Intercostal Tube Drainage Research Articles

Clinical profile of chest trauma patients in a tertiary care center: a prospective observational study

BACKGROUND: Road traffic accidents form a major epidemic in the current century. The economic loss estimated to our country due to accidents amounts to Rs.5000 crores annually. Chest trauma estimates at about 50% of the total victims and 25% causative agent of mortality. Less than 10% of the blunt chest injuries and only 15 to 30% of penetrating chest injuries require operative intervention.METHODS: The present study is a prospective observational study that emphasizes on the epidemiology and the clinical profile of chest trauma patients that presented to the Himalayan Hospital over a period of 1 year.RESULTS: Chest Injury was encountered in about 20% of all trauma admissions with RTA (61%) being the major cause followed by Fall from height (30%). Fracture of the ribs was the most common chest injury. Blunt trauma abdomen and Neuro trauma were the most common associated injuries in polytrauma cases. Inter costal tube drainage (ICD) was the main stay of treatment in 84% of the cases.CONCLUSIONS: Epidemiologically thoracic injuries are one of the major causes of death in the younger age group. These injuries may present at varied timeframes and with vast variety of signs. Early identification and Prompt emergency management have proven to be of positive value in curing patients and decreasing their hospital stay.

CLINICAL PROFILE AND OUTCOME OF NEONATAL PNEUMOTHORAX IN TERTIARY CARE CENTRE IN CENTRAL INDIA.

Neonatal pneumothorax is a life-threatening emergency situation. Respiratory distress syndrome, meconium aspiration, birth trauma or positive pressure ventilation may cause pneumothorax in neonates. It may manifest as respiratory distress, hypoxemia or respiratory failure depending upon severity of pneumothorax and eventually may cause compromise of cardiac function. Early radiological diagnosis by chest radiograph, point of care Ultrasonography, emergency needle thoracocentesis and supportive care may improve the outcome of pneumothorax. In this case report, we present a case of a full-term new born baby who required positive pressure ventilation with Ambu-Mask, who developed severe respiratory distress in immediate postnatal period after resuscitation. Early diagnosis of pneumothorax with chest radiograph and ultrasonography was done. Pneumothorax lead to cardiac function compromise which necessitated emergency needle thoracocentesis. Intercostal drainage tube was placed and secured for denitive resolution. Hence, patient was stabilized because of timely diagnosis and expeditious intervention.

Congenital chylothorax managed with octreotide and skimmed milk: a case report

Pleural effusion occurs when a large amount of free fluid accumulates in the pleural space. A chylothorax is caused by chyle-containing lymphatic fluid draining into the pleural cavity. This is the most common type of pleural effusion observed during the neonatal period. It causes a number of respiratory and nutritional issues and has a significant mortality rate. It is usually treated by intercostal chest tube drainage and total parenteral nutrition. Octreotide is a relatively newer strategy in the management. Here we describe the case of a 16 days old male neonate who presented to us with sudden onset severe respiratory distress requiring invasive ventilation. Radiology suggested pleural effusion and so intercostal chest tube was inserted, which revealed Chylous effusion. The patient was successfully managed with dietary therapy including skimmed milk and octreotide infusion.

Management of bronchopleural fistula using Amplatzer duct occluder device.

Management of bronchopleural fistula using Amplatzer duct occluder device.

Lung Hydatid and Broncho-Cavitary Communications: Challenges in the Management and Outcome

