Aims and Objectives:~The primary objective of this study is to compare gravity-driven versus wall suction-driven large volume therapeutic thoracentesis on the development of chest discomfort during the procedure.~Expected Outcomes:~We anticipate that gravity driven therapeutic thoracentesis will result in improved clinical outcomes compared to wall suction driven thoracentesis, defined by less chest discomfort throughout the procedure as measured at 5 minutes post-procedure (primary endpoint).~Primary endpoint:~The Global Pain Score will be determined at 5 minutes post-procedure using a VAS 0-100 and represents the pain experienced by the patient during the entire procedure from the beginning to the 5-minute post-procedure assessment (On average, how much discomfort have you felt during the procedure?). The primary endpoint is defined as the overall procedural chest pain scored 5 minutes following the procedure.~This study is a randomized controlled trial designed to compare the changes of chest pain scores between gravity-driven therapeutic thoracentesis and wall suction-driven thoracentesis. The estimated minimal clinically important difference of the change is 10.~Secondary endpoints:~Duration of procedure timed from the beginning of fluid drainage to catheter removal.~Differences in narcotics used after the procedure.~Incidence of pneumothorax detected on the post procedural CXR~Incidence of clinically apparent re-expansion pulmonary edema~Incidence of radiographically apparent re-expansion pulmonary edema detected on the post procedural CXR
The primary objective of this study is to compare gravity-driven versus wall suction-driven large volume therapeutic thoracentesis on the development of chest discomfort during the procedure.~This study is a multicenter, single-blinded, randomized controlled trial designed to compare chest discomfort between gravity-driven and wall suction-driven therapeutic thoracentesis. Patients will be stratified by study centers, and randomly assigned to intervention and control arms; and will remain blinding to their group assignment during the procedure.