Closed Chest Drainage Research Articles

Analysis of 31 cases with ribs fracture combined with delayed hemothorax

The clinical data of 31 patients with delayed hemothorax between August 2003 to November 2010 was retrospectively analyzed. All patients had chest pain, difficult breathing in 14 cases (45％), heart rate increased in 19 patients (61％), fever in 16 cases (52％), abdomen pain in 3 patients (10％), and shock in 1 case (3％). Haemothorax was medium to massive and combined with pneumothorax in 9 cases. Twenty one patients received closed chest drainage, 4 recieved chest puncture to eliminate fluid, 5 were treated conservatively, and 1 had surgery for diaphragmatic hernia and hemorrhage.All patients recovered eventually. The key of diagnosis and treatment for delayed hemothorax is to take chest X-ray for patients with rib fractures in 2 to 9 days after chest trauma, and carefully observing the changes of chest signs, breathing, heart rate and body temperature. Key words: Rib fractures; Hemothorax

The current concepts of closed chest drainage in lobectomy of lung cancer

肺叶切除术后应用传统胸腔闭式引流术，被大多数胸外科医生所采用的主要原因：一是引流效果好；二是经验、习惯和观念。外科技术的发展和医疗观念的更新使传统胸腔闭式引流术在临床应用中的不足越来越明显，但尚未引起足够重视。近几年对肺癌术后引流问题无论是应用方法还是观念都有更新和发展。本文将结合国内外研究进展和我们工作中的体会，从以下三方面进行概述：一是胸腔引流术应用现状和存在问题；二是常规水封引流系统加用负压吸引之优势与不足；三是单胸腔引流管的临床应用进展与争议。

Neumotórax catamenial secundario a endometriosis torácica

We report the case of a 27-year-old tertipara, with one caesarean, with menarche at the age of 13 years, regular cycles, disabling dysmenorrhea twice a year, and one sexual partner, who reported mild dyspareunia and was referred to our hospital, which serves a rural population in Jalisco (Mexico). The patient showed poor general health status, with severe dyspnea, and reported that she had experienced the same symptoms twice before in the previous 4 months. The patient showed a pneumothorax size of 40%. A closed chest drainage system was placed, producing substantial improvement in the 3 subsequent days with respect to admission. Pulmonary tomography 3 days later showed no abnormalities. CA125 determination revealed 102 U/ml and pelvic ultrasound showed a positive anechoic, 4×5-cm image in the left annex. Pelvic laparotomy was performed, revealing mild endometriosis with lesions in the posterior uterine wall and no diaphragmatic lesions. Thoracoscopy showed two endometriotic foci of approximately 1×1 cm, and another of 1×0.5 cm. The histological diagnosis was endometrial tissue in the lung parenchyma.

Bacterial mediastinitis after heart transplantation: clinical presentation, risk factors and treatment

Background The incidence of mediastinitis after heart transplantation has been reported to be between 2.5% and 7.5%. Most previous reports from the transplant literature have assessed patients who had not received induction therapy. Methods From December 1996 to January 2002, a total of 230 heart transplants were performed using induction therapy with rabbit anti-thymocyte globulin at La Pitié Salpêtrière Hospital (Paris, France). Mediastinitis developed in 15 patients (6.5%). A case–control study was performed to characterize the clinical presentation, microbiology, risk factors and therapy of mediastinitis after heart transplantation. Results Only 4 patients (26%) had a temperature of >38°C and 6 patients (40%) had a white blood cell count of >10,000 cells/mm 3. Septicemia (46%) and positive temporary epicardial pacing wires culture (60%) were frequently observed. Staphylococcus aureus (5 of 15), Staphylococcus epidermidis (5 of 15) and gram-negative bacteria (5 of 15) were the causative organisms cultured intra-operatively. Mean duration of mechanical ventilation (2.4 vs 1.6 days; p < 0.03) and use of ventricular assistance (20% vs 0%; p < 0.04) were different between cases and controls. The mortality rate at hospital discharge was 6.7% (1 of 15). Conclusions In the context of immunosuppression after heart transplantation, a high degree of suspicion is necessary to make the diagnosis of mediastinitis. Positive blood and temporary epicardial pacing wires cultures can be helpful in suggesting the presence of mediastinitis. Using vancomycin and an aminoglycoside as prophylaxis has to be considered because of the high prevalence of methilcilin-resistant S epidermidis and gram-negative bacteria. Conservative therapy (sternal debridement without muscle flap closure, and closed-chest drainage) showed excellent results in this series.

