Required Chest Drain Insertion Research Articles

Manual aspiration of a pneumothorax after CT-guided lung biopsy: outcomes and risk factors.

Quantify the outcomes following pneumothorax aspiration and influence upon chest drain insertion. This was a retrospective cohort study of patients who underwent aspiration for the treatment of a pneumothorax following a CT percutaneous transthoracic lung biopsy (CT-PTLB) from January 1, 2010 to October 1, 2020 at a tertiary center. Patient, lesion and procedural factors associated with chest drain insertion were assessed with univariate and multivariate analyses. A total of 102 patients underwent aspiration for a pneumothorax following CT-PTLB. Overall, 81 patients (79.4%) had a successful pneumothorax aspiration and were discharged home on the same day. In 21 patients (20.6%), the pneumothorax continued to increase post-aspiration and required chest drain insertion with hospital admission. Significant risk factors requiring chest drain insertion included upper/middle lobe biopsy location [odds ratio (OR) 6.46; 95% CI 1.77-23.65, p = 0.003], supine biopsy position (OR 7.06; 95% CI 2.24-22.21, p < 0.001), emphysema (OR 3.13; 95% CI 1.10-8.87, p = 0.028), greater needle depth ≥2 cm (OR 4.00; 95% CI 1.44-11.07, p = 0.005) and a larger pneumothorax (axial depth ≥3 cm) (OR 16.00; 95% CI 4.76-53.83, p < 0.001). On multivariate analysis, larger pneumothorax size and supine position during biopsy remained significant for chest drain insertion. Aspiration of a larger pneumothorax (radial depths ≥3 cm and ≥4 cm) had a 50% rate of success. Aspiration of a smaller pneumothorax (radial depth 2-3 cm and <2 cm) had an 82.6% and 100% rate of success, respectively. Aspiration of pneumothorax after CT-PTLB can help reduce chest drain insertion in approximately 50% of patients with larger pneumothoraces and even more so with smaller pneumothoraces (>80%). Aspiration of pneumothoraces up to 3 cm was often associated with avoiding chest drain insertion and allowing for earlier discharge.

OGBN P03 Per oral endoscopic myotomy (POEM) for primary achalasia: single-centre, retrospective analysis of 128 patients

Abstract Background Achalasia is a neurodegenerative motility disorder of the oesophagus, presenting with the main symptoms of dysphagia, weight loss, chest pain, and regurgitation. Surgical myotomy is considered the gold standard treatment. However, peroral endoscopic myotomy (POEM) seems to be a safe and effective alternative option which was introduced in 2008. POEM is a procedure performed endoscopically, which allows transection of the muscular fibres of the distal oesophagus and of the lower oesophageal sphincter. In our centre POEM has become a more frequent management option to treat primary achalasia when compared to surgical myotomy. The aim of the study is to analyse the outcomes from a single centre experience. Methods From June 2015 to May 2022, 128 patients underwent a POEM procedure to treat primary achalasia. We performed a retrospective analysis focusing on short term outcomes. Results All 128 patients underwent gastroscopy and manometry as part of the pre-operative workup to diagnose achalasia. Out of the 128 patients, 66 (52%) were women with age ranging from 17 to 79. BMI values ranged from 17 to 42. At 3/128 occasions the procedure was abandoned due to technical difficulty with all 3 patients at the early days of performing POEM highlighting the learning curve of the procedure. 6/128 patients had ongoing symptoms of achalasia post POEM and went on to have a laparoscopic Heller's myotomy. Median length of stay is 2 days (1–11). 6/128 had Clavien Dindo complications class 2 and 2/128 patients required aspiration of peumoperitoneum intra-op and one patient requiring chest drain insertion for surgical emphysema. 15/128 patients had a post-operative water soluble contrast swallow study to exclude leak following challenging cases or concerns for perforation. The median Eckardt score at last follow-up decreased from 7 to 1. Conclusions Our results show that POEM is a safe procedure to treat primary achalasia with minimal complications and preferable outcomes for patients in terms of symptom control. It can performed safely by experienced oesophageal surgeons and there are very good short-term outcomes. In our unit POEM is the primary treatment modality for achalasia.

