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Thrombosis Research Apr 2012Venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE), is the third most common cardiovascular disease after coronary artery... (Review)
Review
Venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE), is the third most common cardiovascular disease after coronary artery disease and cerebrovascular disease and is responsible for significant morbidity and mortality in the general population. Full dose anticoagulation is the standard therapy for VTE, both for the acute and the long-term phase. The latest guidelines of the American College of Chest Physicians recommend treatment with a full-dose of unfractioned heparin (UFH), low-molecular-weight-heparin (LMWH), fondaparinux, vitamin K antagonist (VKA) or thrombolysis for most patients with objectively confirmed VTE. Catheter-guided thrombolysis and trombosuction are interventional approaches that should be used only in selected populations; interruption of the inferior vena cava (IVC) with a filter can be performed to prevent life-threatening PE in patients with VTE and contraindications to anticoagulant treatment, bleeding complications during antithrombotic treatment, or VTE recurrences despite optimal anticoagulation. In this review we summarize the currently available literature regarding interventional approaches for VTE treatment (vena cava filters, catheter-guided thrombolysis, thrombosuction) and we discuss current evidences on their efficacy and safety. Moreover, the appropriate indications for their use in daily clinical practice are reviewed.
Topics: Embolic Protection Devices; Evidence-Based Medicine; Humans; Mechanical Thrombolysis; Suction; Treatment Outcome; Venous Thromboembolism
PubMed: 22119500
DOI: 10.1016/j.thromres.2011.11.003 -
Medicine Dec 2019Close suction drainage systems are widely used in orthopedics and spine surgeries. There are less studies investigating the outcomes of using subfascial closed suction... (Comparative Study)
Comparative Study Observational Study
Close suction drainage systems are widely used in orthopedics and spine surgeries. There are less studies investigating the outcomes of using subfascial closed suction drains in adolescent patients who had undergone idiopathic scoliosis surgery. We evaluated the outcomes of patients with and without closed suction drainage and to investigate whether close suction drainage is needed after adolescent idiopathic scoliosis (AIS) surgery.We retrospectively investigated 63 patients, who underwent posterior spinal surgery for AIS from January 2015 to January 2018. The patients were divided into the following groups: Groups A (drainage group) and B (nondrainage group). We evaluated the wound drainage (wound oozing), need for transfusion, preoperative and postoperative hemoglobin levels, length of hospital stay, and postoperative blood loss from closed suction drains. Patients' scoliosis was categorized according to the Lenke Classification System for Scoliosis. The level of instrumentations was also evaluated.The median postoperative hemoglobin level was lower in group A than in group B. Postoperatively, group A underwent more blood transfusions than group B. Postoperative hospital stay was also significantly longer in group A than in group B. There was no statistical difference in the infection rate between the two groups.Using drains after AIS surgery increases hospital stay duration, blood transfusion rate and patients' anxiety of drain tube removal. Thus, closed suction drainage may not be suitable after AIS surgery.
Topics: Adolescent; Cohort Studies; Female; Follow-Up Studies; Humans; Length of Stay; Male; Orthopedic Procedures; Reference Values; Retrospective Studies; Risk Assessment; Scoliosis; Severity of Illness Index; Statistics, Nonparametric; Suction; Surgical Wound Infection
PubMed: 31860955
DOI: 10.1097/MD.0000000000018061 -
Journal of Cardiothoracic Surgery Apr 2021We investigated the most effective suction pressure for preventing or promptly improving postoperative air leaks on digital drainage devices after lung resection.
BACKGROUND
We investigated the most effective suction pressure for preventing or promptly improving postoperative air leaks on digital drainage devices after lung resection.
METHODS
We retrospectively analyzed the postoperative data of 242 patients who were monitored with a digital drainage system after pulmonary resection in our institution between December 2017 and June 2020. We divided the patients into three groups according to the suction pressure used: A (low-pressure suction group: - 5 cm HO), B (intermediate-pressure group: - 10 cm HO), and C (high-pressure suction group: - 20 cm HO). We evaluated the duration of air leaks, timing of chest tube replacement, the amount of postoperative air leak, volume of fluid drained before chest tube removal, and the total number of air leaks during drainage.
