The Frequency of Reexpansion Pulmonary Edema after Trocar and Hemostat Assisted Thoracostomy in Patients with Spontaneous Pneumothorax

PURPOSE: Several risk factors for development of reexpansion pulmonary edema (REPE) after drainage of pneumothoraces have been reported, but the association between the method of thoracostomy and the development of REPE is unknown. The aim of this study was to compare the frequency of REPE after treatment of spontaneous pneumothorax with trocar or hemostat assisted closed thoracostomy. MATERIALS AND METHODS: We performed a prospective, observational study including 173 patients with spontaneous pneumothorax who visited the emergency department from January 2007 to December 2008. In 2007, patients were treated with hemostat-assisted drainage, whereas patients in 2008 were treated with trocar-assisted drainage. The main outcome was the development of REPE, determined by computed tomography of the chest 8 hours after closed thoracostomy. Outcomes in both groups were compared using univariate and multivariate analyses. RESULTS: Ninety-two patients were included, 48 (42 males) of which underwent hemostat-assisted drainage and 44 (41 males) underwent trocar-assisted drainage. The groups were similar in mean age (24+/-10 vs. 26+/-14 respectively). The frequencies of REPE after hemostat- and trocar-assisted drainage were 63% (30 patients) and 86% (38 patients) respectively (p=0.009). In multivariate analysis, trocar-assisted drainage was the major contributing factor for developing REPE (odds ratio=5.7, 95% confidence interval, 1.5-21). Age, gender, size of pneumothorax, symptom duration and laboratory results were similar between the groups. CONCLUSION: Closed thoracostomy using a trocar is associated with an increased risk of REPE compared with hemostat-assisted drainage in patients with spontaneous pneumothorax.

Preemptive epidural analgesia for post thoracotomy pain

Pain treatment before surgery can minimized pain after surgery, may reduce anaesthestic need during the procedure, and could minimized the risk of chronic pain conditions developing in long term [1]. The aim of this study was to determine if preemptive epidural analgesia performed before thoracotomy incision and during the operation reduces post operative pain. In this randomized, double -blinded placebo controlled study, Patients in the treatment group received 8 ml of 0.25% bupivacaine and 2mL of fentanyl [50micro g /ml] via the epidural route prior to skin incision, followed by an infusion of bupivacaine 0.1% and fentanyl 10 micro g/mL at 6ml/hr. while the control group received saline in the epidural. At the time of chest closure patients of both groups received 8 ml of 0.25% bupivacaine and 2 mL of fentanyl 50 micro g/ml via the epidural route. The patients in the treatment group had lower maximum pain scores in the first six hours postoperatively. In addition they required less isoflurane intraoperatively. No significant differences were noted after the first six hours. Preemptive thoracic epidural analgesia appeared to reduce severity of post -thoracotomy pain but did not extend beyond six hours postoperatively

Manejo protocolizado de la toracostomía mínima en pacientes traumatizados, hospital escuela Antonio Lenin Fonseca, junio 2003- marzo 2005 / Manage protocolized of the minimum toracostomía in traumatized patients, hospital school Antonio Lenin Fonseca, June 2003 - March 2005

El traumatismo de tórax constituye una de las causas más comunes de consulta en el Servicio de Cirugía General del HEALF, siendo la toracostomía la principal terapia en pacientes con hemoneumotórax traumático. Las pautas para su manejo aún varían ampliamente en cuanto a utilización de antibióticos, radiografías y criterios de retiro del tubo de tórax. En dicho cewntro, en el período junio 2003 a marzo 2005 se estandarizó un protocolo de manejo de la toracostomía tubo de tórax conectado a succión continua y luego a sello de agua, uso de antibióticos profilácticos, realización de menos radiografías de control y reducción de la estancia hospitalaria, comparándolo con los pacientes tratados de forma convencional (sello de agus únicamente). La diferencia entre grupos fue evaluada con las pruebas de Chi Cuadrado y Mann Withney "U" test. Fueron 25 pacientes en el grupo experimental y 30 pacientes en el grupo de control. En el primer grupo la estancia hospitalaria logró reducirse a dos días o menos y a dos radiografías de control. En ambos se observó igual número de complicaciones; perpo con un importante ahorro ecnómico de aproximadamente 45, 000 córdobas en el grupo experimental

Re-expansion pulmonary oedema: revisited.

A case of re-expansion pulmonary oedema (RPO) following chest tube insertion for left spontaneous pneumothorax is reported. There were no severe symptoms and routine chest radiograph done four hours after tube thoracostomy showed features of pulmonary oedema in the re-expanded left lung. RPO is an uncommon complication of rapid pleural drainage of air or fluid with potentially serious cardiopulmonary manifestations but appears to run a benign course if there is no prior systemic hypoxaemia and if pneumothorax is drained without suction. Chest radiograph should be done routinely within four hours after chest tube insertion for early detection of RPO.

