Pleural Effusions

My mother had a lot of brownish fluid (2+liters) removed from her chest, yet that was the beginning of her downward spiral into complete lack of oxygen and death within 80 hours since the drainage began, when her O2 level was ok at approx. 95%. The pneumonia was NOT bacterial or virally caused. I think they might have drained the fluid out too quickly (apx 2 1/2 days)

[National Jewish]

Pleural effusion is extra fluid in the space between the lungs and the chest.  This can be caused by infections such as pneumonia.  It can be treated surgically to remove the fluid.  Chest tubes to drain the fluid and a closed-drainage system to gradually open the lung can also treat it.
It is likely that your mother died of respiratory failure.  The process in her lungs that gave rise to the brownish fluid, rapidly progressed, causing extensive lung damage.  I

[RTFLY]

I am sorry to hear of your loss. I can tell you that it is not uncommon to drain off that much fluid in 2 1/2 days. You say the pneumonia was not bacterial or viral. Was it a fungal pneumonia?  Is that what caused your mother to experience the pleural effusion? Also, there are some community-acquired, atypical pneumonias that are hard to diagnose. There are certainly risks involved when doing such invasive procedures(thoracentesis) and I hope that the physician was clear with you on these risks. It would certainly be odd if they drained off that much fluid at once, that is unheard of. But 2+ liters over 72 hours is not. Again, you should seek out the physician who took care of your mother and ask him/her what happened. There may be other factors involved that you may be unaware of. I hope you find your answers. Take care and good luck.
                    
                                               J.C.I. RRT RCP

[RTFLY]

I am sorry to hear of your loss. I can say that it is not uncommon to take that much fluid off in the time frame that you have provided (2+liters/2 1/2 days). Was your mothers pneumonia a fungal infection? You said it wasn't viral or bacterial so I am wondering what the source of infection was. Fungal pneumonias can lead to pleural effusions. There are certainly side effects with the procedure that was performed as I am sure you are aware. However, I would suggest speaking with the physician who cared for your mom and ask him/her what may have been the cause or what may have led to her untimely passing. I am sure they would take the time to answer the questions you have. Again, though...the amount of fluid taken off of your mothers lungs is not uncommon. There may be other factors involved and I'm sure the physicians will provide you with those details. Take care and I hope you get your questions answered.
                                  
                                                J.C.I. RRT RCP

[Fubsy]

Thanks for your comments.
A few months previously my mother had strained her chest, developed a bruise along her clavicle, got pneumonia, was treated at home for a month with antibiotic (in case it was bacterial, which it wasn't) steroids and nebulizer. A chest x-ray she had 13 months prior showed her lungs were clear. Not improving, her m.d. wanted a chest xray taken at the hospital, after which they decided to insert a chest tube, with the bubbling suction machine (there was no discussion of any risks) in her right side, which was most affected. Within a couple hours they had drained 1.35 liters. That's when the crackling "rales" from her lungs began. That night they did a cat scan, saw "shadows" on her lung(s), figuring the lesions were from cancer since she had no temperature, and had smoked till 3 years ago. Treatment (surgery and chemo) was not advisable in her case, home hospice care instead seemed likely.  They never biopsied, or tested the fluid or her sputum, so cancer was never confirmed. I was informed about the "doubling effect" in cancers that could cause them to grow so quickly. She also had some dementia, and bad osteoporosis, arteriosclerosis, so her passing was not an unanticipated event at nearly 80 years....Maybe they couldn't remove the cause of the effusion, but they did remove the cause of the pneumonia, yet her oxygen level went down to critical in only 80 hours, like a kind of emphysema took over now that the lungs were freed from the pressure of the fluid. I also wonder if the shadows might have been from chest trauma, not cancer. It's annoying that this was never definitively resolved. She was still eating 12 hours before her death, oddly enough. If it was cancer, I guess pneumonia is still the "old person's friend."

[RTFLY]

That does sound odd that they just dismissed the "shadows" as cancer and not biopsy the lung. They may have had other reasons why they presumed cancer. As I said before, there are risks when a chest tube is inserted or when they do a thoracentesis to drain fluid. I do not know what caused your mother to pass. However, as the NJC RN mentioned previously, respiratory failure is certainly a component I agree with, that may have contributed to your mom's passing. Sometimes, when the lungs re-expand when fluid is removed, there can be an "overload" of fluid into the blood vessels in the lungs. This can cause edema in the lungs, that is excess fluid in the lungs that can make breathing difficult. It also sounds like rales crackles when heard through a stethoscope. If it is bad enough, you don't need a stethoscope to hear the rales/crackles. This will also cause a drop, sometimes a critical drop, in oxygen levels. I can see how this would be frustrating! Take care...
                                            J.C.I. RRT, RCP

[Fubsy]

Thanks RTFLY,
as I recall, they were going to do a biopsy, but by the 3rd day, the lung dr. seemed to feel, as I recall, the "lesions" were sizable enough that whatever they actually were, it didn't matter. The tube was removed, she was made comfortable and given a morphine drip. He put cancer on her death cert, but admitted to me it was never definitively diagnosed, his experience told him that's what it was.

I was not aware at the time, but have since learned that the fluid can be tested for indication of cancer, they didn't do that either. Would have been simple enough, I would imagine. I'm just a curious type I guess...My dad died in his sleep and cause was never determined in his case.

And yes, you didn't need a stethoscope to hear the crackling, at first I thought the "rales" were a mechanical-type noise, produced by the suction machine, but the nurse advised me they were actually produced by the lungs, opening up. They gave her cough syrup at times, asking her if she could cough. I would of thought there were more sophisticated ways of clearing a demented person's lungs these days, but I guess not.

[RTFLY]

Yes, they can test the fluid that was being drained for cancer however, the doctor didn't feel the need in this case. Rales are produced by the small air sacs in the lungs "popping" open. But they are also caused by fluid in the lungs and lung tissue changes. There are ways of keeping peoples lungs clear of mucous and secretions. The best way is adequate hydration and coughing but...for someone who has dementia, maybe asking her to cough wasn't going to work. Actually cough syrup is used a lot to keep secretions "moving". Guiafenesin is an expectorant found in cough syrups used to keep airway secretions thin and easy to expectorate(cough up). It sounds as if your mother passed in a peaceful way. It is very humane of you to make her comfortable and not delay what seemed to be inevitable. Take care...

[amazon-woman]

I am truly sorry for the loss of your mother. I lost my mother only this last may . She died due to congestive heart failure due to copd. She had had 5 heart attacks back to back, her heart was working at 15% capacity,she lived 1 year like that. She fell and hurt her hand.She also complained of pain in her ribcage. I figured she broke a rib. Finally when she couldn't breathe even with the oxygen she was on she agreed to go to the e.r. She had indeed broke her hand and they admitted her for further testing after a lung exray showed the whole bottom lobe of her lung fluid filled. The tried aspirating with a needle and finally put in a chest tube. The first hour they drained off 3 liters of fluid. she had the tube in for 4 days. With massive amounts of fluid. She had some dementia, wwas hypertensive,had diabetes. The dementia was due to the carbon buildup in her system because her heart wasn't pumping properly. It wasn't so much her lungs. My mom got very depressed due to the fact this hampered her activity and her enjoyment. It was difficult on myself as her caretaker to watch her go downhill. Your mom sounds as if wshe might have had the start of cpod. If it helps, think that she was spared in some way from existing hjust barely. My mom resented her illness so much. I know you miss her as much as I miss my mom and that thought keeps me sane. You see, we lost my dad only 2 months prior to my mom.