RESULTS
In total, 217 patients were included in this study. The duration of air leaks gradually decreased with significant difference between the groups, the highest decrease in A, the lowest decrease in C (P = 0.019). Timing of chest tube replacement, on the other hand, did not significantly differ between the three groups (P = 0.126). The number of postoperative air leaks just after surgery did not significantly differ between the three groups (P = 0.175), but the number of air leaks on postoperative day 1 were fewest in group A, then B, and greatest in group C (P = 0.033). The maximum amount of air leaks during drainage was lowest in A, then B, and highest in C (P = 0.036). Volume of fluid drained before chest tube removal did not significantly differ between the three groups (P = 0.986).
CONCLUSION
Low-pressure suction after pulmonary resection seems to avoid or promptly improve postoperative air leaks in digital drainage devices after lung resection.
TRIAL REGISTRATION
This is a single-institution, retrospective analysis-based study of data from an electronic database. Study protocol was approved by the Akashi Medical Center Institutional Research Ethics Board (approval number: 2020-9).
Topics: Adult; Aged; Algorithms; Chest Tubes; Drainage; Equipment Design; Female; Hemorrhage; Humans; Lung; Male; Middle Aged; Pneumonectomy; Postoperative Period; Retrospective Studies; Suction; Treatment Outcome
PubMed: 33882977
DOI: 10.1186/s13019-021-01485-z -
PloS One 2021To investigate the effectiveness of aerosol clearance using an aerosol box, aerosol bag, wall suction, and a high-efficiency particulate air (HEPA) filter evacuator to...
PURPOSE
To investigate the effectiveness of aerosol clearance using an aerosol box, aerosol bag, wall suction, and a high-efficiency particulate air (HEPA) filter evacuator to prevent aerosol transmission.
METHODS
The flow field was visualized using three protective device settings (an aerosol box, and an aerosol bag with and without sealed working channels) and four suction settings (no suction, wall suction, and a HEPA filter evacuator at flow rates of 415 liters per minute [LPM] and 530 LPM). All 12 subgroups were compared with a no intervention group. The primary outcome, aerosol concentration, was measured at the head, trunk, and foot of a mannequin.
RESULTS
The mean aerosol concentration was reduced at the head (p < 0.001) but increased at the feet (p = 0.005) with an aerosol box compared with no intervention. Non-sealed aerosol bags increased exposure at the head and trunk (both, p < 0.001). Sealed aerosol bags reduced aerosol concentration at the head, trunk, and foot of the mannequin (p < 0.001). A sealed aerosol bag alone, with wall suction, or with a HEPA filter evacuator reduced the aerosol concentration at the head by 7.15%, 36.61%, and 84.70%, respectively (99.9% confidence interval [CI]: -4.51-18.81, 27.48-45.73, and 78.99-90.40); trunk by 70.95%, 73.99%, and 91.59%, respectively (99.9% CI: 59.83-82.07, 52.64-95.33, and 87.51-95.66); and feet by 69.16%, 75.57%, and 92.30%, respectively (99.9% CI: 63.18-75.15, 69.76-81.37, and 88.18-96.42), compared with an aerosol box alone.
CONCLUSIONS
As aerosols spread, an airtight container with sealed working channels is effective when combined with suction devices.
Topics: Aerosols; Air Filters; Dust; Suction; Ventilators, Negative-Pressure
PubMed: 33882091
DOI: 10.1371/journal.pone.0250213 -
Interactive Cardiovascular and Thoracic... May 2021A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was: what is the optimal level of suction on digital...
A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was: what is the optimal level of suction on digital chest drainage devices following pulmonary lobectomy? Altogether 367 papers were found using the reported search, of which 4 randomized controlled trials using digital chest drainage devices represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. The new digital drainage systems enhance early mobilization as recommended in the enhanced recovery after surgery programme. There is, however, no consensus on the optimal level of suction to apply after pulmonary lobectomy. This is especially the case for digital drainage devices. Surgeon preference will likely continue to guide practice, until the evidence gives clear-cut recommendations. According to the current data, a low suction reduces total fluid drainage and perhaps air leak duration compared to higher suction levels in both video-assisted thoracoscopic surgery and open pulmonary lobectomies using digital drainage devices, although the evidence is not overwhelming.
