Algoritmo diagnóstico y terapéutico de las lesiones esplácnicas provocadas durante la inserción de sondas pleurales / Diagnostic and Therapeutic Algorithm for Splanchnic Injuries Caused during Chest Tube Insertions

Introducción: La colocación de sondas pleurales es un procedimiento quirúrgico frecuente que puede tener graves complicaciones, las cuales dependen en la mayoría de los casos de la experiencia del operador, el tamaño del tubo y el uso de imágenes para guiar la inserción. Objetivo: Describir las principales lesiones esplácnicas provocadas durante la inserción de sondas pleurales y presentar algoritmos para el diagnóstico precoz y el tratamiento oportuno de estas iatrogenias. Métodos: Se realizó una revisión descriptiva narrativa durante el primer trimestre del año 2023. Se utilizaron las bases de datos electrónicas PubMed, LILACS, EBSCO y Cochrane. Se revisaron artículos publicados desde 1984 hasta el 2022. Se procuró que la mayoría de la información se enmarcara en un período no mayor de 10 años de antigüedad. Desarrollo: De las lesiones esplácnicas de la cavidad torácica, la de pulmón es la más frecuente y puede conducir a sangrado o fuga aérea persistente. Las lesiones vasculares son graves y pueden provocar la muerte si no se toman las medidas pertinentes. Se han descrito lesiones de órganos huecos de la cavidad abdominal que suelen ser parte de una hernia diafragmática. Dentro de las lesiones esplácnicas en el abdomen más frecuentes están la hepática y la esplénica. Conclusiones: Estas lesiones son prevenibles y se debe tener en cuenta su mecanismo de producción para evitarlas. Para este fin recomendamos una selección cuidadosa del sitio de inserción, realizar una confirmación adecuada de la posición de la sonda, manipularla cuidadosamente y monitorear constantemente al paciente(AU)

Introduction: Chest tube insertion is a frequent surgical procedure that can have serious complications, which depend mostly on the practitioner's experience, the tube's size and the use of imaging to guide the insertion. Objective: To describe the main splanchnic injuries caused during chest tube insertion, as well as to present algorithms for early diagnosis and timely treatment of these types of iatrogeny. Methods: A descriptive narrative review was performed during the first quarter of the year 2023. The electronic databases PubMed, LILACS, EBSCO and Cochrane were used. Articles published from 1984 to 2022 were reviewed. Most of the information was secured to be framed within a period of no more than 10 years. Development: Among the splanchnic injuries within the thoracic cavity, lung injury is the most frequent and may lead to bleeding or persistent air leak. Vascular injuries are severe and can lead to death if appropriate measures are not taken. Injuries to hollow organs of the abdominal cavity have been described to be usually part of a diaphragmatic hernia. Among the most frequent splanchnic lesions within the abdomen are the hepatic and splenic injuries. Conclusions: These lesions are preventable and their mechanism of production should be taken into account in order to avoid them. To achieve this, we recommend that the insertion site be carefully selected and that the tube's position be adequately confirmed, as well as the careful handling of the tube and the constant monitoring of the patient(AU)

Spontaneous bilateral pneumothorax in a previously healthy COVID-19 patient: A case report

Coronavirus disease 2019 (COVID-19) is commonly linked with mild cough, fever, and shortness of breath symptoms. However, there have been reports of pneumothorax, which particularly occurred at least 1 week following symptom onset in elderly COVID-19 patients. Spontaneous pneumothorax (SP) is an uncommon but possibly fatal complication of COVID-19 pneumonia and is rarely reported in non-intubated patients. We report a case of a healthy, non-smoker 35-year-old young woman who presented with a 7-day cough, fever, and sudden shortness of breath. She was diagnosed with severe COVID-19 pneumonia, experienced a right SP, and developed a second pneumothorax on the contralateral side. She improved gradually following chest tube insertion in the right lung and conservative management for the left pneumothorax.

Early chest tube removal following single-direction versus conventional uniportal video-assisted thoracoscopic lobectomy: A retrospective cohort study / 中国胸心血管外科临床杂志