Abstract Background: The aim was to analyse the challenges and outcomes in operated patients of hydatid lung with broncho-cavitary communications. Materials and Methods: The retrospective data between June 2017 and May 2022 were obtained. The number of broncho-cavitary communications was recorded and they were suture repaired using polypropylene. The duration required for repair and the average fall in the SpO2 were recorded. Those with incomplete data or follow-up were excluded. The outcome parameters considered were number of broncho-cavitary communications, duration of stay, duration of intercostal tube, duration of air leak and requirement of ventilator support. Results: A total of 33 patients out of 36 formed the study group. The mean age was 6 years (range 2–18 years). There were 23 right-sided, eight left-sided and two bilateral cysts. Broncho-cavitary communications were seen in 33 patients. The average number of communications was 3 (range: 2–8). The average duration required to suture close the communications was 30 s (range 20–180 s). The average fall in the SpO2 was 40% (range 20%–74%). The main challenge was rapid identification of communications and prompt repair. The mean duration of surgery was 2.15 h (range 1.45–3.15 h). Ventilator support in the post-operative period was required in four patients. The average duration of intercostal tube drainage required was 7 days (range: 6–14 days). The average duration of hospital stay was 14 days (range 12–34 days). All the communications were repaired using Prolene 3-0 sutures. None of the patients was operated with a double-lumen endobronchial tube. Conclusion: Broncho-cavitary communication in hydatid cyst is associated with an operative challenge due to sudden air leak. These patients require judicious management.

Ovarian Carcinoma Presenting as Meigs’ Section Syndrome- A Rare Case Report

Presence of fluid and air within pleural space is known as hydropneumothorax. A large proportion of patients present with shortness of breath, dry cough and pricking type of pleuritic chest pain as a result of pleural involvement. However, fever and constitutional symptoms like loss of appetite and loss of weight is most likely associated with tuberculosis. Meigs’ syndrome is a triad of ascites, hydrothorax and benign ovarian tumours (ovarian fibromas and fibrothecomas). Pseudo-Meigs’ syndrome shows accumulation of ascites, pleural effusion and associated with a pelvic or abdominal tumours. Here, is a case report of a 62-year-old postmenopausal female, who presented with right pleuritic chest pain and breathlessness, since one week. Chest radiograph showed right-sided hydropneumothorax which required an intercostal drainage tube insertion. Upon further evaluation, the primary unknown cancer was found to be of ovarian origin.

Mediastinal extension of amoebic liver abscess: A case report on the rare thoracic complication of Entamoeba histolytica

Amoebic liver abscess is one frequently encountered intra-abdominal infection, caused by Entamoeba histolytica and has various abdominal and thoracic life-threatening complications. Herein, describe a case of a 30-year-old female, who suffered from multiple amoebic liver abscesses and presented with massive right-sided pleural effusion. She was managed with recommended antibiotics and pigtail catheter for liver abscess and an intercostal drainage tube for massive pleural effusion. However, postintercostal drainage, her chest X-ray demonstrated a right mediastinal shadow, which was confirmed as an intrathoracic extension of the hepatic liver abscess on computed tomography. An ultrasound-guided pigtail catheter was manipulated and placed at the site of thoracic communication. This led to clinical and radiological improvement, but unfortunately, she developed ventilator-acquired pneumonia and died due to her illness. The case represents an uncommon complication of amoebic liver abscess, which is rarely described and adds more knowledge on the thoracic complexities of this infectious disease.

Comparative analysis of pigtail catheter versus intercostal tube drainage for pleural effusion: a tertiary centre study

Background: This study was conducted to compare the effectiveness and complications between chest tube and pigtail catheter thoracostomy for drainage of pleural effusion.Methods: We retrospectively reviewed the medical records of 60 patients with pleural effusion during the period of January 2021 to June 2022. We collected data on fluid drainage, complications, and hospital stays among participants.Results: The difference between various parameters (protein, sugar, pH, and culture positive) measured on drained pleural fluid was statistically nonsignificant (p>0.5). A total of 4 (13.3%) and 2 (6.7%) cases were not drained in the intercoastal tube and pigtail catheter groups, respectively (p=0.389). Further, a total of 14 (46.7%) and 6 (20%) participants in the intercoastal tube and pigtail catheter groups respectively complained of wound pain (p=0.028). Lastly, the incidence of complications among the participants in the intercoastal tube and pigtail catheter groups was 30% and 16.7% (p=0.222). The most common complications in both groups were pneumothorax. Moreover, a total of 10% of participants in the intercoastal tube group experienced kinking or dislodgment of the tube. The duration of hospital stay was significantly shorter among participants with pigtail catheters.Conclusions: The pigtail catheter was equally efficacious as an intercoastal tube, but it caused lower pain, shorten the duration of hospital stay, and reduced the complications among participants.

