neumología (Planta 4.ª B) Hospital Universitario de Girona Dr Josep Trueta Avda. de Francia, s/n 17007 Girona, Spain
, Juan Carlos Calderón-López, Gladis Sabater-Talaverano, Núria Font Vall-Llobera, Luis Alberto Álvarez-Castillo, Salvi Sendra-Salillas
Servicio de Neumología, Hospital Universitario de Girona Dr. Josep Trueta, Girona, Spain
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Objective

To analyze the methods used in our hospital for obtaining pleural fluid to determine the acid-base balance and to evaluate the clinical repercussions of each method.

Methods

Initially we studied the methods used by physicians in our hospital to collect pleural fluid for determination of the acid-base balance. In a second phase, we performed a prospective, descriptive, comparative study with the participation of 71 patients with pleural effusions in order to compare the acid-base balance according to the technique used to obtain the fluid.

Results

Pleural fluid was obtained using 3 methods: a) direct extraction using a heparinized syringe (group 1); b) extraction using a 20-mL syringe with subsequent aspiration from this syringe into a heparinized syringe (group 2); and c) filling a heparinized syringe from the 20- mL syringe (group 3). The only significant differences between group 1 and groups 2 and 3 were an increase in the pleural PO2 and oxygen saturation. The difference in the mean pH between groups 1 and 2 was 0.009 (95% confidence interval: −0.39 to 0.02; P=.5) and between groups 1 and 3 was 0.007 (95% confidence interval: −0.38 to 0.023; P=.6). The correlations between findings for PO2, pH, and PCO2 obtained in the different groups were statistically significant, with values superior to .95 in the last 2 variables.

Conclusions

Physicians who perform thoracentesis in our hospital use different methods for obtaining fluid to determine the pleural acid-base balance. The 3 methods analyzed show no significant differences with regard to pH or PCO2. Pleural fluid may be obtained by a single puncture with a large-volume syringe, subsequently transferring the fluid to a heparinized syringe without this significantly affecting the pH or PCO2, thus reducing the number of manipulations and the risk of complications.

Key words:
Pleural effusion
pH
Thoracentesis
Objetivo

Analizar las formas de obtención del líquido para determinar el equilibrio ácido-base pleural en nuestro medio y su influencia o relevancia clínica.

Métodos

En una primera fase se describieron las formas en que los médicos de nuestro hospital obtenían el líquido para determinar el equilibrio ácido-base pleural. En una segunda fase se realizó un estudio prospectivo, descriptivo y comparativo de 71 pacientes con derrame para comparar el equilibrio ácido-base pleural según las formas de obtención.

Resultados

El líquido pleural se obtenía de 3 formas distintas: a) extracción directa con jeringa heparinizada (grupo I); b) extracción con jeringa de 20 ml, aspirando de esta jeringa con la jeringa heparinizada (grupo II), o c) llenando la jeringa heparinizada con la jeringa de 20 ml (grupo III). Se observó un aumento significativo sólo en los valores de la presión parcial (PO2) y saturación de oxígeno entre el grupo I y los grupos II o III. La diferencia de las medias del pH entre los grupos I y II fue de 0,009 (intervalo de confianza del 95%, −0,039 a 0,02; p = 0,5), y entre los grupos I y III, de 0,007 (intervalo de confianza del 95%, −0,038 a 0,023; p = 0,6). Las correlaciones entre los distintos grupos de la PO2, pH y presión parcial de anhídrido carbónico (PCO2) fueron estadísticamente significativas y con valores superiores a 0,95 en las 2 últimas.

Conclusiones

Los médicos que realizan las toracocentesis en nuestro hospital procesan de formas distintas el líquido para determinar el equilibrio ácido-base pleural. Las 3 formas analizadas no mostraron diferencias significativas en cuanto al pH y la PCO2. La obtención del líquido puede realizarse con una única punción con jeringas de mayor capacidad, para posteriormente llenar la jeringa heparinizada, sin que se modifiquen de forma significativa los valores del pH y la PCO2, y con una disminución del número de manipulaciones y el riesgo de complicaciones.

Palabras clave:
Derrame pleural
pH
Toracocentesis
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