@#Objective    To explore the feasibility of early chest tube removal following single-direction uniportal video-assisted thoracoscopic surgery (S-UVATS) anatomical lobectomy. Methods    The clinical data of consecutive VATS lobectomy by different surgeons in Xuzhou Central Hospital between May 2019 and February 2022 were retrospectively reviewed. Finally, the data of 1 084 patients were selected for analysis, including 538 males and 546 females, with a mean age of 61.0±10.1 years. These patients were divided into a S-UVATS group with 558 patients and a conventional group (C-UVATS) with 526 patients according to the surgical procedures. The perioperative parameters such as operation time, blood loss were recorded. In addition, we assessed the amount of residual pleural effusion and the probability of secondary thoracentesis when taking 300 mL/d and 450 mL/d as the threshold of chest tube removal. Results    Tumor-negative   surgical margin was achieved without mortality in this cohort. As compared with the C-UVATS group, patients in the S-UVATS group demonstrated significantly shorter operation time (P<0.001), less blood loss (P=0.002), lower rate of conversion to multiple-port VATS or thoracotomy (P=0.003), but more stations and numbers of dissected lymph nodes as well as less suture staplers (P<0.001). Moreover, patients in the S-UVATS demonstrated shorter chest tube duration, less total volume of thoracic drainage and shorter postoperative hospital stay, with statistical differences (P<0.001). After excluding patients of chylothorax and prolonged air leaks>7 d, subgroup analysis was performed. First, assuming that 300 mL/d was the threshold for chest tube removal, as compared with the C-UVATS group, patients in the S-UVATS group would report less residual pleural effusion and less necessitating second thoracentesis with residual pleural effusion>500 mL (P<0.05). Second, assuming that 450 mL/d was the threshold for chest tube removal, as compared with the C-UVATS group, the S-UVATS group would also report less residual pleural effusion and less necessitating second thoracentesis with residual pleural effusion>500 mL (P<0.05). Further multivariable logistic regression analysis indicated that S-UVATS was significantly negatively related to drainage volume>1 000 mL (P<0.05); whereas combined lobectomy, longer operation time, more blood loss and air leakage were independent risk factors correlated with drainage volume>1 000 mL following UVATS lobectomy (P<0.05). Conclusion    The short-term efficacy of S-UVATS lobectomy is significantly better than that of the conventional group, indicating shorter operation time and less chest drainage. However, early chest tube removal with a high threshold of thoracic drainage volume probably increases the risk of secondary thoracentesis due to residual pleural effusion.

Thoracic drainage with traditional chest tube versus central venous catheter after video-assisted thoracoscopic lobectomy: A randomized controlled study / 中国胸心血管外科临床杂志

@#Objective    To evaluate the effectiveness and safety of a central venous catheter for thoracic drainage after video-assisted thoracoscopic lobectomy compared with a conventional chest tube. Methods    This study collected 200 patients with lung cancer who underwent thoracoscopic lobectomy and systematic hilar and mediastinal lymph node dissection between January 2018 and September 2019 in our hospital. The patients were randomly divided into two groups, including a group A (left with 28F chest tubes postoperatively) and a group B (left with 12G central venous catheters postoperatively). Patients in both groups were left with 2 chest tubes after upper lobectomy and 1 chest tube after middle or lower lobectomy. Duration and total volume of drainage, length of hospital stay, maximum visual analogue scale score and so forth were compared between the two groups. Results    Finally, 151 patients were included for analysis. There were 73 patients in the group A, including 26 males and 47 females, with an average age of 55.38±9.95 years, and 78 patients in the group B, including 37 males and 41 females, with an average age of 59.86±10.18 years. No statistical  difference was found between the two groups in drainage volume on postoperative day 2, and proportion of prolonged air leaks, hemothorax, chylothorax or drain reinsertion (all P>0.05). There was a statistical difference in drainage volume on postoperative day 1 [200.0 (120.0, 280.0) mL vs. 57.5 (10.0, 157.5) mL, P=0.000], postoperative day 3 [155.0 (100.0, 210.0) mL vs. 150.0 (80.0, 215.0) mL, P=0.023], total volume of drainage [890.0 (597.5, 1 530.0) mL vs. 512.5 (302.5, 786.3) mL, P=0.000], maximum pain score (2.29±0.72 points vs. 2.09±0.51 points, P=0.013) and length of hospital stay [7 (7, 9) d vs. 5 (4, 7) d, P=0.000]. Conclusion    Compared with conventional chest tubes, central venous catheters for chest drainage in patients with lung cancer after thoracoscopic lobectomy shortens the length of hospital stay and reduces postoperative pain.

Challenging chest drainage: a case report / Drenaje torácico desafiante: reporte de un caso

Introduction. Chest trauma is one of the most common causes of death corresponding to 20 to 25 % of cases. The majority of the patients (85%), can be managed with only a tube thoracostomy. Our objective by presenting this case report is to provide an example of how to manage a challenging chest tube thoracostomy in a patient with cardiac hernia diagnosed in the preoperative phase, based on signs of computed tomography. Case report. A 45-year-old male presented to our emergency department who fell from a light pole 7 meters high. He fell to the ground on his back. Physical examination revealed a huge subcutaneous emphysema on his entire anterior chest wall and presented no sensitivity or movements below the navel line. After the initial assessment and management care, the patient improved. As the patient stabilized we decided to go to CT. The scan revealed pericardial rupture with only the right pericardial circumference intact, the heart herniated into the left pleural space, bilateral pneumothorax, small right hemothorax and a relevant subcutaneous emphysema surrounding the chest. We decided to perform the blunt dissection technique to insert chest tubes bilaterally because of safety. After performed it the patient was transferred to cardiothoracic department. Discussion. There is a variety of techniques to perform tube thoracostomy but the blunt dissection remain the safer, especially when we are facing an anatomic distortion of the heart. Conclusion. We present a case report of a challenging thoracic drainage performed in a patient with traumatic cardiac hernia, which procedure was successful