Incessant Pleural Drainage - Can It Be a Masquerading Esophageal-Pleural Fistula?

Spontaneous esophageal-pleural fistula (EPF) is extremely rare. We present a case of a 52-year gentleman who presented with shortness of breath and decreased appetite, whose chest X-ray and ultrasonogram of thorax depicted a pleural effusion like picture. Intercostal drainage tubes were inserted to alleviate his dyspnea. Plain computerized tomography (CT) thorax initially revealed a pleural cyst, which was surgically drained. Subsequent CT thorax with contrast and barium swallow revealed EPF, which was confirmed with endoscopy. Pleural fluid analysis revealed candida as the cause of EPF. Candida as a cause of EPF that too in an nonimmunocompromised patient is very rare. Multidisciplinary approach is required to diagnose and prevent mortality in such cases.

Severe dengue associated withStaphylococcus aureussepsis in pediatric patients: a case series

Staphylococcus aureus co-infection is seldom reported in children with severe dengue. In this retrospective study, we reported five children with severe dengue and S. aureusco-infection admitted to pediatric intensive care unit (PICU) during July-December 2021. All children had prolonged fever, persistence of bilateral pleural effusion beyond the critical phase, thrombocytopenia and raised inflammatory markers [C-reactive protein (CRP) and procalcitonin]. S. aureuswas isolated from pleural fluid (n = 2, 40%), blood (n = 2, 40%) and endotracheal aspirate (n = 1, 20%). Four children (80%) grew methicillin-sensitive S. aureus, while 1 (20%) had methicillin-resistant S. aureus. Two children (40%) had septic thromboemboli in skin, and 1 (20%) had limb cellulitis. One child required anterior thoracotomy, pericardiectomy and bilateral pleural decortication, while all other children required intercostal chest tube drainage. All children required prolonged targeted antibiotics, invasive mechanical ventilation and had prolong stay in PICU and all of them survived. In children with severe dengue, persistence of fever, persistence of pleural effusion beyond critical phase and raised CRP and procalcitonin should raise suspicion of bacterial/S. aureus co-infection.

Right-Sided Pancreaticopleural Fistula: An Unusual Presentation of Chronic Pancreatitis

Pleural effusions due to pancreatitis are more common on the left side, but right-sided pleural effusion is very rare. This case report describes a young male who presented with features of right-sided massive pleural effusion. Magnetic resonance cholangiopancreatography showed, chronic pancreatitis with pseudocyst extending into the mediastinum through esophageal hiatus and communicating with right pleural cavity (pancreaticopleural fistula). The patient improved clinically after placing an intercostal drainage tube and stenting of the main pancreatic duct. A clinician should consider pancreatic pathology also in the differential diagnosis of right-sided pleural effusion, even in the absence of abdominal symptoms and risk factors for pancreatitis, when initial evaluation is inconclusive.

Lymphangiography and thoracic duct embolization (both antegrade and retrograde approaches) in a case of spontaneous chylous leak after failed thoracic duct ligation.

A 57-year-old man with complaints of dyspnea of 3 months’ duration was found to have spontaneous right-sided chylous pleural effusion. Surgery in the form of thoracoscopic thoracic duct clipping had been performed at another institution. His complaints persisted with an intercostal drainage (ICD) tube output of 2 L/d from the intraoperatively placed ICD tube. The patient provided written informed consent for treatment at our institution and the report of his case details and imaging studies.

Empyema Thoracis in children: A Five-Year Analysis from a Tertiary Care Center in Eastern Nepal