Topics: Benchmarking; Chest Tubes; Drainage; Humans; Length of Stay; Pneumonectomy; Suction; Thoracic Surgery, Video-Assisted; Time Factors; Treatment Outcome
PubMed: 33569581
DOI: 10.1093/icvts/ivab028 -
The European Respiratory Journal Oct 1999Manual lung hyperinflation (MH) is one of a number of techniques which are employed by the physiotherapist in the critical care setting. The technique was first... (Review)
Review
Manual lung hyperinflation (MH) is one of a number of techniques which are employed by the physiotherapist in the critical care setting. The technique was first described with physiotherapy 30 yrs ago and commonly involves a slow, deep inspiration, inspiratory pause and fast unobstructed expiration. The use of MH varies between and within countries. It is commonly employed by physiotherapists to assist in the removal of secretions and re-expand areas of atelectasis. Despite the popularity of the technique, research examining its efficacy is conflicting, especially the effect of MH on cardiovascular parameters. Recent studies examining mucociliary transport in intubated and ventilated patients have shown impaired clearance of secretions, but research evaluating the role of MH specifically in airway clearance is scant. The use of the additional physiotherapy techniques, gravity assisted drainage and chest wall vibrations, may enhance the efficacy of MH in promoting airway clearance, but further research is necessary. Controversy exists regarding the safety and effectiveness of application of manual lung hyperinflation in intubated patients. Clearly, more randomized controlled studies are necessary in order to provide a sound scientific rationale for the application of manual lung hyperinflation in the treatment of critically ill patients.
Topics: Airway Obstruction; Humans; Intubation, Intratracheal; Mucus; Physical Therapy Modalities; Respiration, Artificial; Respiratory Care Units; Respiratory Insufficiency; Suction
PubMed: 10573249
DOI: 10.1034/j.1399-3003.1999.14d38.x -
Journal of Cardiac Surgery Jul 2020A new, self-contained, digital, continuous pump-driven chest drainage system is compared in a randomized control trial to a traditional wall-suction system in cardiac... (Comparative Study)
Comparative Study Randomized Controlled Trial
BACKGROUND
A new, self-contained, digital, continuous pump-driven chest drainage system is compared in a randomized control trial to a traditional wall-suction system in cardiac surgery.
METHODS
One hundred and twenty adult elective cardiac patients undergoing coronary artery bypass graft and/or valve surgery were randomized to the study or control group. Both groups had similar pre/intra-operative demographics: age 67.8 vs 67.0 years, Euroscore 2.3 vs 2.2, and body surface area 1.92 vs 1.91 m . Additionally, a satisfaction assessment score (0-10) was performed by 52 staff members.
RESULTS
Given homogenous intra-operative variables, total chest-tube drainage was comparable among groups (566 vs 640 mL; ns), but the study group showed more efficient fluid collection during the early postoperative phase due to continuous suction (P = .01). Blood, cell saver transfusions and postoperative hemoglobin values were similar in both groups. The study group experienced drain removal after 29.8 vs 38.4 hours in the control group (ns). Seven crossovers from the Study to the Control group were registered but no patient had drain-related complications. The Personnel Satisfaction Assessment scored above 5 for all questions asked.
CONCLUSIONS
The new, digital, chest drainage system showed better early drainage of the chest cavity and was as reliable as conventional systems. Quicker drain removal might impact on intensive care unit (ICU) stay and reduce costs. Additional advantages are portable size, battery operation, patient mobility, noiseless function, digital indications and alarms. The satisfaction assessment of the new system by the staff revealed a higher score when compared to the traditional wall suction chest drainage system.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Coronary Artery Bypass; Cost Savings; Female; Heart Valves; Humans; Length of Stay; Male; Middle Aged; Outcome Assessment, Health Care; Postoperative Care; Safety; Suction; Thoracic Cavity; Young Adult
PubMed: 32436655
DOI: 10.1111/jocs.14629 -
Medical Science Monitor : International... Sep 2018BACKGROUND Clogging of the suction tip frequently occurs during orthopedic surgery. We developed a novel anti-clog suction tip using 3D printing technology to improve...