Introducción. El traumatismo torácico es una de las causas más comunes de muerte y corresponde al 20 a 25 % de los casos. La mayoría de los pacientes (85 %) pueden tratarse solo con toracostomía. Nuestro objetivo al presentar este informe de caso es proporcionar un ejemplo de cómo manejar una toracostomía desafiante en un paciente con hernia cardíaca, diagnosticada en la fase preoperatoria, basada en signos de tomografía computarizada. Presentación del caso. Paciente masculino de 45 años que ingresa a nuestro departamento de emergencias luego de caída de 7 metros de altura (poste de luz), cayendo de espaldas al suelo. El examen físico reveló un enfisema subcutáneo importante en todo el tórax anterior y sin sensibilidad ni movimientos debajo de la línea del ombligo. Después de la evaluación y atención inicial el paciente mejoró y se decidió realizar una tomografía computarizada que reveló la rotura pericárdica, con solo la circunferencia pericárdica derecha intacta, el corazón herniado en el espacio pleural izquierdo, neumotórax bilateral, pequeño hemotórax en el lado derecho y enfisema subcutáneo rodeando completamente el tórax. Se escogió una técnica de disección roma para insertar el tubo torácico en ambos hemitórax, debido a su mayor seguridad. Posteriormente, el paciente fue trasladado al departamento de cirugía cardiotorácica. Discusión. Existe una variedad de técnicas para realizar una toracostomía con sonda, pero la disección roma sigue siendo la más segura, especialmente cuando enfrentamos una distorsión anatómica del corazón. Conclusión. Presentamos el caso de un drenaje torácico desafiante practicado a un paciente con hernia cardíaca traumática, con éxito.

Application of Two Ultrafine Chest Tube for Drainage after Pulmonary Uniportal Video-assisted Thoracoscopic Surgery / 中国肺癌杂志

BACKGROUND@#At present, an ultrafine chest tube combined with a traditional thick tube were often used after pulmonary uniportal video-assisted thoracoscopic surgery (U-VATS). However, the thick tube was often placed in the incision, which increased the risk of poor wound healing and postoperative pain. The aim of this study is to investigate the feasibility and safety of using two ultrafine chest tubes (10 F pigtail tube) for drainage after pulmonary U-VATS.@*METHODS@#The medical records of patients who underwent pulmonary U-VATS during June 2018 and June 2020 in the department of cardiothoracic surgery of the second affiliated hospital of Soochow university were retrospectively reviewed to compare two different drainage strategies, receiving two 10 F pigtail tubes as chest tube (group A) or one 10 F pigtail tube as lower chest tube combined with one 24 F tube as upper chest tube (group B).@*RESULTS@#106 patients in group A receiving two 10 F pigtail tubes during June 2019 and June 2020 and 183 patients in group B receiving one 10 F pigtail tube as lower chest tube combined with one 24 F tube as upper chest tube during June 2018 and June 2019 were included. There was no significant difference between two groups in terms of the postoperative thoracic drainage (mL) (1st: 199.54±126.56 vs 203.59±139.32, P=0.84; 2nd: 340.30±205.47 vs 349.74±230.92, P=0.76; 3rd: 435.19±311.51 vs 451.37±317.03, P=0.70; 4th: 492.58±377.33 vs 512.57±382.94, P=0.69; Total: 604.57±547.24 vs 614.64±546.08, P=0.88), drainage time (d) (upper chest tube: 2.54±2.20 vs 3.40±2.07, P=0.21; lower chest tube: (2.24±2.43 vs 3.82±2.12, P=0.10), postoperative hospital stays (d) (6.87±3.17 vs 7.06±3.21, P=0.63), poor wound healing (0 vs 3.28%, P=0.09), replacement of lower chest tube (0.94% vs 2.19%, P=0.66) and the VAS1 (3.00±0.24 vs 2.99±0.15, P=0.63). Notably, there were significant differences between two groups in terms of the VAS₂ (2.28±0.63 vs 2.92±0.59, P<0.01) and VAS₃ (2.50±1.58 vs 2.79±1.53, P=0.02), as well as the frequency of using additional analgesics (25.47% vs 38.25%, P=0.03) and replacement of the upper chest tube (0 vs 4.37%, P=0.03).@*CONCLUSIONS@#It's feasible and safe to use two 10 F pigtail tubes for drainage after pulmonary U-VATS, which can achieve less postoperative pain and lower frequency of replacement of the upper chest tube on some specific patients.

The advancement of postoperative chest drainage in patients with lung cancer / 中国胸心血管外科临床杂志

@#Chest tube is routinely used after thoracoscopic lung cancer surgery for evacuating air and fluids. Development of enhanced recovery after surgery (ERAS) makes the disadvantages of traditional drainage clearly. In this review, we summarized the advantages and disadvantages of small-bore chest tube, the use of digital drainage system, the time of removing the chest tube, the indications of non chest tube, the improvements of drainage tube hole suture and the complications of chest tube placement after thoracoscopic lung cancer surgery.

