Patients Underwent Chest Tube Research Articles

Predictors of surgical intervention in first episode primary spontaneous pneumothorax requiring chest drain insertion.

Primary spontaneous pneumothorax occurs in patients with no underlying lung disease and guidelines recommend chest tube drainage for the first episode, with surgical intervention reserved for recurrent episodes, persistent air leak or failure of lung re-expansion. Modern surgical management is associated with reduced length of hospital stay and superior freedom from recurrence compared with chest tube drainage alone. The objective of this study was to identify risk factors for failed chest tube drainage in patients who present with first episode primary spontaneous pneumothorax. A retrospective analysis of patients who presented to Royal Prince Alfred Hospital, Australia with first episode PSP and underwent chest tube insertion was performed. Patient demographics and size of pneumothorax were examined in relation to the primary outcome, a composite of failed chest tube drainage and recurrent ipsilateral pneumothorax. Fifty-five patients underwent chest tube drainage for first episode primary spontaneous pneumothorax between 1st January 2017 and 31st December 2020. Complete lung collapse on admission chest x-ray was associated with an increased risk of the primary outcome (63% versus 19%, OR 7.3 [96% CI 2.0-27.4), P = 0.004). This small retrospective study found that patients that undergo chest drain insertion for first episode primary spontaneous pneumothorax who present with complete lung collapse on admission are at high risk of requiring pleurodesis and therefore may benefit from early surgical referral.

Nurses' knowledge and practice regarding care of patients undergoing chest tube

Chest tube is a postoperative therapeutic intervention widely applied to the respiratory tract and cardiothoracic care. -Aim: To assess nurses’ knowledge and practice regarding care of patients undergoing chest tube. Design: A descriptive exploratory study design was used _Setting: Intensive Care Unit, Surgical and Operational Departments, in El-Mahalla Chest Hospital, and El-Mahalla Cardiac Center. Sample: A convenient sample of all available nurses (60 nurses) who work with patient undergoing chest tube. Tools: 1) Self-administered interview questionnaire consists of two parts part 1: Nurse’s demographic data characteristics, part 2: Nurse’s knowledge about chest tube. Tool 2) Observational checklist. Results: Findings of the present study showed that more than one third of the studied nurses had average knowledge regarding management of patient with chest tube drainage. While one third and less than one quarterbof them had poor and good knowledge, respectively. Conclusion: the majority of the studied nurses had insufficient knowledge and practice regarding management of patient with chest tube drainage. Recommendations: Development of in-service training programs to maintain efficient performance of nurses Replication of the study on a larger sample and in different geographical areas in Egypt for generalization of findings.

Nurses' Knowledge and Practice Regarding Care of Patients Undergoing Chest Tube

Chest tube is a postoperative therapeutic intervention widely applied to the respiratory tract and cardiothoracic care. A chest tube can be a life-saving intervention for patients with pneumothorax, effusion and hem thorax. However, it is associated with significant morbidity and mortality. Aim: To assess nurses’ knowledge and practice regarding care of patients undergoing chest tube. Design: A descriptive exploratory study design was used _Setting: Intensive Care Unit, Surgical and Operational Departments, in El-Mahalla Chest Hospital, and El-Mahalla Cardiac Center. Sample: A convenient sample of all available nurses (60 nurses )who work with patient undergoing chest tube. Tools: 1) Self-administered interview questionnaire consists of two parts part 1: Nurse’s demographic data characteristics, part 2: Nurse’s knowledge about chest tube. Tool 2) Observational checklist. Results: Findings of the present study showed that more than one third (41.7%) of the studied nurses had average knowledge regarding management of patient with chest tube drainage. While one third and less than one quarter (35% &23.3%) of them had poor and good knowledge, respectively. Moreover, nearly two-thirds (60%) of the studied nurses had incompetent practice regarding management of patient with chest tube drainage. On the other hand more than one third (40%) of them had competent practice regarding management of patient with chest tube drainage. Finally, There was a highly statistical correlation between total nurse's knowledge and their total practice regarding management of patient with chest tube drainage (P<0.01). Conclusion: the majority of the studied nurses had insufficient knowledge and practice regarding management of patient with chest tube drainage. Recommendations: 1) Development of in-service training programs to maintain efficient performance of nurses, 2) Replication of the study on a larger sample and in different geographical areas in Egypt for generalization of findings.

