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Lakartidningen Feb 2022A couple of decades ago, most large pneumothoraces were managed initially through the insertion of large-bore chest tubes, active suction and in hospital admission.... (Review)
Review
A couple of decades ago, most large pneumothoraces were managed initially through the insertion of large-bore chest tubes, active suction and in hospital admission. Mounting evidence has since established that the patient's symptoms, not the size of the pneumothorax, should guide whether invasive management is required for spontaneous pneumothoraces. There is also mounting evidence that small traumatic and iatrogenic pneumothoraces can be managed conservatively. Small-bore chest tubes are just as effective as large-bore chest tubes for all types of pneumothoraces and likely associated with fewer complications. Passive drainage allows for out-of-hospital follow-up for selected patients. This article presents a stepwise approach to the management of pneumothoraces in the emergency department based on a review of the current literature.
Topics: Chest Tubes; Drainage; Emergency Service, Hospital; Humans; Pneumothorax; Treatment Outcome
PubMed: 35226352
DOI: No ID Found -
Respiratory Medicine Jan 2022Pleural effusion is a frequent complication of acute pulmonary infection and can affect its morbidity and mortality. The possible evolution of a parapneumonic pleural... (Review)
Review
Pleural effusion is a frequent complication of acute pulmonary infection and can affect its morbidity and mortality. The possible evolution of a parapneumonic pleural effusion includes 3 stages: exudative (simple accumulation of pleural fluid), fibropurulent (bacterial invasion of the pleural cavity), and organized stage (scar tissue formation). Such a progression is favored by inadequate treatment or imbalance between microbial virulence and immune defenses. Biochemical features of a fibrinopurulent collection include a low pH (<7.20), low glucose level (<60 mg/dl), and high lactate dehydrogenase (LDH). A parapneumonic effusion in the fibropurulent stage is usually defined "complicated" since antibiotic therapy alone is not enough for its resolution and an invasive procedure (pleural drainage or surgery) is required. Chest ultrasound is one of the most useful imaging tests to assess the presence of a complicated pleural effusion. Simple parapneumonic effusions are usually anechoic, whereas complicated effusions often have a complex appearance (non-anechoic, loculated, or septated). When simple chest tube placement fails and/or patients are not suitable for more invasive techniques (i.e. surgery), intra-pleural instillation of fibrinolytic/enzymatic therapy (IPET) might represent a valuable treatment option to obtain the lysis of fibrin septa. IPET can be used as either initial or subsequent therapy. Further studies are ongoing or are required to help fill some gaps on the optimal management of parapneumonic pleural effusion. These include the duration of antibiotic therapy, the risk/benefit ratio of medical thoracoscopy and surgery, and new intrapleural treatments such as antibiotic-eluting chest tubes and pleural irrigation with antiseptic agents.
Topics: Chest Tubes; Drainage; Exudates and Transudates; Fibrinolytic Agents; Humans; Pleura; Pleural Effusion
PubMed: 34896966
DOI: 10.1016/j.rmed.2021.106706 -
Thoracic Cancer Feb 2022To introduce a new postoperative pulmonary rehabilitation program named physical manipulation pulmonary rehabilitation (PMPR) and to explore the effect of perioperative... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
To introduce a new postoperative pulmonary rehabilitation program named physical manipulation pulmonary rehabilitation (PMPR) and to explore the effect of perioperative management, including PMPR, on patients with non-small cell lung cancer (NSCLC) after thoracoscopic lobectomy.
METHODS
A randomized controlled trial was conducted between April and June 2021 at the Department of Thoracic Surgery, Beijing Hospital. Adult patients with NSCLC who had undergone thoracoscopic lobectomy were allocated to the treatment and control groups using a random number table. The treatment group received both conventional pulmonary rehabilitation (CVPR) and 14 days of PMPR after surgery; the control group patients received CVPR only. PMPR included relaxing and exercising the intercostal muscles, thoracic costal joint and abdominal breathing muscles. Pulmonary function tests and the 6-min walk test were conducted preoperatively and 7, 14, 21 and 28 days postoperatively. The postoperative length of hospital stay, chest tube retention time and postoperative pulmonary complications were recorded. The baseline data, pulmonary function parameters and prognosis were compared with t- and chi-square tests between the two groups.