Is the recurrence of primary spontaneous pneumothorax predictable?

Background: Recurrence of Primary Spontaneous Pneumothorax (PSP) constitutes a serious challenge for both physicians and patients.Methods: A retrospective study was conducted in 115 patients who had chest tubes at their first onset of PSP. Considering the development of recurrence, two groups were composed and comparatively examined in terms of age, body mass index, smoking status, side and size of initial pneumothorax, presence of bulla and duration of chest tube drainage at the first episode.Results: Among 115 patients with PSP, 24 cases developed recurrence. Male gender was prominently relevant to develop recurrent PSP (p=0.034) whereas remaining inspected parameters revealed no significant relationship with a relapse. Interval between first onset and recurrence of PSP was calculated as 9.2 months. Interestingly, most of the patients developed recurrence in low-temperature months.Conclusions: Recurrence of PSP is substantially unpredictable. Therefore, close follow-up of cases in the following year of their first episode and also informing the patients about probability of a relapse and measures to consider under this circumstance is of great importance.

Profile of tuberculous pneumothorax and comparison with pulmonary tuberculosis without pneumothorax

Background: Tuberculosis is the most common cause of secondary spontaneous pneumothorax (SSP) in India. The prevalence of SSP in patients with pulmonary tuberculosis (PTB) is between 1- 3%. There were only few studies in the literature that specifically analyze tuberculous PNTX. In a study from this hospital, author found PTB was the most common cause of SSP. Now, author aimed at studying the clinical profile of tuberculosis associated PNTX cases and compared with pulmonary tuberculosis cases without PNTX.Methods: This was a single centre prospective observational case control study done at a tertiary care hospital. Fifty patients of tuberculous pneumothorax as cases, and 100 patients of pulmonary tuberculosis without pneumothorax were taken as control. The demographic data, clinical presentation, and radiologic presentation, outcomes after treatment were recorded in both the groups. The data was analyzed using statistical software (SPSS) using appropriate statistical tools.Results: The mean age of patients in the PNTX group was 38.18±14.132, where as in the control group it was 45.29±14.89 (p-value of 0.0052). Past history of tuberculosis was present in 27 (54%) cases of PNTX group and in 41 (41%) cases in the control group (p-value of 0.091). The mean duration of length of hospital stay in PNTX group was 16.5±11.865 days and in non-pneumothorax group was 6.2±2.54 days (p-value was 0.0001).Conclusions: Tuberculous pneumothorax was more common between 30-40 yrs age group. Gender and smoking have no association with PNTX. Tuberculous pneumothorax was more common in previously treated cases of TB. Patients with tuberculous PNTX have prolonged hospital stay and complications resulting in increased morbidity, financial burden and mortality.

The timing of chest tube removal after resection of the lung or esophageal cancer: A randomized controlled study / 中国胸心血管外科临床杂志

@#Objective    To evaluate the timing of chest tube removal after resection of lung or esophageal cancer. Methods    A prospective randomized controlled study was performed. From June 2014 to February 2016, 150 patients suspected as the cancer of lung or esophagus undergoing neoplasm resection and lymph node dissection in our single medical unit were classified into 3 groups according to the random number generated by SPSS17.0 with 50 patients in the each group. The drainage volume for chest tube removal was ≤100 mL/d in the group Ⅰ, 101–200 mL/d in the group Ⅱ, and 201–300 mL/d in the group Ⅲ. Chest radiography was performed 48 hours following chest tube removal. Results    The 127 patients (108 males and 19 females, with an average age of 59.0±8.7 years) eligible for analysis consisted of 45 patients in the group Ⅰ, 41 in the group Ⅱ, and 41 in the group Ⅲ respectively after the 23 patients were excluded from this study who were diagnosed as benign lesions through intraoperative frozen pathology (n=20) and postoperative complications (empyema in 2 patients and chylothorax in 1 patient). Age, sex, types of neoplasm, and comorbidities except procedures via video-assisted thoracic surgery (and laparoscopy) showed no significant difference among the three groups (P>0.05). No mortality was observed in this study. There were postoperative complications in 6 patients and its distribution had no statistical differences among the three groups (P>0.05). The mean postoperative duration of chest tube was 181.0±68.2 h, 111.0±63.1 h, 76.0±37.2 h, the mean drainage volume was 1 413.0±500.9 mL, 1 005.0±686.4 mL, 776.0±505.8 mL, and the mean hospital stay time following chest tube removal was 19.0±9.7 d, 14.0±8.0 d, 9.0±4.8 d in the group Ⅰ,Ⅱ and Ⅲ,  respectively; there was a significant difference among the three groups (P=0.000). The 13 patients required reintervention after chest tube removal due to pleural effusion accumulation and it had no difference among the three groups (P>0.05). Chest pain relieved essentially after chest tube removal in all patients. Conclusion    A drainage volume of ≤300 mL/d as a threshold for chest tube removal after resection of lung or esophageal cancer can shorten postoperative hospital stay and accelerate early recovery of the patients.