MANAGEMENT AND OCCURRENCE OF CHEST EMPYEMA IN COVID-19 ERA

TYPE: Late Breaking Abstract TOPIC: Chest Infections PURPOSE: Empyema is defined as an infected pleural fluid collection. The aim of this study is to highlight the importance of early diagnosis and management of empyema in an attempt to avoid needless procedures while shining a light into the warrant of a multidisciplinary approach that would had a paramount significance during the lockdown period between March 2020 to Sept 2021due to COVID-19. METHODS: During this period 22patients were treated ,19 of them were male, ages ranging from 22-71 years old. The cause of empyema was parapneumonic effusion in 20 patients and the other 2 were tuberculous empyema and extension.Predominately the patients were admitted with stage III empyema. Diagnosis was confirmed with CT scan and drainage of pus . All patients underwent chest tube insertion and antibiotic therapy nonetheless 13 of them required surgical management with VATS or open decortication. RESULTS: The impedance in seeking medical advice due COVID-19 and the insufficiency of an interdisciplinary approach in the management of those patients were determined as the reason for such high admittance with stage III empyema. . Ten patients underwent open decortication and drainage and three managed with VATS. Postoperative complications were encountered in 3 patients which included prolonged air leak, surgical infection, and septic shock. One patient died from multiple organ failure due to postoperative septic shock. The duration of tube drainage varied from 5-15 days. The mean stay was 13,5 days. CONCLUSIONS: The early diagnosis and adequate therapy avoid the complicatins and reduce the mortality CLINICAL IMPLICATIONS: Chest infections and surgical therapy DISCLOSURE: Nothing to declare. KEYWORD: empyema

Comparison of Eutectic Mixture of Local Anesthesia Cream and Subcutaneous Lidocaine to Reduce Chest Tube Removal Pain and Willingness to Repeat Procedure

Background:. Patients with chest tube have allodynia (pain from stimuli that is normally painless) and hyperalgesia (increased sensitivity to pain). Anesthetics has not been used routinely when removing chest tubes assuming that the procedure is brief and that the pain is short-lived, even though it could be the most painful part of chest tube procedures.Objective: This study compared the effectiveness of local anesthetic EMLA cream and subcutaneous infiltration of lidocaine to reduce pain of chest tube removal, 10 minutes after, and it’s effect on the patient's willingness to repeat the procedure.Method: A quasi-experimental clinical trial conducted on 28 patients undergoing chest tube removal at dr. Moewardi from September 2020. The EMLA group (n = 14) received 2 grams of topical EMLA cream applied 2 hours before chest tube removal. The lidocaine group (n = 14) received subcutaneous infiltration of 2% lidocaine 5 minutes before chest tube removal. Pain was measured by VAS pain before, during, and 10 minutes after the chest tube was removed, followed by filling out a willingness to repeat procedure questionnaire.Results: Topical EMLA cream was comparable to 2% lidocaine infiltration for reducing pain during chest tube removal (p = 0.679) and 10 minutes thereafter (p = 0.833). EMLA cream did not increase the patient's willingness to repeat the procedure (p = 0.815)Conclusion: Topical EMLA cream able to replace the subcutaneous infiltration of 2% lidocaine as a local anesthetic for chest tube removal but does not increase the patient's willingness to repeat the procedure.