Introduction: Complicated community-acquired pneumonia resulting in empyema thoracis remains the largest single cause of morbidity and mortality worldwide in children. This study was carried out to evaluate the clinical profile, associated complications and outcome of empyema thoracis in children. Methods: A retrospective study was conducted in the Department of Paediatrics at a tertiary care center in Eastern Nepal. A total of 106 children were managed with the diagnosis of complicated pneumonia with effusion or empyema thoracis from March 2017 to February 2021 (Five years). Only those patients who had clinico-radiological evidence of pleural effusion or empyema thoracis and received treatment with or without intercostal chest tube drainage (ICD) as the initial procedure were enrolled in the study. Besides supportive treatments and antibiotics; streptokinase was instilled intrapleurally in all the patients for three days. Patients who did not respond underwent VATS / decortication. Results: Majority of the children (60.19%) were below five years of age and were males (73.58%). Majority (55.67%) had a right-sided pleural effusion and fever was the predominant symptom (55.66%) at presentation. The pleural fluid culture was sterile in more than half (55.66%) of the patients with Staphylococcus aureus grown in 33.96%. The three most common complications were subcutaneous emphysema, thickened pleura, and pyo-pneumothorax. The success rate of medical management was 83.96% and the mortality was low (2.84%). Conclusions: The success rate of conservative management with antimicrobial therapy, intercostal drainage and fibrinolytics in this study was high (83.96%) with no major adverse effects of fibrinolytic therapy in empyema thoracis.

Spontaneous bilateral pneumothorax and pneumomediastinum independent of mechanical ventilation as complications of COVID-19 pneumonia: A case report.

Since the beginning of the COVID-19 pandemic, several infected patients have suffered from unusual and severe complications. Among these rare complications, pneumothorax and pneumomediastinum have attracted clinical attention. Such complications might be challenging to diagnose immediately because of the atypical presentation in some cases. Accurate diagnosis is essential to ensure effective treatment. Here, we present the case of a 62-year-old male who presented with symptoms of COVID-19 acute respiratory distress. There was diffuse subcutaneous emphysema in the face, neck, shoulder, and chest wall on clinical examination. The patient was started on oxygenation via a non-rebreather mask. On further evaluation, his chest X-ray revealed bilateral peripheral opacities in the lung fields, bilateral pneumothorax, and subcutaneous emphysema, after which intercostal drainage tubes were inserted. The patient's oxygen saturation was not satisfactory, and he was switched to a high-flow nasal cannula. However, his condition deteriorated, and he was put on mechanical ventilation and inotropic support. Despite our best efforts, the patient succumbed to the disease. We want to emphasize the importance of this adverse event despite his nonsmoking history and the exclusion of positive pressure ventilation. Although benign, early diagnosis of this condition is vital, as the condition could lead to worse morbidity if left unrecognized.

Comparison of small lumen versus large lumen inter costal catheter drainage in empyema thoracis on degree of comfort and re-expansion of lungs: An open label, quasi randomized study

BackgroundUse of intercostal drainage tube (ICDT) is an accepted treatment of empyema thoracis (ET).We compared the effectiveness of small versus large lumen ICDT on degree of pain on 4th day of ICDT insertion as well as drainage of pus in cases of ET. MethodsIt was an open labelled quasi randomized study, conducted in a tertiary care Hospital of Northern India. Children 2 month to 12 year old were randomized by days of the week into two groups. In group A, 12/14F and in group B, >14F ICDT was used (1,2,12).Face, Legs, Activity, Cry, Consolability (FLACC) pain scoring was used on 4th day of ICDT insertion. Ultrasound (USG) of thorax was done on day1,between day 5-6 and 10-12 to assess the amount of fluid. ResultsFrom September 2018 to August 2019,130 cases (66 in group A and 64 in group B) were enrolled. FLACC Pain score was higher in group B (7.50±1.272) as compared to group A (2.86 ± 0.839) (p = 0.034).there was no significant difference in amount of fluid drained between day1and 5 in group A versus group B (159.3 ml ±125.9 ml versus 179.5 ml ±167.6 ml, p=0.2) and between day 1 & 10 (205.6 ml ± 130.2 ml versus 244.5 ml ±174.7 ml, p= 0.7). ConclusionSmall lumen (12F-14F) ICDT cause substantially less pain than large lumen (>14F) ICDT without significant difference in drainage of pus and duration of hospital stay in children with ET.