Videothoracoscopic surgery before and after chest tube drainage for children with complicated parapneumonic effusion / Cirurgia torácica vídeoassistida antes e depois de drenagem torácica em crianças com derrame parapneumônico complicado

Abstract Objectives To evaluate the effectiveness of videothoracoscopic surgery in the treatment of complicated parapneumonic pleural effusion and to determine whether there is a difference in the videothoracoscopic surgery outcome before or after the chest tube drainage. Methods The medical records of 79 children (mean age 35 months) undergoing videothoracoscopic surgery from January 2000 to December 2011 were retrospectively reviewed. The same treatment algorithm was used in the management of all patients. Patients were divided into two groups: in group 1, videothoracoscopic surgery was performed as the initial procedure; in group 2, videothoracoscopic surgery was performed after previous chest tube drainage. Results Videothoracoscopic surgery was effective in 73 children (92.4%); the other six (7.6%) needed another procedure. Sixty patients (75.9%) were submitted directly to videothoracoscopic surgery (group 1) and 19 (24%) primarily underwent chest tube drainage (group 2). Primary videothoracoscopic surgery was associated with a decrease of hospital stay (p = 0.05), time to resolution (p = 0.024), and time with a chest tube (p < 0.001). However, there was no difference between the groups regarding the time until fever resolution, time with a chest tube, and the hospital stay after videothoracoscopic surgery. No differences were observed between groups regarding the need for further surgery and the presence of complications. Conclusions Videothoracoscopic surgery is a highly effective procedure for treating children with complicated parapneumonic pleural effusion. When videothoracoscopic surgery is indicated in the presence of loculations (stage II or fibrinopurulent), no difference were observed in time of clinical improvement and hospital stay among the patients with or without chest tube drainage before videothoracoscopic surgery.

Resumo Objetivos Avaliar a eficácia da cirurgia torácica videoassistida no tratamento de derrame pleural parapneumônico complicado e determinar se há diferença no resultado da cirurgia torácica videoassistida realizada antes ou depois da drenagem torácica. Métodos Analisamos retrospectivamente prontuários médicos de 79 crianças (idade média de 35 meses) submetidas a cirurgia torácica videoassistida de janeiro de 2000 a dezembro de 2011. O mesmo algoritmo de tratamento foi utilizado no manejo de todos os pacientes. Os pacientes foram divididos em dois grupos: o Grupo 1 foi submetido a cirurgia torácica videoassistida como procedimento inicial; o Grupo 2 foi submetido a cirurgia torácica videoassistida após drenagem torácica prévia. Resultados A cirurgia torácica videoassistida foi eficaz em 73 crianças (92,4%); as outras seis (7,6%) necessitaram outro procedimento. Sessenta pacientes (75,9%) foram diretamente submetidos a cirurgia torácica videoassistida (Grupo 1) e 19 (24%) foram primeiramente submetidos a drenagem torácica (Grupo 2). A cirurgia torácica videoassistida primária foi associada à redução do tempo de internação (p = 0,05), do tempo para resolução (p = 0,024) e do tempo com o tubo torácico (p < 0,001). Contudo, não houve diferença entre os grupos a respeito do tempo até que não tivessem mais febre, do tempo com o tubo torácico e do tempo de internação após a cirurgia torácica videoassistida. Não foram observadas diferenças entre os grupos com relação à necessidade de cirurgia adicional e à presença de complicações. Conclusões A cirurgia torácica videoassistida é um procedimento altamente eficaz para tratar crianças com derrame pleural parapneumônico complicado. Quando a cirurgia torácica vídeoassistida é indicada na presença de loculações (fase II ou fibrinopurulenta) não há diferença no tempo de melhora clínica e no tempo de internação entre os pacientes com ou sem drenagem torácica antes da cirurgia torácica videoassistida.

Effectiveness of medical thoracoscopy and thoracoscopic talc poudrage in patients with exudative pleural effusion

<p><b>INTRODUCTION</b>This study aimed to assess the effectiveness of medical thoracoscopy (MT) and thoracoscopic talc poudrage (TTP) in patients with exudative pleural effusion.</p><p><b>METHODS</b>We evaluated the diagnostic yields, complications and outcomes of MT and TTP in 41 consecutive patients with symptomatic pleural effusions who were planned to undergo both procedures from 1 December 2011 to 30 November 2012. Data was reviewed retrospectively and prospectively up to March 2013.</p><p><b>RESULTS</b>Among the 41 patients, 36 underwent MT with the intent of biopsy and talc pleurodesis, 2 underwent MT for pleurodesis only and 3 had failed MT. Aetiologies of pleural effusion included lung cancer (n = 14), tuberculosis (n = 9), breast cancer (n = 7), ovarian cancer (n = 2), malignant mesothelioma (n = 1), congestive cardiac failure (n = 1), peritoneal dialysis (n = 1) and hepatic hydrothorax (n = 1); pleural effusion was undiagnosed in five patients. The overall diagnostic yield of MT, and the yield in tubercular and malignant pleural effusions were 77.8%, 100.0% and 82.6%, respectively; it was inconclusive in 22.2%. Complications that occurred were self-limiting, with no procedure-related mortality. The 30-day mortality rate was 17.1%. A total of 15 patients underwent TTP. The 30-, 60- and 90-day success rates were 77.8%, 80.0% and 80.0%, respectively, with one patient having complications (i.e. empyema). The 30-day mortality was 40.0%.</p><p><b>CONCLUSION</b>MT is a safe procedure with high diagnostic yields in undiagnosed pleural effusions. TTP is an effective method to stop recurrence of pleural effusions.</p>

