Tube Placement Research Articles

Noninvasive ventilation in chest trauma-related acute respiratory failure related to chest trauma: Efficacy and risk of pneumothorax.

Current guidelines recommend noninvasive ventilation (NIV) for chest trauma patients with acute respiratory failure. This study aimed to identify factors predictive of NIV failure and assess the risk of pneumothorax during NIV. This retrospective study was conducted in four adult ICUs from January 2010 to January 2021. Patients were included if they were admitted with chest trauma and treated with NIV for acute respiratory failure. A total of 134 patients were included in the study. At NIV initiation the mean PaO2/FiO2 ratio was 251mm Hg and 30% of patients were hypercapnic. NIV failure occurred in 33 patients (24.6%). In multivariate analysis, no independent factors were significantly associated with failure. Among the 79 patients without a pneumothorax before NIV, 1 patient (1.3%) developed a pneumothorax under NIV. 55 patients had a pneumothorax before NIV, 33 were treated with a chest tube, and 2 (6%) experienced recurrence of pneumothorax during NIV. For the remaining 22 patients with minimal pneumothorax monitored without chest tube, 3 (13.6%) had worsening of the pneumothorax under NIV. In this multicenter study on chest trauma patients, NIV success was observed in approximately 75% of cases. No independent predictive factors for NIV failure were identified. While the risk of pneumothorax worsening under NIV was low, careful monitoring is essential, particularly when managing pneumothorax conservatively without chest tube placement.

Nutritional Outcomes in HPV-Associated Oropharyngeal Squamous Cell Carcinoma After Transoral Robotic Surgery.

Nutritional outcomes following transoral robotic surgery (TORS) for human papillomavirus (HPV) associated oropharyngeal squamous cell carcinoma (OPSCC) are poorly understood. This study evaluates how TORS, with or without adjuvant treatment, impacts swallowing and weight loss. All patients treated with TORS for HPV-associated OPSCC from January 2016 to December 2023 were included. Weight loss, functional oral intake, feeding tube dependence, patient demographics, and treatment course were collected from patients' electronic medical records. In total, 160 patients with HPV-associated OSPCC treated with TORS were included. 87.5% were male, with a median age of 60.0 years. Most patients were diagnosed with pT1 (53.8%) or pT2 (40.0%) and pN1 (78.1%) disease. 31.9% underwent TORS alone, while 42.5% received adjuvant radiation and 25.6% adjuvant chemoradiation. The median follow-up time was 2.27 (range 0.26-7.56) years. 87.4% of patients underwent nasogastric tube placement during TORS. Prolonged postoperative nasogastric tube dependence was significantly associated with increased rates of feeding tube replacement (p < 0.001; 95% CI, 1.051-1.181) later during treatment. Weight loss from three months to three years postoperatively was significantly greater in patients who received adjuvant radiation and chemoradiation (p < 0.001), despite no significant difference in swallowing outcomes. There was no significant difference in weight loss between adjuvant radiation and chemoradiation groups. Adjuvant treatment following TORS is associated with significantly greater long-term weight loss but does not significantly alter swallowing outcomes. Longer duration of nasogastric tube dependence in the postoperative period is associated with higher rates of enteral feeding dependence later in treatment.

Bilateral Spontaneous Hemothorax: A Rare Case of Primary Pleural Angiosarcoma and Literature Review