The efficacy of endobronchial valves for the treatment of bronchopleural fistula: a single-arm clinical trial

BackgroundA bronchopleural fistula (BPF) is defined as communication between the bronchus and pleural cavity, and it is a dreaded complication of severe pulmonary disease. Surgical intervention, pleurodesis, and prolonged chest tube drainage have several disadvantages. To overcome these, many attempts have been made to treat BPF with bronchoscopy, especially with the insertion of an endobronchial one-way valve (EBV). Endobronchial valves for the treatment of BPF which had less trauma, relatively short operation time, better safety, and patients are more likely to accept this operation. If there is a definite efficacy, it should be widely used in later clinical practice. This study aimed to confirm the efficacy of endobronchial valves for the treatment of BPF.MethodsWe retrospectively reviewed data from 26 patients who were treated for BPF using an EBV between August 2017 and October 2020. This sample constitutes all patients treated in our hospital (Shanghai Pulmonary Hospital, Tongji University School of Medicine) for this condition and with this intervention during this timeframe. We collected general information about the patient, complications of the procedure, and chest tube indwelling to assess the efficacy and safety of the procedure.ResultsA total of 26 patients underwent EBV placement procedures; left upper lobe (LUL) was the most common lobe in which the valves were placed. The underlying etiologies for BPF were postoperative BPF (50%; n=14), pneumothorax (15%; n=4), non-tuberculosis mycobacteria (NTM) (19%; n=5), and tuberculosis (12%; n=3). Eleven patients underwent chest tube insertion. The average chest tube duration in the group of patients before receiving valves was 66 days (median, 65 days; range, 14–187 days). The average duration after which the chest tube was removed was 17.5 days after EBV placement (median, 7 days; range, 2–90 days). The effective rate of EBV for the treatment of BPF was 73.1%. Patients for whom the valves were not removed, there were no valve related complications.ConclusionsEBV placement is a relatively mature procedure, which is safe and effective, and generates less trauma and fewer complications. And this intervention may be suitable for wide application in clinical practice.

Occurrence and Management of Empyema Thoracis During Covid-19 Times

Introduction: Empyema is defined as an infected pleural fluid collection, evidenced either by purulent fluid or the presence of bacterial organisms. The aim of this study is to highlight the importance of early diagnosis and management of empyema in an attempt to avoid needless procedures and dreaded complications while shining a light into the warrant of a multidisciplinary approach that would had a paramount significance during the lockdown period in Greece, between March-June of 2020 due to COVID-19, in ameliorating those issues. Patients and Methods: During the aforementioned period 12 patients were treated at our Department, 11 of them were male, ages ranging from 22-71 years old. The cause of empyema was parapneumonic effusion from a bacterial pneumonia in 10 patients and the other 2 were tuberculous empyema and extension of an intraabdominal process (Diffuse large B-cell lymphoma of the stomach). Predominately the patients were admitted to our Department with stage III empyema. Diagnosis was confirmed with CT scan and drainage of frank pus from the chest tube. All patients underwent chest tube insertion and antibiotic therapy nonetheless 9 of them required surgical management with VATS or open decortication. Results and Conclusion: The impedance in seeking medical advice due to fear of COVID-19 and the insufficiency of an interdisciplinary approach in the management of those patients were determined as the reason for such high admittance with stage III empyema. The decision of open vs VATS decortication was made based on the medical status and history of each individual, the stage of the empyema and ultimately our ability to achieve the two primary goals of empyema treatment, complete evacuation, and lung reexpansion [1]. Eight patients underwent open decortication and drainage and one managed with VATS decortication. Postoperative complications were encountered in 3 patients which included prolonged air leak, surgical wound infection, and septic shock. One patient died from multiple organ failure due to postoperative septic shock. The duration of chest tube drainage varied from 5-15 days. The mean hospital stay was 13,5 days.

Albumin and leukocyte: pre-operative factors for advanced management in pleural empyema?