A Case of Secondary Spontaneous Pneumothorax in a Patient with Interstitial Lung Disease

Secondary Spontaneous Pneumothorax occurs in people with wide variety of parenchymal lung disease. These individuals have underlying pulmonary pathology that alters normal lung structure. Patients presenting with acute respiratory distress with underlying lung pathology should always be evaluated radiologically for any complications such as secondary spontaneous pneumothorax and managed accordingly. My case report of secondary spontaneous pneumothorax in a female patient with interstitial lung disease illustrates the importance of computed tomography (CT scan of Chest), insertion of intercostal drain tube and course of antibiotics for infection control and prevention. Keywords: Secondary spontaneous pneumothorax, Interstitial lung disease, Intercostal drainage tube

Disseminated Staphylococcal Disease Complicated with Intracranial Internal Carotid Artery Mycotic Pseudoaneurysm and Cerebral Infarcts—A Rare Presentation in a Malnourished Child

AbstractA 2.5-year-old girl child patient with moderate malnutrition presented with right forehead abscess followed by ipsilateral orbital cellulitis. She also developed a left hydropneumothorax within a week. Subsequently she had left focal onset seizures with secondary generalized status epilepticus followed by development of left hemiparesis. Neuroimaging showed infarcts of varying ages in the right cerebral hemisphere and basal ganglia. Angiography revealed right internal carotid artery pseudoaneurysm. Blood and pus cultures grew methicillin-resistant Staphylococcus aureus (MRSA). Investigations for immunodeficiency were negative. The patient received vancomycin intravenously for 6 weeks and intercostal tube drainage for hydropneumothorax. She was discharged with an antiepileptic drug and aspirin. There was complete resolution of the orbital cellulitis and hydropneumothorax and also the pseudoaneurysm on follow-up angiography 3 months later.

Re-expansion Pulmonary Oedema in Chronic Pneumothorax

A case of unilateral re-expansion pulmonary oedema in a chronic pneumothorax is presented. The patient had a longstanding left-sided pneumothorax. Intercostal drainage tube was inserted following which the patient developed severe hypotension and respiratory failure. Chest radiograph (postero-anterior view) showed partial lung expansion with unilateral pulmonary oedema. The patient responded to the standard management of pulmonary oedema and the lung was fully re-expanded.

Lung herniation post-removal of thoracostomy tube

A 30-year-old gentleman presented with complaints of fever, productive cough, and shortness of breath for 10 days. On presentation, he had a right intercostal drainage tube (ICD) in situ in view of chest radiograph findings where hydropneumothorax was suspected. He had a past history of pulmonary tuberculosis 3 years back for which he self-discontinued anti-tubercular therapy after 3 months. He was also diagnosed 2 years back with right pulmonary aspergilloma for which he was receiving anti-fungal therapy. Contrast-enhanced computed tomography (CECT) of the chest suggested right destroyed lung with multiple cavitations, ICD inserted in the right-sided lung cavity, and intracavitatory aspergilloma in the left lung. Hence, it was confirmed that the patient had a lung abscess with pus in a large cavity in the right lung which on chest radiograph had mimicked hydropneumothorax. The patient was subsequently diagnosed with a case of chronic cavitatory pulmonary aspergillosis, and the thoracostomy tube was removed. Post-tube removal, the patient developed lung herniation from the suture site which was confirmed on a CT scan for which the patient was successfully managed conservatively. Follow-up at 3 months did not reveal any evidence of lung herniation.

Bronchoscopic Management of Bronchopleural Fistula using Cyanoacrylate Glue

Bronchopleural Fistula (BPF) is a potential complication following pulmonary surgeries, lung infections, chest trauma, chemoradiotherapy, and inappropriate mechanical ventilation with significant morbidity and mortality. Surgical repair of BPF is a definitive treatment, particularly in those who develop BPF following lung resection. However, bronchoscopic management is an excellent treatment option for BPF for causes other than pulmonary resection. The present case report describes about a 50-yearold male patient who presented with a left-sided pneumothorax. He was immediately managed with Intercostal Drainage (ICD) but there was a persistent pneumothorax due to BPF. Video bronchoscopy was done, and at the site of the air leak, cyanoacrylate glue was injected. The resolution of pneumothorax was confirmed with a radiograph, the ICD tube was removed and he was discharged. He was on regular follow-up for the next six months, and there was no recurrence of pneumothorax.