Introduction and case report: Angiosarcomas, rare soft tissue malignancies originating from endothelial cells, represent only 1–2% of all soft tissue sarcomas. Primary pleural angiosarcoma (PPA) is exceptionally rare, with only 43 reported cases since 1943. There are many diagnostic and therapeutic challenges due to the rarity of these tumors. We present the case of a 72-year-old man presenting with back pain, dyspnea and anemia. Conventional imaging revealed bilateral pleural effusion and a thickened parietal pleura, while contrast chest MR was able to identify pleural sites of contrast enhancement. Left chest tube placement evidenced a hemothorax, and the cytology result was negative. A thoracoscopic approach was chosen, allowing us to perform different parietal pleural biopsies. Radiological and pathological features led to the diagnosis of epithelioid PPA. Despite pleural drainage and blood transfusions, the patient died only 4 days after diagnosis. Objectives: To present a literature review, evaluating the disease epidemiology and the clinical, diagnostic and therapeutic features of PPA. Methods: We reviewed cases of PPA in the literature (1954–2024) by searching the PubMed database for the terms “pleural angiosarcoma” and “pleura + angiosarcoma”. Results: We found a total of 47 cases that were described between 1987 and 2024 with sufficient data to be included in our review. PPA was found to be a challenging diagnosis, found mostly in older Caucasian males. The cytology is mostly indeterminant, and an endoscopic approach is usually needed. Radical surgery is the most common treatment option, and chemotherapy and radiation therapy are also often used. However, the prognosis is poor. Conclusions: PPA is very rare, and complex cases such as this one showcase the importance of innovative approaches like MRI and emphasize the significance of multidisciplinary collaboration for optimal patient management. Bilateral spontaneous hemothorax, as seen in this case, is uncommon and poses additional challenges in disease management. Further research to advance the diagnostic capabilities and treatment efficacy is needed.

Laparoscopic‐assisted ‘pull‐introducer technique’ for gastrostomy tube placement in small infants: A single‐centre experience

AbstractKirberg et al. described in 2016 a one‐step gastrostomy tube placement, the ‘pull‐introducer’ technique, designed for small‐for‐gestational‐age neonates, combining two endoscopic techniques. Nine infants (weight 3.4–8.1 kg) in our centre required a gastrostomy placement (two infants) or a combined gastrostomy placement and Nissen fundoplication (seven infants). A single‐stage balloon gastrostomy was preferred in all cases because of a significant anaesthetic risk. The pull‐introducer method was chosen because the commercially available one‐step balloon gastrostomy gastropexy devices were considered too large. There were no immediate or long‐term complications (except local infection). All nine infants were discharged from the hospital as planned. After 6 months, the balloon gastrostomy tube was replaced with a balloon button or balloon gastrostomy tube.

Frontal Sinus Trephination and Repeated Irrigation in a Cat with Chronic Rhinosinusitis: A Case Report

A 2-year-old neutered female domestic shorthair cat presented with chronic, progressively worsening upper respiratory symptoms that were unresponsive to long-term medical treatment. Initial management involved antibiotics, antivirals, and anti-inflammatory drugs, all of which failed to provide substantial clinical improvement. Diagnostic imaging with computed tomography revealed bilateral nasal and frontal sinus obstructions with viscous inflammatory exudate and localized osteolytic changes in the patient. Despite adjustments to the antimicrobial therapy regimen based on the PCR results, clinical signs persisted. Surgical intervention through frontal sinus trephination, physical removal of the exudate, placement of a temporary drainage tube, and repeated irrigation successfully resolved most of the clinical symptoms. Follow-up over two years showed sustained clinical improvement, with only mild intermittent serous nasal discharge reported. This case highlights the efficacy of surgical management, specifically frontal sinus trephination and repeated irrigation, in the treatment of cats with refractory chronic rhinosinusitis.

Success Rates for Endoscopic Placement of Post-Pyloric Nasoenteric Tube Underperform Expectations.

Enteral nutrition plays a pivotal role in maintaining nutritional status and supporting recovery in hospitalized patients who are unable to meet their caloric requirements. The benefits of enteral nutrition include preserving gut integrity, reducing infection risks, and supporting immune function, which are vital in critically ill and post-operative patients. Nasoenteric feeding tubes often serve as important tools to deliver enteral nutrition efficiently, yet their optimal placement remains a subject of significant clinical consideration. Nasoenteric feeding tubes can be compromised by placement-related complications such as displacement, malpositioning, and tube-related discomfort. Our review of the relevant literature is complemented by review of our recent data. Our own clinical experience suggests that endoscopic placement of naso-enteric feeding tubes fails during the wire exchange process. This report reviews the importance of enteral nutrition for enhancing patient outcomes, documents findings from our retrospective study on endoscopically placed nasoenteric feeding tubes and focuses on the challenges and future advancements in nasoenteric feeding tube placement techniques.