Background: Surgical intervention such as video-assisted thoracoscopic surgery (VATS) has shown the benefit of reducing morbidity and mortality in the management of pleural empyema. The objective of the study was to investigate preoperative factors that could predict the need for VATS rather than chest tube thoracostomy.Methods: This is retrospective observational study of consecutive patients diagnosed with pleural empyema admitted to the Dr. Zainoel Abidin Hospital, Banda Aceh in period of 2015 to 2017. The demographic, clinical dan laboratory data of the patients were evaluated from hospital medical records.Results: A total of 48 consecutive patients were identified. The mean age of the patients was 34.3 ± 20.4 years; and 31 (64.6%) were male. Twenty-six patients underwent VATS decortication and twenty-two patients underwent chest tube thoracostomy. Patient demographics were similar between VATS decortication and chest tube thoracostomy group. The significant preoperative factors associated with the VATS were serum albumin level and leukocytes (p <0.05). The mean serum albumin level was 2.81 ± 0.44 g/dL for the VATS decortication group vs 3.06 ± 0.41 g/dL for the chest tube thoracostomy group (p = 0.047). In addition, serum leukocyte level was higher in VATS decortication group compared to chest tube thoracostomy group (21,600 mm-3 vs 12,900 mm-3; p = 0.024).Conclusion: We demonstrate that a low serum albumin level or an elevated leukocyte level may represent as preoperative factors in which surgical treatment may be required in the management of pleural empyema.

Thoracic Ultrasound as an Early Predictor of Pleurodesis Success in Malignant Pleural Effusion

Malignant pleural effusion (MPE) is common and imposes a significant burden on patients and health-care providers. Most patients require definitive treatment, usually drainage and chemical pleurodesis, to relieve symptoms and prevent fluid recurrence. Thoracic ultrasound (TUS) can identify the presence of pleural adhesions in other clinical scenarios, and could therefore have a role in predicting long-term pleurodesis success or failure in MPE. Patients undergoing chest tube drainage and talc slurry pleurodesis for symptomatic MPE were recruited to a prospective observational cohort pilot study assessing whether TUS findings pre-talc and post-talc instillation predicted treatment outcome. Participants underwent TUS examination immediately before, and 24 h after talc slurry administration to derive pleural adherence scores for the affected hemithorax. The recorded TUS scans were additionally scored by two independent assessors blinded to the patient's clinical status. The primary outcome was pleurodesis success at 1-month and 3-month follow-up. Eighteen participants were recruited to the pilot study. Participants who suffered pleurodesis failure had a lower pleural adherence score at 24 h post-talc instillation than those who were successful (difference of 6.27; 95% CI, 3.94-8.59). TUS examination was acceptable to patients, while TUS scoring was highly consistent across all assessors (intraclass correlation coefficient, 0.762; 95% CI, 0.605-0.872). A TUS-derived pleural adherence score may facilitate early prediction of long-term outcomes following chemical pleurodesis, with implications for personalized care and decision making in MPE. Further research is needed to evaluate this novel finding. ClinicalTrials.gov; No. NCT02625675; URL: www.clinicaltrials.gov.

Pneumatoceles in pediatric blunt trauma: Common and benign

IntroductionTraumatic pneumatoceles are reported to be rare in children and to have an uncertain clinical significance. We report a single institution series of traumatic pneumatoceles to better define their frequency and clinical significance. MethodsAfter obtaining approval from the IRB, data were extracted from the trauma registry of a level 1 pediatric trauma center on children diagnosed with a pulmonary contusion (International Classification of Diseases-9th edition diagnosis codes: 861.21 to 861.31) who presented between June, 2006 and September, 2016. Patient demographics, mechanism of injury, injury severity score, diagnosis and procedure codes, length of hospital stay, outcome, imaging techniques and findings with attention to the identification of a pneumatocele, were examined. ResultsOf the 10,229 trauma admission, 204 children were identified as having a pulmonary contusion, 25 of whom (12.3%) were diagnosed with a pneumatocele. Their mean age was 13years (3–17). Seventy-six percent (19) were male. The most common mechanism of injury was a motor vehicle collision (10), followed by falls (6), and sports (5). Sixteen children (64%) suffered a long bone fracture, 12 (48%) an abdominal solid organ injury and 3 (12%) a traumatic brain injury. The mean Injury Severity Score was 17 (9–34). Twenty-three patients presented as transfers. There were no fatalities. The pneumatocele was identified on chest computerized tomography (CT) alone in 15 (60%), on chest CT and chest radiograph (CXR) in 3 (12%), the upper portions of an abdominal CT in 6 (24%) and on CXR alone in 1 (4%). Seven patients were found to have a solitary pneumatocele and 18 patients had 2 or more. The largest pneumatocele was 3.7cm in diameter. Ten children (40%) were admitted to the intensive care unit, 3 of whom required intubation. One patient (4%) had a respiratory complication: pneumonia. Three patients underwent chest tube placement for: pneumothorax, hemothorax and hemopneumothorax. No child underwent intervention specific to the pneumatocele. Seventeen (68%) patients were seen in follow-up in Trauma Clinic and the remainder by another practitioner ranging from 1week to 6months after injury. One child (4%) underwent a follow-up chest CT to rule out a congenital pulmonary malformation 6months after injury and this demonstrated complete resolution of the pneumatocele. ConclusionThe incidence of traumatic pneumatoceles among children with a pulmonary contusion was 12.3% in this series, but is probably higher given that only 24% were visible on radiographs and a small minority of children with pulmonary contusions underwent chest CT. Pneumatoceles are common in children with pulmonary contusions, but are usually small. The majority do not appear to be clinically significant nor require follow-up imaging. Level of evidenceIV.