RESULTS
A total of 86 patients were enrolled, and 44 patients were allocated to the treatment group. There were no significant differences in the baseline data for age, sex, body mass index, basic disease, surgical plan or preoperative pulmonary function between the two groups (all p > 0.05). The peak expiratory flow of patients in the treatment group was higher than that of those in the control group 21 days after surgery (316 ± 95 vs. 272 ± 103 l/min, respectively, p = 0.043), and forced expiratory volume in the first second on day 28 after surgery was greater than that in the control group (2.1 ± 0.2 vs. 1.9 ± 0.3 L, respectively, p < 0.001). There were no significant differences in forced vital capacity or 6-min walk test scores (both p > 0.05). There were no significant differences in the incidences of pneumonia and atelectasis between the two groups (both p > 0.05). The postoperative length of hospital stay (3.3 ± 1.3 vs. 3.9 ± 1.5 days, p = 0.043) and chest tube retention time (66 ± 30 vs. 81 ± 35 h, p = 0.036) in the treatment group were shorter than those in the control group.
CONCLUSIONS
We determined that PMPR could improve early lung function in patients with NSCLC after thoracoscopic lobectomy, and that chest tube retention time and length of hospital stay were shortened.
Topics: Adult; Carcinoma, Non-Small-Cell Lung; Chest Tubes; Humans; Length of Stay; Lung; Lung Neoplasms; Pneumonectomy; Thoracic Surgery, Video-Assisted
PubMed: 34882313
DOI: 10.1111/1759-7714.14225 -
Interactive Cardiovascular and Thoracic... Jun 2022The optimal location to insert a chest tube for postoperative drainage has not been identified. We performed a retrospective equivalence study to identify whether the...
OBJECTIVES
The optimal location to insert a chest tube for postoperative drainage has not been identified. We performed a retrospective equivalence study to identify whether the efficiency is similar regarding anterior or posterior position of chest tube in thoracic cavity after video-assisted thoracoscopic surgery for non-small-cell lung cancer.
METHODS
A retrospective review of 4263 patients undergoing non-small-cell lung cancer resection from October 2009 to August 2019 in the Western China Lung Cancer Database was conducted. Propensity score matching was performed to balance baseline characteristics between anterior and posterior groups. Chest tube duration, drainage volume, postoperative complications and hospitalization cost were compared. Equivalence margin was defined as (-1, 1) in 95% confidence interval of the mean difference of chest tube duration.
RESULTS
After propensity score matching, we investigated 2912 patients with anterior or posterior (1456 vs 1456) chest tube location following lung cancer resection. The mean time to chest tube removal was 3.39 days in the anterior group and 3.38 days in the posterior group (P = 0.52), while the mean difference and 95% confidence interval were 0.02 (-0.17, 0.20). The mean postoperative hospital stays in 2 groups were 5.47 vs 5.24 days (anterior vs posterior, P = 0.02). No significant differences were identified regarding the drainage volume during the first 3 postoperative days, postoperative complications and hospitalization cost.
CONCLUSIONS
The comparison of clinical outcomes between anterior and posterior location of chest tube met the criteria for equivalence. For lung cancer patients undergoing video-assisted thoracoscopic surgery resection, it was free choice on anterior or posterior single-tube insertion.
Topics: Carcinoma, Non-Small-Cell Lung; Chest Tubes; Drainage; Humans; Lung Neoplasms; Pneumonectomy; Postoperative Complications; Retrospective Studies; Thoracic Surgery, Video-Assisted
PubMed: 35285910
DOI: 10.1093/icvts/ivac069 -
JAMA Jan 2020Malignant pleural effusion (MPE) is challenging to manage. Talc pleurodesis is a common and effective treatment. There are no reliable data, however, regarding the... (Comparative Study)
Comparative Study Randomized Controlled Trial
Effect of Thoracoscopic Talc Poudrage vs Talc Slurry via Chest Tube on Pleurodesis Failure Rate Among Patients With Malignant Pleural Effusions: A Randomized Clinical Trial.
IMPORTANCE
Malignant pleural effusion (MPE) is challenging to manage. Talc pleurodesis is a common and effective treatment. There are no reliable data, however, regarding the optimal method for talc delivery, leading to differences in practice and recommendations.
OBJECTIVE
To test the hypothesis that administration of talc poudrage during thoracoscopy with local anesthesia is more effective than talc slurry delivered via chest tube in successfully inducing pleurodesis.