Pneumonias necrosantes em crianças previamente saudáveis

Background: Necrotizing pneumonia used to be rare in the postantibiotic era. Its incidence appears to be rising in our hospital although there is no clear explanation for that. Patients and Methods: Retrospective analysis of the clinical presentation and evolution of necrotizing pneumonia in previously healthy children admitted at our hospital during two years. Results: Among 392 admissions for pneumonia in the study period, 15 patients (3,4–2, 4 years; 9 boys) had evidence of lung necrosis on thoracic computed tomography. Despite appropriate antibiotic therapy, fever persisted for 13–7 days. Ten patients deve loped pneumatoceles and three lung abscesses. Twelve patients had parapneumonic pleural effusions (4 empyemas), nine of whom need closed chest drainage. An agent was isolated from pleural fluid or blood culture in 3 children (2 S. aureus and 1 Enterobacter cloacae); in two further, bacteria were seen on Gram-stained pleural fluid. Two patients had an immunodefficiency state previously unknown (IgA deficiency and hiper-IgE syndrome). Thoracotomy were performed in 9 patients: 2 pleural debridement, 6 decortication, 1 ressection of a giant pneumatocele, 1 abscess drainage and 2 lobectomies. The mean length of hospital stay was 30–11 days and there were no deaths. During the follow-up period (18–9 months) 3 patients required surgery for recurrent infection or fibrothorax. In the remaining, asymptomatic children, 2 have pleural ticknening, 1 a residual pneumatocele and 1 bronchiectasis. Conclusions: The results of this study do not explain the recent increase of the suppurative complications of community acquired-pneumonia in children. The low rate of infectious agent isolation was probably related with frequent previous antibiotic use. Although the final outcome was generally good, the clinical course was very prolonged and surgery was frequently needed. In order to clarify the reason for the increase of this kind of pneumonia complications a prospective multicenter study is warranted. REV PORT PNEUMOL 2002; VIII (1):

Incidence of infectious complications following tube thoracostomy with and without use of antibiotic therapy: meta-analysis study

Objective - Thoracic lesions and resulting complications have gained increased importance in literature because they present a serious problem despite the generalized use of antibiotic therapy. Our study, therefore, aims at obtaining better estimates regarding the benefits obtained using antibiotic therapy in patients with isolated thoracic trauma and who have undergone closed chest drainage. Methods - Eight prospective and randomized studies were selected and meta-analysis was used to statistically associate the results. Results - The results demonstrated a statistical significance which favored the use of antibiotic therapy in preventing pleural empyema and a 9.25 (IC 95% 2.85 - 30.01) total relative risk for patients who did not receive antibiotic therapy. The total risk regarding all the infectious complications that occurred was 4.29 (IC 95% 2.70 - 8.97). Conclusion - The results of this meta-analysis study showed that antibiotic therapy effectively reduces the incidence of infectious complications in patients with isolated thoracic trauma, who have undergone closed pleural drainage.

Trauma torácico: importância da antibioticoterapia sobre o tempo de internação

No que tange a comprovada eficácia da drenagem pleural fechada, grande controvérsia ainda persiste em relação ao uso associado da antibioticoterapia. Os autores estudaram 167 pacientes, com trauma isolado do tórax, com objetivo de avaliar a importância do uso do antibiótico sobre o tempo de internação pós-drenagem pleural fechada. Dois grupos de pacientes foram incluídos num estudo longitudinal e prospectivo de acompanhamento de coortes. O grupo controle incluiu 104 pacientes sem uso da antibioticoterapia; no grupo experimental, 63 pacientes receberam a cefalotina sódica no pós-operatório (500 mg IV - 6/6 h). Entre os pacientes estudados, 12 (7.2%) apresentavam trauma fechado; 98 (58.6%), ferimento por arma branca; 41 (24.6%) ferida por projétil de arma de fogo e, 16 (9.6%) lesões por outros agentes vulnerantes. Entre os pacientes do grupo controle o tempo médio de permanência hospitalar foi de 5.7± 3.2 dias e, no grupo com antibiótico, 5.7± 2.9 dias. Os resultados mostraram que nos pacientes que não receberam antibiótico e evoluíram com algum tipo de complicação pleuropulmonar, o tempo de internação foi, em média, 3.2 dias maior que nos demais.

Retropleural thoracotomy

Herniated thoracic discs, unlike their lumbar counterparts, are difficult to read and safely resect using traditional posterior approaches. Historically, the use of a laminectomy for thoracic disc resection has yielded poor clinical outcomes. Posterolateral and anterolateral approaches have become the standard surgical means of treating these lesions. The traditional anterolateral approach, the transpleural thoracotomy, is an extensive procedure that requires direct retraction of the lung, a deep surgical field, and postoperative closed-chest drainage. An alternative to this anterior approach, the retropleural thoracotomy, is described here. This approach provides the shortest direct route to the thoracic spine and leaves the pleura intact. A smaller incision and less retraction than traditional approaches may reduce postoperative pain and pulmonary-related complications. The retropleural thoracotomy is a valuable technique for the neurosurgeon treating thoracic disc disease.