Assessment the Nurses Performance in Providing Care to Patients Undergoing Chest Tube in Suez Canal University Hospital

Chest tube care is one of’ the most important nursing procedures because patients who need chest tubes are usually seriously ill and require advanced nursing care. Accordingly, vigilant and expert nursing care can prevent serious complications. The aim of the present study is to assess nurses’ performance in providing care to patients undergoing chest tube. The study was a descriptive research design was used to conduct this study; a total number of 70 nurses were selected randomly using systematic sampling technique. Data were collected for a period of four months, using two tools: Tool (1) Questionnaire sheets to assess nurses, knowledge about care provided to patients undergoing chest tube. Tool (2): Observational checklist to assess the nurses’ practice in providing care to patients undergoing chest tube. The results of the present study revealed that unsatisfactory level of performance in providing care to patients undergoing chest tube among nurses in the sample. There was significant relation between nurses, knowledge, practice and degree of qualification. Also there was no correlation between nurses, knowledge and practice .The study recommended that improve nurses, theoretical knowledge and clinical applications of chest tube care &continuous evaluation of nurse’s knowledge and performance is essential to identify nurse’s needs.

The effect of cold application and lavender oil inhalation in cardiac surgery patients undergoing chest tube removal.

Post-surgical chest tube removal (CTR) is associated with a significant pain and discomfort for patients. Current treatment strategies for reducing CTR-associated pain and anxiety are limited and partially efficacious. To determine the effects of cold application, inhalation of lavender essential oil, and their combination on pain and anxiety during CTR was investigated. This randomized controlled open-label trial was conducted with 80 patients in the cardiac surgery intensive care unit who had a chest tube for duration of at least 24 hours after coronary artery bypass grafting (CABG). Patients were randomized (n=20 in each group) to receive cold application, aromatherapy with lavender oil, cold application in combination with lavender oil inhalation, or none of the above interventions (control group). The intensity and quality of pain and anxiety were evaluated using the visual analogue scale, short form and modified-McGill pain questionnaire (SFM-MPQ) and the Spielberger situational anxiety level inventory (STAII) scale, respectively. Patients in all treatment groups had significantly lower pain intensity and anxiety compared with the control group immediately, 5, 10 and 15 min after CTR. There was no statistically significant difference in the SFM-MPQ total scores between the intervention groups. With respect to anxiety score, there was a significantly reduced anxiety level immediately after CTR in the aromatherapy and cold-aromatherapy combination groups versus the cold application group. The present results suggested the efficacy of cold application and aromatherapy with lavender oil in reducing pain and anxiety associated with post-CABG CTR.