Cervical and transdiaphragmatic paraxiphoid thoracoscopy in dogs: evaluation of respiratory response and blood pressure / Toracoscopias cervical e paraxifóide transdiafragmática em cães: aplicação de técnica e avaliação da resposta respiratória e pressão sanguínea

This study evaluated the cervical and transdiaphragmatic thoracoscopic approaches regarding their implementation, intrathoracic evaluation and application of a chest tube, using the treatment of pneumothorax as an experimental model. After injection of 20ml kg-1 of air per hemithorax, thoracoscopy was made by transdiaphragmatic paraxiphoid or cervical positions. After cavity examination, a thoracic drain was inserted using the surgical site to drain the pneumothorax. The cardiorespiratory function and arterial blood gas were measured during time of evaluation. The cavity examination allowed visualizing the aspect and function of intrathoracic structures. There were no significant differences between the two approaches when comparing the measurements made in each period evaluated. Both enabled intracavitary exploration and application of thoracic drain. Cervical access shows viability, but resulted in the death of two patients, and it not recommended as a substitute for the latter in the insertion of thoracic drains in dogs.

Este estudo avaliou os acessos toracoscópicos cervical e paraxifóide em relação à sua aplicação, avaliação intratorácica e colocação de dreno torácico, utilizando o tratamento de pneumotórax como modelo experimental. Após a injeção de 20ml kg-1 de ar por hemitórax, a toracoscopia foi realizada pelas técnicas cervical ou paraxifóide transdiafragmática. Após a exploração da cavidade, foi inserido um dreno torácico utilizando o acesso cirúrgico para drenar o pneumotórax. A função cardiorrespiratória e a gasometria arterial foram aferidas durante o tempo de avaliação. A exploração da cavidade permitiu visualização do aspecto e função das estruturas intratorácicas. Não houve diferenças significativas entre os dois acessos quanto aos dados aferidos em cada período de avaliação. Ambos permitiram exploração intracavitária e aplicação do dreno torácico. O acesso cervical demonstra viabilidade, porém resultou na morte de dois pacientes, e não é recomendado como substituta à paraxifóide transdiafragmática para a aplicação de drenos torácicos em cães.

Feasibility and safety of early chest tube removal after complete video-assisted thoracic lobectomy.

OBJECTIVE: The aim was to evaluate the feasibility and safety of early chest tube removal after complete video‑assisted thoracic lobectomy (CVATL). METHODS: Retrospective analysis was performed on effects of chest tube removal on patients with lung cancer after pulmonary lobectomy between November 2013 and October 2014. 154 eligible patients included 97 cases for CVATL and 57 cases for open thoracic lobectomy. Patients with CVATL were divided randomly into experimental group (EG) and control group (CG), in which 51 patients in EG had chest tube removal on the 2nd day after operation; 46 patients in CG had the tube removal when the drainage volume <100 ml/day. Patients in open thoracic lobectomy group (OG) had the tubes removal as CG. The drainage volumes of the 1st and 2nd 24 h after operation, duration of chest tubes, cases of pain alleviation, and recurrent pleural effusions requiring reintervention were measured. RESULTS: The average drainage volume of the 1st 24 h after operation of CVATL group from EG and CG was significantly reduced than that in OG (260.41 ml vs. 353.16 ml, P < 0.001). The average drainage volume of the 2nd 24 h after operation of CG was significantly reduced than that in OG (163.91 ml vs. 222.98 ml, P < 0.001). The average duration of chest tube of CG for 2.98 days showed significant different compared with OG for 3.81 days (P < 0.001). Chest tube removal in CVATL group increased more chest pain alleviation than OG (80.4% vs. 56.1%, P = 0.001). The frequencies of recurrent pleural effusions requiring reintervention were 5.88% (3/51), 4.35% (2/46) and 5.26% (3/57), respectively, which had no significant differences between three groups (P = 1.000). CONCLUSIONS: Complete video‑assisted thoracic lobectomy brings less drainage volume after operation. Early removal of chest tube in CVATL shows feasible and safe and demonstrates that it may reduce postoperative pain and help fast recovery.