DESIGN, SETTING, AND PARTICIPANTS
Open-label, randomized clinical trial conducted at 17 UK hospitals. A total of 330 participants were enrolled from August 2012 to April 2018 and followed up until October 2018. Patients were eligible if they were older than 18 years, had a confirmed diagnosis of MPE, and could undergo thoracoscopy with local anesthesia. Patients were excluded if they required a thoracoscopy for diagnostic purposes or had evidence of nonexpandable lung.
INTERVENTIONS
Patients randomized to the talc poudrage group (n = 166) received 4 g of talc poudrage during thoracoscopy while under moderate sedation, while patients randomized to the control group (n = 164) underwent bedside chest tube insertion with local anesthesia followed by administration of 4 g of sterile talc slurry.
MAIN OUTCOMES AND MEASURES
The primary outcome was pleurodesis failure up to 90 days after randomization. Secondary outcomes included pleurodesis failure at 30 and 180 days; time to pleurodesis failure; number of nights spent in the hospital over 90 days; patient-reported thoracic pain and dyspnea at 7, 30, 90, and 180 days; health-related quality of life at 30, 90, and 180 days; all-cause mortality; and percentage of opacification on chest radiograph at drain removal and at 30, 90, and 180 days.
RESULTS
Among 330 patients who were randomized (mean age, 68 years; 181 [55%] women), 320 (97%) were included in the primary outcome analysis. At 90 days, the pleurodesis failure rate was 36 of 161 patients (22%) in the talc poudrage group and 38 of 159 (24%) in the talc slurry group (adjusted odds ratio, 0.91 [95% CI, 0.54-1.55]; P = .74; difference, -1.8% [95% CI, -10.7% to 7.2%]). No statistically significant differences were noted in any of the 24 prespecified secondary outcomes.
CONCLUSIONS AND RELEVANCE
Among patients with malignant pleural effusion, thoracoscopic talc poudrage, compared with talc slurry delivered via chest tube, resulted in no significant difference in the rate of pleurodesis failure at 90 days. However, the study may have been underpowered to detect small but potentially important differences.
TRIAL REGISTRATION
ISRCTN Identifier: ISRCTN47845793.
Topics: Aged; Chest Tubes; Drainage; Female; Humans; Male; Middle Aged; Pleural Effusion, Malignant; Pleurodesis; Talc; Thoracoscopy; Treatment Failure
PubMed: 31804680
DOI: 10.1001/jama.2019.19997 -
World Journal of Surgery Mar 2021Traditional management of traumatic hemothorax/hemopneumothorax (HTX/HPTX) has been insertion of large-bore 32-40 French (Fr) chest tubes (CTs). Retrospective studies... (Randomized Controlled Trial)
Randomized Controlled Trial
INTRODUCTION
Traditional management of traumatic hemothorax/hemopneumothorax (HTX/HPTX) has been insertion of large-bore 32-40 French (Fr) chest tubes (CTs). Retrospective studies have shown 14Fr percutaneous pigtail catheters (PCs) are equally effective as CTs. Our aim was to compare effectiveness between PCs and CTs by performing the first randomized controlled trial (RCT). We hypothesize PCs work equally as well as CTs in management of traumatic HTX/HPTX.
METHODS
Prospective RCT comparing 14Fr PCs to 28-32Fr CTs for management of traumatic HTX/HPTX from 07/2015 to 01/2018. We excluded patients requiring emergency tube placement or who refused. Primary outcome was failure rate defined as retained HTX or recurrent PTX requiring additional intervention. Secondary outcomes included initial output (IO), tube days and insertion perception experience (IPE) score on a scale of 1-5 (1 = tolerable experience, 5 = worst experience). Unpaired Student's t-test, chi-square and Wilcoxon rank-sum test were utilized with significance set at P < 0.05.
RESULTS
Forty-three patients were enrolled. Baseline characteristics between PC patients (N = 20) and CT patients (N = 23) were similar. Failure rates (10% PCs vs. 17% CTs, P = 0.49) between cohorts were similar. IO (median, 650 milliliters[ml]; interquartile range[IR], 375-1087; for PCs vs. 400 ml; IR, 240-700; for CTs, P = 0.06), and tube duration was similar, but PC patients reported lower IPE scores (median, 1, "I can tolerate it"; IR, 1-2) than CT patients (median, 3, "It was a bad experience"; IR, 3-4, P = 0.001).