Role of routine chest xrays and device checks in detecting peri-procedural complications associated with cardiac device implantation: a UK tertiary centre experience

Abstract Introduction Complications associated with Cardiac implantable electronic devices (CIEDs) are not uncommon, most of which occur in the perioperative phase. Until recently, guidance on implemented measures for early detection of peri-operative complications were lacking. The ESC guidelines on pacing recommend routine follow up of all newly implanted devices within 72 hours of implant. While the recently published EHRA expert consensus and practical guide on CIEDs recommend that a chest x-ray should be performed within 24 hours in all patients to rule out pneumothorax and document lead positions. Purpose At our tertiary centre for CIEDs, it is routine practice to perform CIEDs implantations on a day-case basis, targeting same day discharge for uncomplicated procedures. CXRs are performed 4 hours after the implant, and CIEDs are fully checked twice, once “on table” at the end of the procedure, and again after mobilisation and prior to discharge. In our analysis, we aimed to identify the yield of complications that could be detected early-on using these routine measures in all our implant procedures. Methods We performed a retrospective analysis of consecutive CIED implants performed between January and December 2019. The following information were collected; types and indications for device therapy, device checks reports, CXR reports, and clinical notes for documented symptoms or signs suggestive of peri-procedural complications. Results A total of 578 patients (Age 74±16 years, 68% male) were included in our analysis, for demographics see table. All patients had routine CXRs and 2 device checks. There were 16 (2.8%) peri-procedural complications associated with our device implants, 7 (1.2%) pneumothoraxes, 6 (1%) pericardial effusions, and 3 (0.5%) lead displacements. In 4 out of the 7 peri-procedural pneumothoraxes, the operator reported difficulty gaining access. 2 patients with pneumothorax reported chest pain, 1 patient reported shortness of breath and 1 had low O2 saturations. There were 2 asymptomatic cases of pneumothorax after reportedly straightforward procedures and were only detected on the routine CXRs, one of them required chest drain insertion and the other treated conservatively. 2 out of the 3 lead displacements were detected on both CXRs and pre-discharge pacing checks and didn't require intervention, while 1 case of lead displacement occurred after the pacing checks and CXRs were reported to be satisfactory, further pacing checks triggered by patient's symptoms and bradycardia on the monitor revealed lead displacement requiring intervention prior to discharge. Conclusion Routine post CIED implantation CXRs can detect early – otherwise clinically silent-periprocedural complications and appropriately remains a requirement for all CIED implants. While repeat post mobilisation device checks has low yield of detection of complications and can be reasonably abandoned provided that initial “on-table” checks are satisfactory. Funding Acknowledgement Type of funding sources: None.

Medical Chest Drain Insertion-Considerations for a Pleural Service

This is an observational study of all patients requiring chest drain insertion in the respiratory unit in Christchurch Hospital from January 2015 to December 2016. We analysed patient characteristics, type of drain inserted, and the nature of pleural fluid. We report the success of fibrinolytic therapy for empyema and pleurodesis for malignant pleural effusions.

Feasibility of a Standardized Management for Primary Spontaneous Pneumothorax in Children and Adolescents: A Retrospective Multicenter Study and Review of the Literature.

Introduction: The management of primary spontaneous pneumothorax (PSP) in children still remains controversial. The current literature shows a lack of scientific evidence supporting a standardized management. Materials and Methods: A multicenter retrospective study was performed, patients admitted for PSP in five Pediatric Surgical Units over a 9-year period (from 2008 to 2017) were included. Patient data were reviewed for each case. Management and outcomes were statistically analyzed. Results: Overall 159 patients (135 males and 24 females) were included in this study. During the first hospital admission, 62/159 patients (39%) were conservatively managed with oxygen therapy; 95/159 patients (60%) required a chest drain insertion; 2/159 patients (1%) underwent surgery because of a bilateral pneumothorax. Thoracoscopy was performed in 75/159 (47%) patients after the second hospital admission or for persistent air leak during the first access. Postoperatively, 8/75 (11%) patients developed recurrent pneumothorax requiring chest drain insertion in 3/8 (37%) cases or aspiration in 1/8 (13%), whereas 4/8 (50%) patients were conservatively managed. All of the patients but one, were confirmed to be affected by emphysematous-like changes at histology. Conclusions: Despite the limitations of being a retrospective study, we suggest that the early surgical management in children with PSP is feasible and safe and it seems to significantly reduce the recurrence rate. To the best of our knowledge there are no pediatric guidelines for the management of PSP, therefore, we support the need for prospective studies to create the evidence-based pillars for correct and standardized management of this condition.

A chest tube may not necessary in children thoracoscopic lobectomy.