End-of-Life Care and Health Care Spending for Medicare Beneficiaries With Dementia in Accountable Care Organizations

Individuals with dementia may receive high-intensity care at the end of life (EOL) that does not align with their preferences and is costly. Medicare Accountable Care Organizations (ACOs) are an alternative payment model that aims to incentivize high-quality care and lower spending. To compare EOL care processes, outcomes, and health care spending between Medicare beneficiaries with dementia in a Medicare Shared Savings Program (MSSP) ACO and non-ACO. This quasi-experimental study of EOL care used a nationally representative 20% random sample of Medicare fee-for-service beneficiaries with dementia (age ≥66 years) who died from 2017 to 2020. Difference-in-differences and event study design approaches were used to compare outcomes between beneficiaries attributed to MSSP ACO vs those who were not. Data were analyzed from June 2023 to December 2024. MSSP ACO entry from 2017 to 2019 vs non-ACO. Differential changes in 5 areas: (1) billing for advance care planning; (2) palliative care counseling in last 6 months of life; (3) hospice in last 6 months of life; (4) high-intensity care in last 30 days of life (ie, emergency department visit, hospitalization, intensive care unit admission, in-hospital death, cardiopulmonary resuscitation or mechanical ventilation, feeding tube placement); and (5) health care spending in last 6 months of life. Of 162 034 eligible Medicare beneficiaries (mean [SD] age, 85.0 [7.9] years; 94 304 female [58.2%]), 51 191 (31.6%) were attributed to MSSP ACO. Adjusted trends in outcomes were similar between ACO and non-ACO groups before ACO entry. The difference-in-differences analyses found no evidence that EOL care processes or outcomes (eg, hospice in last 6 months of life, -0.4 percentage points [pp]; 95% CI, -1.4 pp to 0.5 pp; P > .99) or spending (eg, total health care spending in last 6 months of life, -$632; 95% CI, -$1377 to $113; P = .96) differed between beneficiaries treated in ACOs vs non-ACOs. The event study design also showed no evidence of differential changes in outcomes between the 2 groups. Sensitivity analyses using inverse probability weighting yielded similar results. Using nationally representative data on beneficiaries with dementia at EOL, this quasi-experimental study found no evidence that EOL care processes, outcomes, or spending changed with ACO entry for Medicare fee-for-service beneficiaries vs non-ACO beneficiaries. Alternative payment models to ACOs may be needed to coordinate high-quality care with lower spending for beneficiaries with dementia at the EOL.

PREVENT TUBES MIGRATION AND SUBCUTANEOUS EROSION IN THREE-PIECES PENILE IMPLANTS AL-ANSARI TECHNIQUE

PREVENT TUBES MIGRATION AND SUBCUTANEOUS EROSION IN THREE-PIECES PENILE IMPLANTS AL-ANSARI TECHNIQUE

NOVEL TECHNIQUE TO AVOID TUBING MIGRATION AND SUBCUTANEOUS EROSION IN THREE-PIECES PENILE IMPLANTS

NOVEL TECHNIQUE TO AVOID TUBING MIGRATION AND SUBCUTANEOUS EROSION IN THREE-PIECES PENILE IMPLANTS

Safety of a gastropexy device in infants and young children in percutaneous endoscopic gastrostomy tube placement

In our practice, there is a growing need to perform gastrostomy tube placement in infants and young children with feeding difficulties. To avoid possible complications arising from pull-through method (pull-through PEG) we began to perform a one-step endoscopic gastrostomy with a gastropexy device (push GT). This study aimed to evaluate the safety of this technique in infants and young children. In our study, 60 pull-through PEG and push GT procedures were retrospectively analysed in patients between 2.83 and 8.6 kg. We analysed the adverse events in both groups. Age, sex, weight, diagnosis, early (occurring ≤ 7 days after the procedure) and late (occurring > 7 days after the procedure) complications were compared in the two groups. Median follow-up duration was 12 months. Early minor complications occurred only in the push GT group, but this was not statistically significant. There was no significant difference between the groups regarding early major complications. Late minor complications were significantly more common in the push GT group. There were no late major complications in the push GT group, which is statistically significant. In infants and young children, push GT with a gastropexy device is a safe method to perform gastrostomy even in patients unsuitable for pull-through PEG placement.