Safety Profile of the Use of Iodopovidone for Pleurodesis in Patients with Malignant Pleural Effusion

Background: Iodopovidone is an alternative agent used to promote pleurodesis in patients with malignant pleural effusion (MPE). However, safety is a concern, and many authors still reject its use. Objectives: Our main objective is to describe the occurrence of common and severe adverse events after pleurodesis with two different doses of iodopovidone in patients with MPE. Our secondary objective is to evaluate dose dependency, efficacy, quality of life, and systemic inflammation. Methods: We conducted a double-blind, randomized clinical trial including patients with recurrent MPE. Patients underwent chest tube insertion and were randomized into two groups according to the doses of iodopovidone: group 1 received 1% iodopovidone, and group 2 received 2% iodopovidone. During follow-up, adverse events, inflammatory markers, quality of life, and imaging exams were systematically evaluated and registered. Results: Sixty patients were analyzed (55 females, 5 males, median age 55.9 years). Overall, 227 adverse events possibly related to pleurodesis were registered, including 47 serious adverse events (in 34 patients). Pleuritic pain and hypertensive peaks were the most frequently observed serious adverse events (11 and 10 episodes, respectively). Grade 3/4 metabolic events such as hyponatremia and an increase in alkaline phosphatase, AST and ALT levels were also common. C-reactive protein (CRP) levels increased substantially and peaked 48 h after pleurodesis. No difference was observed between groups with regard to adverse events, CRP levels, efficacy, or quality of life. Conclusions: Adverse events after iodopovidone pleurodesis in patients with MPE are common and similar in the two doses studied.

Spontaneous Pneumomediastinum: Analysis of 62 Consecutive Adult Patients

OBJECTIVE To clarify the clinical presentation and course of patients with spontaneous pneumomediastinum (SP) and to determine the usefulness of diagnostic testing in these patients. PATIENTS AND METHODS We conducted a retrospective review of 62 consecutive adult patients (age ≥18 years) diagnosed as having SP during an 11-year period from July 1, 1997, to June 30, 2008. The study cohort included 41 men and 21 women (median age, 30 years; interquartile range, 20-69 years). RESULTS Among the 62 study patients, the most common presenting symptoms were chest pain (39 patients [63%]), cough (28 [45%]), and dyspnea (27 [44%]). Preexisting lung diseases were identified in 27 patients (44%) and included interstitial lung disease, asthma, lung malignancies, bronchiolitis obliterans syndrome, chronic obstructive pulmonary disease, bronchiectasis, and cystic lung lesions. The initial diagnosis of SP was achieved by chest radiography in 52 patients (84%); the remaining cases were diagnosed by computed tomography. Forty-seven patients (76%) were hospitalized for a median duration of 2.5 days. Additional diagnostic procedures were performed in 27 patients (44%) and included contrast esophagography, bronchoscopy, and esophagogastroduodenoscopy; however, they did not yield a pathologic cause in any patient. Pneumothorax was identified in 20 patients (32%), but less than one-third of these patients underwent chest tube thoracostomy. No episodes of mediastinitis or sepsis occurred. Recurrence of SP was seen in 1 patient, and thoracoscopic surgery was performed in 1 patient for persistent air leak (pneumothorax). CONCLUSION Spontaneous pneumomediastinum was associated with a relatively benign clinical course; however, pneumothorax was seen in 32% of cases. Diagnostic testing to determine a pathologic cause yielded little clinically relevant information in these patients. To clarify the clinical presentation and course of patients with spontaneous pneumomediastinum (SP) and to determine the usefulness of diagnostic testing in these patients. We conducted a retrospective review of 62 consecutive adult patients (age ≥18 years) diagnosed as having SP during an 11-year period from July 1, 1997, to June 30, 2008. The study cohort included 41 men and 21 women (median age, 30 years; interquartile range, 20-69 years). Among the 62 study patients, the most common presenting symptoms were chest pain (39 patients [63%]), cough (28 [45%]), and dyspnea (27 [44%]). Preexisting lung diseases were identified in 27 patients (44%) and included interstitial lung disease, asthma, lung malignancies, bronchiolitis obliterans syndrome, chronic obstructive pulmonary disease, bronchiectasis, and cystic lung lesions. The initial diagnosis of SP was achieved by chest radiography in 52 patients (84%); the remaining cases were diagnosed by computed tomography. Forty-seven patients (76%) were hospitalized for a median duration of 2.5 days. Additional diagnostic procedures were performed in 27 patients (44%) and included contrast esophagography, bronchoscopy, and esophagogastroduodenoscopy; however, they did not yield a pathologic cause in any patient. Pneumothorax was identified in 20 patients (32%), but less than one-third of these patients underwent chest tube thoracostomy. No episodes of mediastinitis or sepsis occurred. Recurrence of SP was seen in 1 patient, and thoracoscopic surgery was performed in 1 patient for persistent air leak (pneumothorax). Spontaneous pneumomediastinum was associated with a relatively benign clinical course; however, pneumothorax was seen in 32% of cases. Diagnostic testing to determine a pathologic cause yielded little clinically relevant information in these patients.