Drainage of the thorax postoperatively using chest tubes is a standard procedure in thoracic surgery. However, chest tubes can induce pain and immobilization, increase risk of infection, deteriorate the ventilation capacity, and increase difficulty of postoperative management, particularly in children. This study aimed to investigate the safety and effect of excluding chest tubes after performing thoracoscopic lobectomy in selected children.A retrospective review of medical records was performed in West China Hospital of Sichuan University from January 2014 to June 2018. Patients who underwent thoracoscopic lobectomy without chest tubes were recorded. Patients with accompanying severe pulmonary infection, extensive thoracic adhesions, or undeveloped interlobar fissure were excluded.In total, 246 patients underwent thoracoscopic lobectomy without a chest tube, and none required chest drain insertion or reintervention during hospitalization and follow-up at 90 days postoperatively. Among them, 2 (0.81%) patients developed a delayed pneumothorax which was found after being discharged, and resolved spontaneously in 2 weeks. No hemothorax, atelectasis, and bronchial fistula were found. Furthermore, 202 (82.1%) patients developed subcutaneous emphysema, which was asymptomatic and spontaneously resolved within 3 to 7 days. The length of postoperative hospital stay was 2 days; patients were discharged in the 3rd day postoperatively. Patients could recover to free mobilization and resume regular diet at 6 hours postoperatively. All patients were followed up for at least 3 months; no other complications were found, and all patients recovered well.This study showed that chest tube placement in selected patients may be unnecessary in children undergoing thoracoscopic lobectomy. The minimally invasive procedure and meticulous resection have been the preconditions of this procedure, which may contribute to a rapid recovery and can avoid the chest tube-related complications effectively.

Use of prophylactic antibiotic in preventing complications for blunt and penetrating chest trauma requiring chest drain insertion: a systematic review and meta-analysis

BackgroundChest drain insertion after chest trauma is often associated with high rate of complications. The use of prophylactic antibiotics in patients with blunt and penetrating chest trauma to prevent empyema...

Maternal olmesartan exposure causing neonatal failure

Although angiotensin II receptor blockers (ARBs) are contraindicated during pregnancy, new cases are currently being reported.A 32-week preterm neonate was admitted after C-section due to maternal oligohydramnios. He presented with...

PTH-307 Percutaneous management of pulmonary metastases arising from colorectal cancer; a systematic review

<h3>Introduction</h3> Radiofrequency ablation (RFA) has been successfully utilised in the management of colorectal hepatic metastases and has also been used in the context of colorectal pulmonary metastases (CRPM). The aim was to systematically review the evidence and to assess the safety and efficacy of ablative techniques in the management of CRPM. <h3>Method</h3> A literature search was performed using PubMed, Embase, Cochrane Library, CINAHL and Google scholar databases to identify studies, which analysed ablative techniques and its efficacy in the management of CRPM. The primary outcomes of interest were overall survival and progression free survival. The secondary outcome measure was complication rates. <h3>Results</h3> 7 studies were included in the review with a total of 553 patients and all of which used RFA for ablation. Mortality from ablation was &lt;1% with overall survival ranging from 31–67 months. 1, 2 and 3 year survival ranges of 79–91%, 56–72% and 35–65% respectively. Local progression following ablation ranged from 9–22%. Major complication rates were noted in 1–8% of patients with minor complications ranging between 7–33%. 25% of patients required chest drain insertion post procedure. <h3>Conclusion</h3> This is the first paper to systematically review the use of RFA specifically for CRPM. This review provides evidence that RFA is a safe and effective technique for the management of CRPM. However in the absence of large randomised controlled trials it is unclear where RFA should sit in the treatment algorithm for patients with pulmonary metastases from colorectal primaries. <h3>Disclosure of interest</h3> None Declared.

A novel technique for CT-guided transthoracic biopsy of lung lesions: improved biopsy accuracy and safety.

To present the diagnostic accuracy and safety of a novel technique for CT-guided transthoracic needle aspiration biopsy (TNAB) of lung lesions suspected of malignancy. A novel technique for coaxial CT-guided TNAB is reported in this single-centre, retrospective study. A 22-gauge guide wire is used to accurately locate the lesion prior to biopsy. The technique enables penetration of lung lesions in various locations with less risk of harm to adjacent organs. Malignant and benign diagnoses were confirmed by histology or radiologic resolution. Clinical features of 181 patients included 59% men. Mean lesion size was 24 ± 14.9 mm with a mean depth of 13.6 ± 18.3 mm. Among 160 (88.4%) confirmed malignancies, 151 (94.4%) were diagnosed with TNAB. Among the 13 (7.2%) confirmed benign diagnoses, 11 (84.6%) received a specific, benign diagnosis with TNAB. The overall diagnostic accuracy of CT-TNAB was 93.6% among all confirmed diagnoses (173/181). Complications included 48 (26.5%) with pneumothorax, of which 77.8% resolved spontaneously, 20% by aspiration and 2.2% required chest drain insertion. Intrapulmonary haemorrhage was observed in 3.9% and hemoptysis in 6.0% without clinical significance. The guide wire technique provides a novel method for needle biopsy of lung lesions with improved accuracy and safety. Lung cancer screening has increased the detection of lung lesions. The guide wire technique is a novel method to biopsy lung lesions. The guide wire technique for lung biopsy demonstrates improved accuracy and safety. The chest tube insertion rate is reduced with aspiration during the procedure.