In sheep undergoing general anaesthesia does inclusion of medetomidine result in hypoxaemia?

Question In healthy adult female non-pregnant sheep undergoing general anaesthesia for research studies does the inclusion of intravenous medetomidine as part of the anaesthetic protocol cause hypoxaemia? Clinical bottom line The category of research question was: Treatment. The number and type of study designs that were critically appraised were: Four papers were available for critical appraisal. The quality of the evidence is weak. There were four experimental studies; three of which were cross-over studies and one study which was run in parallel with primary orthopaedic research. None of the studies were specifically focussed on the potential hypoxaemic effects of medetomidine. Critical appraisal of the selected papers meeting the inclusion criteria collectively provide zero/weak/moderate/strong evidence in terms of their experimental design and implementation: Weak. The outcomes reported are summarised as follows… Sheep across all four studies developed hypoxaemia (indicated by arterial oxygen tension; either PaO2 &lt; 80 mmHg/10 kPa when breathing room air, or a statistically significant fall in PaO2 compared with baseline, when breathing oxygen enriched gases), when medetomidine was administered intravenously and in combination with various drugs (i.e. midazolam, propofol, ketamine, halothane, and isoflurane). However, as the sheep were receiving various doses of medetomidine at various timepoints, different quantities of supplemental oxygen (if any), varying ventilatory management (two studies used mechanical ventilation and two studies allowed sheep to breathe spontaneously), and different agents were used to maintain anaesthesia, the clinical significance of the PaO2 values was difficult to assess. In view of the strength of evidence and the outcomes from the studies the following conclusion is made… In clinically healthy (judged by clinical examination) adult female non-pregnant sheep undergoing general anaesthesia (characterised by placement of an endotracheal tube and/or the use of anaesthetic induction agents i.e. barbiturates, ketamine, propofol), the weak evidence presented here suggests that use of intravenous medetomidine can be expected to cause hypoxaemia. However, hypoxaemia is variable and its clinical effects can be lessened with anaesthetic techniques such as the provision of supplemental oxygen.

Safe and Easy Inferior Vena Cava Snaring and Suction Tube Placement Using a Silicon Drain Tube During Minimally Invasive Cardiac Surgery.

Safe and Easy Inferior Vena Cava Snaring and Suction Tube Placement Using a Silicon Drain Tube During Minimally Invasive Cardiac Surgery.

Tension gastrothorax in late-presenting congenital diaphragmatic hernia: a diagnostic dilemma

Background. Tension gastrothorax is a rare life-threatening condition that occurs when the stomach is herniated into the thoracic cavity, most often through the congenital left posterolateral diaphragmatic defect, causing a mediastinal shift when distended with gas and fluid. Case Presentation. A previously healthy 2-year-old boy was admitted with acute abdominal pain, vomiting and dyspnea. Chest X-ray was initially interpreted as hydropneumothorax, but after careful observation the decision was made to insert a nasogastric tube and to perform a computerized tomography scan to confirm the suspicion of tension gastrothorax. Laparotomy was performed the following day, organs were repositioned into the abdomen and reconstruction of the left hemidiaphragm was conducted. Conclusion. When symptoms of respiratory distress occur in an otherwise healthy child, tension gastrothorax should be on the list of differential diagnosis. It is important to recognize distinct radiographic features of this life-threatening condition in order to promptly manage it. Initial placement of nasogastric tube for decompression should be followed by the reduction of the organs into the abdomen and diaphragmatic repair.

Comparison of different adjuvant analgesia for paravertebral block in video-assisted thoracoscopic surgery: A double-blind randomized controlled trial.