Spontaneous Pneumomediastinum: Analysis of 62 Consecutive Adult Patients

To clarify the clinical presentation and course of patients with spontaneous pneumomediastinum (SP) and to determine the usefulness of diagnostic testing in these patients. We conducted a retrospective review of 62 consecutive adult patients (age >or=18 years) diagnosed as having SP during an 11-year period from July 1, 1997, to June 30, 2008. The study cohort included 41 men and 21 women (median age, 30 years; interquartile range, 20-69 years). Among the 62 study patients, the most common presenting symptoms were chest pain (39 patients [63%]), cough (28 [45%]), and dyspnea (27 [44%]). Preexisting lung diseases were identified in 27 patients (44%) and included interstitial lung disease, asthma, lung malignancies, bronchiolitis obliterans syndrome, chronic obstructive pulmonary disease, bronchiectasis, and cystic lung lesions. The initial diagnosis of SP was achieved by chest radiography in 52 patients (84%); the remaining cases were diagnosed by computed tomography. Forty-seven patients (76%) were hospitalized for a median duration of 2.5 days. Additional diagnostic procedures were performed in 27 patients (44%) and included contrast esophagography, bronchoscopy, and esophagogastroduodenoscopy; however, they did not yield a pathologic cause in any patient. Pneumothorax was identified in 20 patients (32%), but less than one-third of these patients underwent chest tube thoracostomy. No episodes of mediastinitis or sepsis occurred. Recurrence of SP was seen in 1 patient, and thoracoscopic surgery was performed in 1 patient for persistent air leak (pneumothorax). Spontaneous pneumomediastinum was associated with a relatively benign clinical course; however, pneumothorax was seen in 32% of cases. Diagnostic testing to determine a pathologic cause yielded little clinically relevant information in these patients.

Clinical Analysis of Cases of Empyema Due to <i>Streptococcus milleri</i> Group

In this study we analyzed 15 cases of empyema due to Streptococcus milleri group treated between January 2000 and December 2007. The majority (87%) were men, and the mean patient age was 62 years (range 36 to 83). An underlying disease was present in 14 of 15 cases. Six cases were complicated by pneumonia. Polymicrobial infection with S. milleri group was recognized in four patients. Most patients underwent chest tube drainage (87%), and all received antibiotic treatment (100%). The average duration of chest tube drainage was 8.4 days and that of antibiotic treatment was 14.0 days. Six cases (40%) underwent video-assisted thoracoscopic surgery for decortication. The duration of hospitalization was 19.6 days. The clinical effect of treatment was comparatively good (93%), and the prognosis was also good (mortality rate 7%).

Outcome analysis of cirrhotic patients undergoing chest tube placement: Lawrence U Liu, Thomas D Schiano, Hassan A Haddadin, Carol Bodian, Samuel H Sigal, Albert D Min, Jessica D Korman, Henry C Bodenheimer, Jr., Division of Liver Diseases, The Mount Sinai Medical Center, New York, New York, NY

Outcome analysis of cirrhotic patients undergoing chest tube placement: Lawrence U Liu, Thomas D Schiano, Hassan A Haddadin, Carol Bodian, Samuel H Sigal, Albert D Min, Jessica D Korman, Henry C Bodenheimer, Jr., Division of Liver Diseases, The Mount Sinai Medical Center, New York, New York, NY

Causes and management of postpneumonectomy empyemas: our experience.

