From the Guidelines
Laying back with a pleural effusion is not recommended as it can exacerbate respiratory distress by allowing the effusion to compress the lung tissue more evenly, thereby reducing lung volume and impairing gas exchange. The recommended position for a patient with a pleural effusion to alleviate respiratory distress is to have them sit upright or semi-recumbent with the affected side down, as this helps to minimize the compression of the unaffected lung by the effusion, allowing for better ventilation of the healthy lung tissue 1.
When a patient lies with the affected side down, the effusion pools in the dependent portion of the pleural space, reducing pressure on the functional lung and improving ventilation-perfusion matching. This position is particularly helpful during acute respiratory distress while awaiting definitive treatment such as thoracentesis or chest tube placement. For patients who cannot sit upright, a lateral decubitus position with the affected side down can also be beneficial.
Some key points to consider when managing a patient with a pleural effusion include:
- The volume of fluid that can be safely removed from the pleural space during a therapeutic thoracentesis is unknown, but monitoring of pleural fluid pressure during the procedure can help determine the safe volume for removal 1.
- Removal of only 1–1.5 L of fluid at one sitting is recommended, as long as the patient does not develop dyspnea, chest pain, or severe cough 1.
- Re-expansion pulmonary edema can occur after rapid removal of air or pleural fluid from the pleural space and is not necessarily related to the absolute level of negative pleural pressure 1.
The physiological basis for these recommendations is that pleural effusions cause respiratory distress by compressing lung tissue and impairing gas exchange, and proper positioning and management help redistribute the fluid to minimize this compression on the functioning lung tissue. It's essential to note that positioning is a temporary measure to improve comfort and oxygenation while addressing the underlying cause of the pleural effusion.
From the Research
Positioning for Pleural Effusion
To alleviate respiratory distress in patients with pleural effusion, positioning plays a crucial role. The recommended position can help in reducing the discomfort and improving breathing.
- Sitting up or standing can help in reducing the shortness of breath, as gravity can assist in draining the fluid away from the lungs 2, 3.
- Laying back or supine position is not recommended as it can worsen the respiratory distress, as the fluid can spread out and exert more pressure on the lungs.
- Elevating the head of the bed by 30-40 degrees can also help in improving lung expansion and reducing respiratory distress 4.
- Avoiding positions that can exacerbate the condition, such as lying on the affected side, is also important.
Treatment Options
Treatment options for pleural effusion depend on the underlying cause and severity of the condition. Some of the treatment options include:
- Thoracentesis: a procedure to remove excess fluid from the pleural space 2, 3.
- Pleurodesis: a procedure to adhere the pleura together to prevent further fluid accumulation 2, 5.
- Indwelling pleural catheter: a catheter inserted into the pleural space to drain excess fluid 3, 6.
- Pleuroperitoneal shunting: a procedure to transfer fluid from the pleural space to the peritoneal cavity 5.