Local anaesthetic adjuvants have been shown to provide better pain relief and extend the duration of analgesia. But little information is available on which adjuvants are more effective in block extension for thoracic paravertebral block (TPVB) during video-assisted thoracoscopic surgery (VATS). This study aimed to compare the analgesic efficacies of different adjuvants with 0.375% ropivacaine in ultrasound-guided TPVB for VATS. A total of 120 patients who underwent VATS at the study hospital in 2022-2023 were recruited and randomly divided into four groups, including the control group (Group R), which received 20 ml ropivacaine 0.375% for TPVB, and the intervention groups: Group D (0.375% ropivacaine with 1 µg/kg dexmedetomidine in a total of 20 ml for TPVB), group E (0.375% ropivacaine with 0.1 mg/kg dexamethasone in a total of 20 ml for TPVB), and group S (0.375% ropivacaine with 0.5ug/ml sufentanil in a total of 20 ml for TPVB). They received a single-injection ultrasound-guided unilateral T5-level TPVB. The primary clinical outcomes were visual analogue scale (VAS) pain scores at rest and during coughing at 4, 8, 12, 16, 20, 24, and 48 h postoperatively. Secondary outcomes included opioid consumption, number of patient-controlled intravenous analgesics (PCIA) used within 48 h, postoperative rescue analgesia, side effects, quality of recovery after surgery, and length of hospital stay. We found that the VAS pain scores in the resting state during the postoperative period at 12-20 h were lower in Group D than in Group R (P < 0.05). The resting VAS pain scores of Groups E and S were lower than those of Group R during the postoperative period of 12-16 h (P < 0.05). Similar differences were observed in the pain scores during coughing at the same time points. Additionally, the co-administration of adjuvants with ropivacaine were associated with decreased consumption of postoperative opioids, less frequent PCIA use, and earlier time to ambulation. The intergroup pairwise comparisons showed that dexmedetomidine was more effective than dexamethasone and sufentanil in reducing additional postoperative analgesics, the length of chest tube placement and length of hospital stay. Subsequently, we administered questionnaires on the quality of recovery, which was positively correlated with the postoperative analgesic effect. These findings suggest that adjuvant analgesia for TPVB can improve postoperative pain in patients undergoing VATS. However, compared with dexamethasone and sufentanil, dexmedetomidine is more effective in extending the duration of analgesia, reducing the demand of postoperative analgesics, improving the quality of recovery at 48 h postoperatively and shorting the length of hospital stay.

Insufflation of the gastric remnant from a transduodenal approach facilitates percutaneous gastrostomy tube placement in a post Roux-en-Y patient

Percutaneous gastrostomy tube insertion in post Roux-en-Y patients can be challenging due to decompression of the excluded stomach and its discontinuity with the proximal enteric tract. Presented here is a 65-year-old woman status post Roux-en-Y gastric bypass who required gastrostomy tube placement for enteral feeding. The remnant stomach collapsed, and direct percutaneous gastric access was not possible for insufflation. To facilitate insufflation, computed tomography (CT) was used to access the duodenal bulb. This duodenal access was used to insufflate the stomach in a retrograde fashion which created a safe percutaneous window for gastrostomy tube placement into the remnant stomach. The technique described in this study can be a useful tool in patients with difficult to access remnant stomachs. Utilizing either direct or transhepatic access to the duodenum with ultrasound or CT guidance for remnant stomach insufflation can facilitate gastrostomy tube placement in challenging cases.

Deep learning algorithm classification of tympanostomy tube images from a heterogenous pediatric population.

Deep learning algorithm classification of tympanostomy tube images from a heterogenous pediatric population.

Gastrostomy Tube Placement in Patients With Trisomy 13 and 18: Surgical Decision Making and Outcomes.

Gastrostomy Tube Placement in Patients With Trisomy 13 and 18: Surgical Decision Making and Outcomes.

Management of middle ear disease in pediatric primary ciliary dyskinesia.

Management of middle ear disease in pediatric primary ciliary dyskinesia.

Performance Enhancement of Multi-tube Latent Thermal Energy Storage System: Optimization of Tube Shape, Placement and Shell Aspect Ratio

Performance Enhancement of Multi-tube Latent Thermal Energy Storage System: Optimization of Tube Shape, Placement and Shell Aspect Ratio

TO CUT, OR NOT TO CUT AT PEG TUBE PLACEMENT

TO CUT, OR NOT TO CUT AT PEG TUBE PLACEMENT