Effects of tube size for drainage on flow rate of different kinds of fluid studied in vitro / 中华急诊医学杂志

Objective To determine the appropriate size of the tube for the thoracic drainage in good efficiency by the experimental study in the influence of the tube size on the flow rate of the fluid with different properties.Methods Three groups were divided according to the different components in the fluid:group A,whole blood with 30％ hematocrit; group B,2.5％ albumin solution; and group C,0.9％ normal saline.The total volume of the fluid was 1000 mL in each group in the experiment.Different sorts of fluids were drained with the chest tubes with different diameters (6F,8F,10F,12F,14F,16F,18F,20F,22F,24F,26F,28F,30F,32F,34F,36F of French F) separately,and the flow rate was calculated.ANOVA was used for the comparison of the differences in flow rate among the groups with given fluid property.Twofactor analysis of variance was used for the analysis of flow rates of fluid with different fluid properties.Curve fitting was performed according to the Poiseuille formula.Results The flow rate was positively correlated with the size of the chest drainage tube.The difference in flow rate among the tubes with difference in size was statistically significant (P ＜ 0.05) but there was no noticeable difference in flow rate between 6F and 8F (P =0.513).The flow rate of the 6F and 8F tubes was higher than that of the control (3.33 mL/min) but there was no significant difference between them (P ＞ 0.05).The flow rate of the tubes in 10F and above was obviously higher than that of control (P ＜ 0.05).The curve was estimated that group A was Q =0.002 9x4,R2 =0.991; group B Q=0.003 2x4,R2 =0.981; group C Q =0.003 4x4,R2 =0.975.When the flow rate was fixed at 3.33 mL/min,the estimated curve in group A was X ≈ 5.82F.Conclusions Our experiment indicated that the chest tube with small diameters (6F-14F) could meet the demand of high efficient drainage in the patients with hemothorax or pleural effusion.

Empyema Thoracis in Children: A Short Term Outcome Study.

This study prospectively evaluates clinical course of pyogenic empyema thoracis in 25 children (2 mo – 12 y) treated with injectable antibiotics and chest tube drainage, and followed for 6 weeks. The median (range) age at presentation was 3 y (4 mo to 11 y). The pleural fluid culture was positive in 24% of patients. Staphylococcus aureus was the most commonly isolated organism. The median (range) duration of injectable antibiotics was 14(14-52) d; median duration of total antibiotics (injectable and oral) was 4 weeks. The median (range) duration of chest tube insertion and hospital stay was 8(5-45) and 14(14-56) days, respectively. All patients were discharged without any surgical intervention besides chest tube drainage. At discharge, pleural thickening was present in 84% and crowding of ribs was seen in 60% of the subjects on radiological examination. All these patients were asymptomatic at discharge. Chest deformity was present in 20% of the patients at 6-weeks follow up. Antibiotics and chest tube drainage is an effective method of treating pyogenic empyema thoracis in children in resource-poor settings.

Predictive Factors of Re-expansion Pulmonary Edema of Patients with Large Spontaneous Pneumothorax after Chest Tube Insertion

PURPOSE: Reexpansion pulmonary edema (REPE) is rare but sometimes fatal complications can follow chest tube insertion for treatment of pneumothorax. The study assessed the medical records of patients who developed large pneumothroax and searched for the predictive factors and prediction equation for REPE. METHODS: The medical records of patients treated at an emergency department for pneumothorax from January 1, 2008 to December 31, 2009 were reviewed retrospectively. We compared the group that developed REPE with the group that did not develop REPE for clinical and demographic factors. Logistic regression analysis was used to identify predictive factors and prediction equation. We used receiver operator characteristic (ROC) curve analysis to identify optimal cut-off value and assessed the validity of the prediction equation. RESULTS: We screened out 92 large pneumothorax patients among 578 pneumothorax patients. Twenty two cases developed REPE. The calculated prediction equation was 28.955+0.147xsymptom duration before chest tube insertion (days)+0.048xsize of pneumothorax(%)-0.359xSaO2 (%). The results of assessment of the prediction equation using ROC curve analysis were Area under the ROC curve=0.834 and sensitivity 90.9% and specificity 70.0% at the cut-off value 0.210. CONCLUSION: In patients with large pneumothorax, time interval between symptom development and chest tube insertion, size of pneumothorax, and oxygen saturation rate of peripheral artery blood were identified as predictive factors. The prediction equation that we developed for REPE showed good predictability.

A Case of Focal Reexpansion Pulmonary Edema after Chest Tube Insertion / 결핵및호흡기질환

Reexpansion pulmonary edema is not a common phenomenon after chest tube insertion but some reports from 0% to 14%. There are various resulting complications, including acute respiratory distress syndrome. We report a case of focal reexpansion pulmonary edema after chest tube insertion. A 49-year-old male came to the hospital due to ongoing dyspnea and left chest pain for 3 days. On chest X-ray, the patient had a left pneumothrax. We planned to insert a chest tube for symptom relief. To determine whether or not the chest had expanded as a result of the chest tube insertion, the patient underwent repeated chest X-rays the following day. The patient experienced brief respiratory symptoms upon initial suction; a chest PA showed patchy consolidated infiltration at the inserted site. After 5 days of conservative management, the recovered completely.