Surgical management of spontaneous pneumothorax.

Spontaneous pneumothorax is a common surgical problem. Although the general principles of drainage of the pleural space and of prevention of recurrence seem well known, the literature shows differences in success rates concerning the treatment of a first pneumothorax and of the eventual recurrences. This is probably due to some technical factors and different views on the therapeutical strategy. In this retrospective review of 62 patients with spontaneous pneumothorax, 8 were treated by bed rest for their not enlarging and less than 20% pneumothorax, and 54 were treated by closed chest tube thoracostomy with an early success rate of 93.5% at the first admission. The simultaneous use of scarifying agents and closed chest drainage appears useful for the treatment of immediate or first recurrence. Sixteen patients were readmitted later for ipsilateral recurrence. According to the magnitude of their pneumothorax, they were treated by bed rest or tube thoracostomy with scarifying agents. Four of these patients needed thoracotomy with oversuturing of subpleural blebs and pleurodesis. The total thoracotomy rate of the initial patient population was 12.9% after an average follow up period of 24.8 months.

Parapneumonic pleural effusion and empyema in children. Review of a 19-year experience, 1962-1980.

Between 1962 and 1980, 50 children admitted to Strong Memorial Hospital had a pleural effusion or an empyema associated with pneumonia. Such parapneumonic effusion and empyema accounted for 52 per cent of cases of pleural effusion and empyema of all etiologies admitted during those years. Review of cases of parapneumonic effusion and empyema suggested that clinical manifestations, laboratory, and roentgenographic findings did not separate these two groups of patients before thoracentesis was performed. Specific organisms were identified in 29 per cent of cases with parapneumonic effusion and 62 per cent with parapneumonic empyema. Staphylococcus aureus, Streptococcus pneumoniae, and Streptococcus pyogenes were responsible for 35, 30, and 20 per cent of cases, respectively. Parapneumonic effusions were treated without closed-chest tube drainage in 76 per cent of the cases, while closed-chest drainage was necessary in virtually all cases of children with empyema.

Recent trends in empyema thoracis

One hundred and twenty-three patients with empyema thoracis presenting between 1968 and 1978 were studied. The predominant cause was pneumonia, with thoracic and gastrooesophageal surgery as the other important predisposing factors. 99 patients had received antibiotics before hospital admission and organisms were isolated from the empyema of 62 of these (63%). Of the 62 patients with organisms 39 (63%) had previously received an antibiotic appropriate to the sensitivity of the pathogen. Staph. aureus, Str. pneumoniae and anaerobes were the organisms most frequently found in empyemata following pneumonia, whilst Gram-negative enteric bacilli, the most frequently isolated organisms, were the predominant pathogens in postoperative cases. Following treatment with antibiotics alone or with closed chest drainage 29% of empyemata resolved but another 64% required subsequent surgery. The former group had a mean duration of symptoms of 2.8 ( se ± 0.8) weeks before hospital treatment whereas the surgically treated group had symptoms for a mean period of 8.3 ( se ± 1.5) weeks. 83% of patients who required thoracotomy had a history of more than four weeks at the time of admission. Thirty-six deaths were recorded, 11 of which were attributable to the empyema, giving an empyema mortality-rate of 9%. We conclude that with widespread use of antibiotics the nature of empyemata has changed and that those now seen are more often refractory to closed chest drainage, particularly if the history prior to hospital admission is longer than four weeks.

Postpneumonectomy empyema in pulmonary carcinoma patients: Treatment with antibiotic irrigation and closed-chest drainage

Seven patients with postpneumonectomy empyema who had had pulmonary carcinoma were treated with intrapleural antibiotic irrigation and closed-chest drainage. Two tubes were used to irrigate and drain the cavity. Although most patients had a bronchopleural or esophagopleural fistula, the treatment was successful in every case. Three of the 7 patients died of far-advanced carcinoma 1 to 2 years postoperatively, but none died of sequela of the empyema. In 3 patients with bronchopleural fistula, empyema recurred during the first postoperative year. However, it responded well to repeated irrigation and drainage. This simple, time-saving, and easily repeatable regimen proved to be both effective and also very comfortable for the patient. It has none of the disadvantages of open thoracic drainage or mutilating thoracoplasty.

Empyema treated with neomycin irrigation and closed-chest drainage

Empyema treated with neomycin irrigation and closed-chest drainage