BACKGROUND Clogging of the suction tip frequently occurs during orthopedic surgery. We developed a novel anti-clog suction tip using 3D printing technology to improve orthopedic surgery efficiency. MATERIAL AND METHODS We studied the root causes of obstructions in suction tips currently employed in orthopedic surgery during actual surgical cases. CAD software and 3D printer was used to design, modify, and print the novel suction tip. The frequency of clogging, the frequency of replacement of the suction tip, the time lost in replacing suction tips or connecting tubes, surgical duration, intraoperative surgical blood loss, and the satisfaction scores for the suction tips as rated by the surgeons were compared between the novel suction tip and the conventional suction tip. Comparisons were made first in laboratory experiments using a simulant liquid and then during total hip replacement surgeries. RESULTS In the simulant liquid experiments, the novel suction tips showed significantly reduced frequency of complete clogging and decreased time spent removing all fluid in comparison to the conventional suction tips (p<0.05). In the clinical trials, the novel suction tips exhibited significantly reduced frequency of complete clogging, shorter surgical duration, and reduced intraoperative surgical blood loss compared to the conventional suction tips (p<0.05). Surgeon satisfaction scores were higher for the novel tips than for the conventional tips (p<0.05). CONCLUSIONS Our surgeon-designed and -produced surgical suction tip utilizing 3D desktop printing technology was highly effective in resolving the problem of clogged suction tips during orthopedic surgery and yielded high surgeon satisfaction.
Topics: Arthroplasty, Replacement, Hip; Computer-Aided Design; Humans; Orthopedic Procedures; Printing, Three-Dimensional; Suction; Surgical Instruments
PubMed: 30251710
DOI: 10.12659/MSM.909900 -
BMC Musculoskeletal Disorders Aug 2021The use of drains reportedly does not improve surgical outcomes after hip replacement. There is still a lack of strict recommendations for drain placement after primary... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
The use of drains reportedly does not improve surgical outcomes after hip replacement. There is still a lack of strict recommendations for drain placement after primary hip replacement. This study aimed to assess the safety of not using suction drainage after primary hip replacement in a population of patients undergoing extended thromboprophylaxis.
METHODS
In this prospective randomized study, all patients were qualified for primary hip replacement and were divided into two groups: with and without drainage. The inclusion criterion was idiopathic hip osteoarthritis. The exclusion criteria were secondary coxarthrosis, autoimmune disease, coagulopathy, venous/arterial thrombosis, hepatic/renal insufficiency, cement, or hybrid endoprostheses. We performed an intention-to-treat analysis. Clinical, laboratory, and radiographic parameters were measured for the first three days after surgery. Hematoma collection, due to extended thromboprophylaxis, in the joint and soft tissues was evaluated precisely. The patients underwent follow-up for 30 days.
RESULTS
The final analysis included a total of 100 patients. We did not find any significant statistical differences between groups in terms of hip fluid collection (9.76 vs. 10.33 mm, with and without drainage, respectively; mean difference, 0.6 mm; 95 % confidence interval [CI] -2.8 to 3.9; p = 0.653), estimated blood loss (1126 vs. 1224 ml; mean difference, 97.1 ml; 95 % CI -84.1 to 278.2; p = 0.59), and hemoglobin levels on postoperative day 3 (11.05 vs. 10.85 g/dl; mean difference, 0.2; 95 % CI -2.1 to 2.5; p = 0.53). In addition, the other parameters did not show significant differences between groups. Notably, two cases of early infections were observed in the no-drainage group, whereas there were no such complications in the drainage group.
CONCLUSIONS
We conclude that the use of closed suction drainage after primary hip replacement is a safe procedure in patients undergoing extended thromboprophylaxis. Further research is warranted to validate these findings.
TRIAL REGISTRATION
The study was successfully registered retrospectively at Clinicaltrial.gov with the identification number NCT04333264 03 April 2020.
Topics: Anticoagulants; Arthroplasty, Replacement, Hip; Drainage; Humans; Postoperative Complications; Prospective Studies; Retrospective Studies; Suction; Venous Thromboembolism
PubMed: 34389016
DOI: 10.1186/s12891-021-04583-0 -
Annals of the Royal College of Surgeons... Mar 2022
Topics: Bone Plates; Bone Screws; Fracture Fixation, Internal; Humans; Rib Fractures; Suction
PubMed: 34825571
DOI: 10.1308/rcsann.2021.0158