CONCLUSION
In patients with traumatic HTX/HPTX, 14Fr PCs were equally as effective as 28-32Fr CTs with no significant difference in failure rates. PC patients, however, reported a better insertion experience. www.ClinicalTrials.gov Registration ID: NCT02553434.
Topics: Adult; Catheters; Chest Tubes; Drainage; Hemopneumothorax; Hemothorax; Humans; Male; Thoracic Injuries; Treatment Outcome
PubMed: 33415448
DOI: 10.1007/s00268-020-05852-0 -
The European Respiratory Journal Jul 2022
Topics: Chest Tubes; Drainage; Humans; Thorax
PubMed: 35863771
DOI: 10.1183/13993003.00434-2022 -
Respiratory Medicine Nov 2010Haemothorax is a problem commonly encountered in medical practice and is most frequently related to open or closed chest trauma or to invasive procedures of the chest.... (Review)
Review
Haemothorax is a problem commonly encountered in medical practice and is most frequently related to open or closed chest trauma or to invasive procedures of the chest. Spontaneous haemothorax is less common and can have various causes, such as the use of anticoagulants, neoplasia, and rupture of pleural adhesions. Identification by radiography and thoracentesis is indicated and treatment of the underlying trauma should start immediately. After insertion of a large chest tube, antibiotic prophylaxis in trauma patients should be administered for 24 h. Further treatment depends on the haemodynamic stability of the patient, the volume of evacuated blood and the occurrence of persistent blood loss. Surgical exploration by VATS or thoracotomy is necessary if >1.500 ml of blood has accumulated and/or an ongoing production of >200 ml of blood per hour is observed. If the haemorrhage is less severe, careful investigation into the underlying cause must be performed and blood should be evacuated by tube thoracostomy. If clotted blood retained in spite of tube thoracostomy, intrapleural fibrinolytic therapy can be applied to breakdown clots and adhesions. If conservative treatment is insufficient, a surgical approach with VATS or thoracotomy is indicated to prevent subsequent complications.
Topics: Anti-Bacterial Agents; Chest Tubes; Hemothorax; Humans; Thoracic Injuries; Thoracotomy; Thrombolytic Therapy
PubMed: 20817498
DOI: 10.1016/j.rmed.2010.08.006 -
Anaesthesiology Intensive Therapy 2021Thoracostomy requires interdisciplinary teamwork. Even though thoracic drainage is a technical surgical procedure, nurses play an important role with major... (Review)
Review
Thoracostomy requires interdisciplinary teamwork. Even though thoracic drainage is a technical surgical procedure, nurses play an important role with major responsibilities during the procedure. This literature review aimed to identify articles related to the interdisciplinary management of thoracostomy. An integrative literature analysis between 2012 and 2019 with a qualitative approach was conducted. An analysis of articles written in English, French, Portuguese, and Spanish was conducted. A search of the PubMed and SCIELO databases was performed using combinations of the terms "Chest Tube; Nursing; Care; Drainage; Insertion". The search terms were included in 11,277 articles. After excluding articles that did not meet the objective of our study, 475 abstracts were analysed. Finally, 19 articles were selected with content focused on nursing care, content related to surgical procedures, and interdisciplinary content. Themes included the following: description of the procedure, interdisciplinary action, quality of the procedure, use of protocols for patient safety, and new technologies. In conclusion, interdisciplinary courses should be encouraged to improve interprofessional teamwork organization. Notwithstanding all these publications, the literature was fragmented into disciplines and isolated analyses. Each medical or nursing discipline addressed the aspects that pertain to its own responsibilities in the execution of the procedure. This review highlighted the need to develop interdisciplinary research and brought a source of rich information that can instrumentalize the creation of optimized processes for the interdisciplinary chest tube insertion.
Topics: Chest Tubes; Drainage; Humans; Thoracostomy
PubMed: 34870385
DOI: 10.5114/ait.2021.111349 -
The Journal of Thoracic and... Mar 2020
Topics: Aged; Artifacts; Calcinosis; Chest Tubes; Device Removal; Diagnosis, Differential; Drainage; Female; Foreign Bodies; Humans; Predictive Value of Tests; Thorax; Tomography, X-Ray Computed
PubMed: 31735386
DOI: 10.1016/j.jtcvs.2019.08.099