Empyema thoracits in children: results of tube thoracostomy and decortication

Empyema thoracis is a common surgical complication of pneumonia. Various modes of treatment are described for the management of this condition. This study describes results of different modes of management of empyema thoracis. During a period of one year, 25 patients of post pneumonic empyema thoracis were managed at the Department of Paediatric Surgery at National Institute of Child Health [NICH], Karachi. There were 11 male and 14 female patients. Majority of patients [56%] was under five years of age. Tube thoracostomy resulted in expansion of lungs in 12 cases [Group I], while decortication was performed in 13 patients [Group II]. Lobectomy was performed in one case. Complications were noted in: a] patients who presented late with organized stage, b] patients in whom air leaks persisted for longer duration and c] in whom lung expansion was also delayed. One patient in this series died. At follow-up asymmetry of chest wall was noted in 5 patients of Group II. The hospital stay of Group I patients on average was 11.8 days in comparison to Group II where it was 31.3 days. The postdecortication stay average was 14 days. Tube thoracostomy in early stage of disease results in expansion of lung in most of the cases. Decortication is well tolerated in children and procedure related complications are few, therefore, decortication should not be delayed if no or partial response is observed in patients with tube thoracostomy

Atualidades em drenagem torácica / News on thoracic drainage

Procedimentos terapêuticos de drenagem pleuro-mediastinal fechada têm recebido substanciais modificações e novas proposições no decorrer da última década, no intuito de se minimizar intercorrências com um máximo de eficiência. Descrevem-se as atuais indicações, complicações, técnica e manuseio da drenagem torácica frente às principais toracopatias

Lesäo da artéria torácica interna por dreno torácico: relato de caso / Internal thoracic artery injury caused by chest tube: a case report

Relata-se caso raro de lesäo da artéria torácica interna por dreno torácico, em paciente com empiema pleural crônico. A rotura desse vaso, levando o paciente ao choque hipovolêmico e hemoptise maciça, indicou a cirurgia. Enfatizam-se os cuidados na drenagem torácica e a importância do controle radiológico pós-drenagem.

Post-traumatic empyema thoracis in blunt chest trauma.

Three out of 42 patients who had isolated blunt chest injury requiring closed tube thoracostomy developed post-traumatic empyema thoracis. All of them were treated by thoracotomy and evacuation of the infected fluid with multiple chest tube drainage. Cultures of the pleural fluid grew Staphylococcus aureus in these 3 patients. Univariate analysis was performed by using Fisher's exact test which revealed the significance of age in association with the development of empyema thoracis. Multivariate analysis was performed by using Logistic Regression. Although no statistical significance was observed, the analysis revealed that the risk of empyema thoracis increased in elderly patients and in patients who had prolonged placement of thoracostomy tube. Intensive pulmonary care in elderly patients who sustained chest injury and early removal of thoracostomy tube is recommended in order to prevent the development of empyema thoracis.

Cirurgia torácica video-assistida: nova alternativa cirúrgica no tratamento de doenças torácicas / Video-assisted thoracic surgery: a new surgical alternative for the tretment of thoracic diseases

Visando analisar prospectivamente a precisäo e segurança desta nova abordagem operatória, foram estudados 53 doentes submetidos à cirurgia torácica vídeo-assistida, para diagnóstico (22 doentes; 41,4 por cento), para tratamento (22 doentes; 41,4 por cento) e ambos (9 doentes; 17,2 por cento). O rendimento diagnóstico e os resultados terapêuticos obtidos foram de 100 por cento no seguimento pós-operatório de até 540 dias. A cirurgia torácica vídeo-assistida - videopleuroscopia - é um procedimento cirúrgico minimamente invasivo, com grande segurança facilitada por excelentes condiçöes de visäo, com rápida recuperaçäo dos doentes e ótimo rendimento diagnóstico e terapêutico

Técnica quirúrgica: drenajes torácicos / Surgical technic: thoracic drenage

El empleo adecuado de la toracocostomía con sonda produce como resultado el drenaje de aire y/o líquidos acumulados en la cavidad pleural y contribuye a la ocupación completa de esta cavidad por el pulmón, con lo cual disminuye el número de complicaiones pleuropulmonares subsecuentes. Además, constituye un método de vigilancia continua de este espacio, mediante la cuantificación de aire y/o líquidos que se extraen. En este artículo explicamos en forma simple la utilización de los tubos de drenaje (drenes) que con mayor frecuencia se usan en patología pleuropulmonar. Sus indicaciones, instalación, manejo, tipo de tubos y frascos, complicaciones y momento de retiro serán los tópicos a tratar