A controlled study between central venous catheter and conventional chest tube for closed pleural drainage in the treatment of traumatic hemothorax / 中华急诊医学杂志

Objective To evaluate file efficacy and safty of central venous cathetr compared with conventional chest tube for closed pleural drainage in the treatment of traumatic hemothorax Method Totally 299 patients of traumatic hemothorax with middling or large effusions,in emergency department,Second Hospital .Affiliated to Medical College of Zhejiang University,from January 2003 to May 2007,were prospective controlled studied.All the 299 patients of were divided into catheter group (n=156) or tube group(n=143) according as patients'hospitalization date was odd or even number respectively.Patients in catheter group underwent drainage by central venous catheter using the Seldinger technique,and patients in tube group did by conventional chest tube using conventional technique.A unue drainage bag system or a wate seal system was connected with the end of the catheter or the tube respectively.The surgical operation time,the successful rate of treatment,the occurreuce rate of serious complications,the using rate of anodyne,the time of cut concrescence and the occurrence rate of cut infection were compared,and the drainage time and the correlative expenses in patients treated successfully were further compared.The data were analyzed by using t or X2 test with SPSS 13.0.A P value less than 0.05 indicated statistical signficance.Results Compared with robe group,the surgical operation time,the using rate of anodyne,the time of cut concrescence and the occurrence rate of cut infection were significantly decreased(P<0.05) in catheter group.There were not significant differences between two groups in the suecessful rate of treatment and the occurrence rate of serious complications(P>0.05).There were not significant differences between two groups in the drainage time and the corrective expenses of patients treated successfully(>0.05).Conclusions Use of central venous catheter catheters for closed pleural drainage in the treatment of traumatic hemothorax is effective,safe,and well-tolerated.It was more simple and less invasive as a procedure compared with conventional large-bore chest robe.

Retiro de la sonda de pleurostomia con succión negativa continua versus instalación de sonda con sello de agua, en cirugía cardiovascular cerrada en niños / Withdrawal of chest tubes without water seal vs. negative continuous suction after closed cardiovascular surgery procedures in children

Objetivo: identificar la frecuencia y tipo de complicaciones, así como tiempo de estancia hospitalaria, en niños con cirugía cardiovascular a quienes se les dejó sonda de pleurostomía con sello de agua en el posoperatorio y a quienes se les retiró bajo succión continua al término de la toracotomía. Material y métodos: se realizó estudio descriptivo, comparativo y retrospectivo en el Hospital de Pediatría, Centro Médico Nacional Siglo XXI. Se estudiaron 88 niños sin sonda (grupo I) y 42 con sonda de pleurostomía (grupo II), sometidos a cirugía cardiovascular cerrada. Resultados: la frecuencia de complicaciones fue de 27.3 y 59.5 % en los grupos I y II. El enfisema subcutáneo tuvo una frecuencia de 13.6 % en el grupo I y de 45.2 % en el II (p = 0.0001); el neumotórax de 13.6 versus 28.6 % (p = 0.04) y el quilotórax de 2.3 versus 2.4 % (p = 1.0). La mediana del tiempo de estancia hospitalaria fue de tres y seis días en los grupos I y II, respectivamente (p = 0.0001). Conclusiones: en algunos tipos de cirugía cardiovascular cerrada en niños, el retiro de la sonda al término de la pleurostomía previa succión negativa continua, puede disminuir la frecuencia de neumotórax y enfisema subcutáneo y la estancia intrahospitalaria, en comparación cuando se deja la sonda con sello de agua en el posoperatorio.

BACKGROUND: We undertook this study to compare the frequency and type of complications, as well as the length of hospital stay, in children who underwent closed cardiovascular surgery with chest tube drainage during the postsurgical period with children in whom the drainage was withdrawn with continuous suction, once thoracotomy was completed. METHODS: A retrospective, descriptive and analytic study was performed at the IMSS Hospital de Pediatria, located at the XXI Century National Medical Center in Mexico City. Eighty eight children who underwent closed cardiovascular surgery (Group I) without chest tubes and 42 with chest tubes (Group II) were studied. RESULTS: In Group I the frequency of complications was 27.3% and in group II 59.5%. Complications were as follows: subcutaneous emphysema was seen in 13.6% (n=12) of group I and in 45.2% (n=19) of group II (p=0.0001); pneumothorax in 13.6% (n=12) vs. 28.6% (n=12), p=0.04; and chylothorax in 2.3% (n=2) vs. 2.4% (n=1), p=1.0, respectively. The median time of hospital stay in group I was 3 days and in group II was 6 days (p=0.0001). CONCLUSIONS: In children, in some closed cardiovascular surgeries, withdrawal of chest tube drainage with negative suction when thoracotomy is completed may decrease the frequency of pneumothorax, subcutaneous emphysema and length of hospital stay, in comparison with patients in whom chest tube drainage is left during the postoperative period.