Infection of the pleural cavity and development of empyema are potential dangers after pneumonectomy. In spite of decrease in frequency of postpneumonectomy empyemas (PPE) formation, this is still a serious complication. The aim of this study was: analysis the mechanisms of postpneumonectomy empyema formation and attempt the elaboration of the optimal management of these patients. 1148 pneumonectomies were performed at the Thoracic Surgery Centre between 1984 and 2002. PPE occurred in 76 (6.6%) patients between the ages of 25-77. For statistical purposes the chi2 test was used. The causes of PPE showed that in 56/76 (73.7%) patients its formation was due to a postoperative complications. In 4/76 (5.3%) cases the cause of empyema was associated with intraoperative infection during the operation. In 3/76 (3.9%) patients a long period of treatment at the intensive care unit due to postoperative shock predisposed to the infection. In 13/76 (17.1%) patients the cause was not established. Statistically significant PPE was associated with postoperative complication (P=0). Postoperative complication caused by one factor was more frequent than those caused by 2 or 3 factors (P=0). PPE was the most often diagnosed in the second postoperative week (P=0.0001). 13 (17.1%) patients died during the 30 days after beginning of the treatment of PPE. The course of complication was more impetuous and more deaths were noted in patients diagnosed during the first week after operation. Only 8 patients from 34, who were selected for thoracentesis and lavage with deposition of antibiotics into the pleural cavity recovered. Jointly 68 (89.5%) patients underwent chest tube drainage. After 2-3 weeks the tube was removed in 16 patients. 17 (22.4%) patients were not qualified for operation. 35 (46.1%) patients underwent different operative procedures: 20 fenestrations, 12 fenestrations with myoplasty and 3 thoracoplastic operations with myoplasty. The most common causes of PPE were postoperative complications, mainly bronchopleural fistula. The scheme of therapeutic management in PPE was elaborated as a result of our experience.

Outcome Analysis of Cirrhotic Patients Undergoing Chest Tube Placement

Patients with cirrhosis can acquire pulmonary conditions that may or may not be related to their illness. Although posing a greater risk for complications, chest tubes are sometimes placed as treatment for hepatic hydrothorax and other pulmonary conditions. The aim of this study was to analyze the outcomes of chest tube placement in cirrhotic patients. A retrospective analysis was performed of 59 adults with cirrhosis undergoing chest tube placement. Variables that were investigated included reason for chest tube placement, complications developing while having the tube in place, and outcome. The 59 subjects were classified as having Child-Turcotte-Pugh (CTP) class A cirrhosis (n = 3), CTP class B cirrhosis (n = 31), and CTP class C cirrhosis (n = 25). Indications for having a chest tube placed were hepatic hydrothorax (n = 24), pneumothorax (n = 9), empyema (n = 8), video-assisted thoracoscopy (VAT) [n = 7], non-VAT (n = 5), and hemothorax (n = 3). The CTP class A subjects had their chest tubes removed without further complications early in the course, and were excluded from further statistical analysis. Twenty-five subjects (42%) had significant pleural effusions requiring chest tube placement. Among the CTP class B and class C subjects, the median duration with chest tube in place was 5.0 days (range, 1 to 53 days). Serum total bilirubin levels, presence of portosystemic encephalopathy, and CTP C classification were predictors of mortality. Mortalities were seen in 5 of 31 CTP class B subjects (16%), and 10 of 25 CTP class C subjects (40%). The tubes were successfully removed in a total of 39 subjects (66%) with no further procedure. Forty-seven subjects (80%) acquired one or more of the following complications: renal dysfunction, electrolyte imbalances, and infection. When placed for all indications, chest tubes may be successfully removed in the majority of cirrhotic patients. However, a third of all patients still die with the chest tube still in place. Failure to remove the chest tube increases mortality in patients with increasing severity of liver disease.