Nurses' knowledge of chest drain management in an Irish Children's Hospital

To explore contact with and knowledge regarding chest drain management among nurses. Chest drains are commonly used in both adult and paediatric settings, for example, for cardiothoracic patients or postspinal surgery, where they are inserted intra-operatively to drain excess fluid. Despite a large number of children requiring chest drain insertion annually, current literature suggests that many nurses have reduced contact with chest drains and a knowledge deficit regarding their management. Furthermore, the literature is limited in relation to chest drain management in the paediatric patient. Mismanagement of chest drains can have devastating consequences for patients. A standardised descriptive survey approach was employed. The sample consisted of 121 critical care and ward nurses from a large urban paediatric hospital, who cared for chest drains on a regular basis. Data were collected using a 37-item questionnaire, adapted from a study in the adult setting. Statistical analysis was performed using spss V15. The findings demonstrate that increased exposure to caring for children with chest drains is synonymous with a greater perception of knowledge levels in this area of practice. While critical care nurses looked after children with chest drains more frequently than ward nurses, there was no difference in the knowledge assessment section of the questionnaire. This research identified where knowledge deficits exist. This study identified the key areas where overall uncertainties existed leading to a decreased knowledge perception. Nurses are engaging with methods of knowledge acquisition; however, those who have less contact with chest drains require regular updates. Addressing misconceptions about chest drain management is imperative. Providing up to date guidelines in clinical areas will improve chest drain management. Strategic educational initiatives are in place to ensure identified knowledge deficits are addressed and a complete revision of chest drain guidelines has been undertaken.

Catamenial pneumothorax

Pneumothorax is a potentially life-threatening condition caused by an accumulation of air or gas in the pleural space. This may occur either spontaneously or as a result of disease or...

A Systematic Review of Radiofrequency Ablation for Lung Tumors

Radiofrequency ablation (RFA) has been increasingly utilized as a non-surgical treatment option for patients with primary and metastatic lung tumors. We performed the present systematic review to assess the safety and efficacy of RFA. Searches for all relevant studies prior to November 2006 were performed on six databases. Two reviewers independently appraised each study using predetermined criteria. Clinical effectiveness was synthesized through a narrative review, with full tabulation of results of all included studies. A total of 17 of the most recent updates from each institution were included for appraisal and data extraction. All were case series and were classified as level-4 evidence. The mean number of lesions treated ranged from 1 to 2.8, and the mean size ranged from 1.7 cm to 5.2 cm. The overall procedure-related morbidity rate ranged from 15.2% to 55.6% and mortality from 0% to 5.6%. The most commonly reported complication was pneumothorax (4.5-61.1%). Most pneumothoraces were self-limiting and only 3.3-38.9% (median = 11%) required chest drain insertion. The local recurrence of tumors at the site of RFA ranged from 3% to 38.1% (median = 11.2%). The median progression-free interval ranged from 15 months to 26.7 months (median = 21 months), and 1-, 2- and 3-year survival rates were 63-85%, 55-65% and 15-46%, respectively. Only observational studies were available for evaluation, which demonstrated some promising safety profiles of RFA.

Learning Curve for Percutaneous Radiofrequency Ablation of Pulmonary Metastases From Colorectal Carcinoma: A Prospective Study of 70 Consecutive Cases

Percutaneous radiofrequency ablation (RFA) for inoperable colorectal pulmonary metastases is associated with a morbidity rate of 30% to 40%. A learning curve in this treatment approach has not been documented before. The clinical and treatment-related data regarding 70 consecutive percutaneous RFA procedures for inoperable colorectal pulmonary metastases were collected prospectively. A comparison between the initial 35 cases (group 1) and the subsequent 35 cases (group 2) was performed. Univariate and multivariate analyses were conducted to identify the significant risk factors for overall morbidity, pneumothorax, and chest drain requirement. There was no hospital mortality. The overall morbidity rate was 37%. The rate of pneumothorax was 27%. Twelve patients (17%) required chest drain insertion for pneumothorax. There was a significant decline in the incidence of overall morbidity, pneumothorax, and chest drain requirement in group 2 as compared with group 1. Both the number of lung metastases ablated and the RFA treatment period (group 1 vs. group 2) were independent risk factors for overall morbidity, pneumothorax, and chest drain requirement. Distribution of lung metastases (unilateral vs. bilateral) was an independent risk factor for overall morbidity and pneumothorax, but not for chest drain requirement. There is a learning curve for percutaneous lung RFA. With accumulated experience in this procedure, a low morbidity rate can be achieved.

The Effectiveness of Catheter Aspiration in the Treatment of Spontaneous Pneumothorax

Catheter aspiration is a simple and minimal invasive method to treat spontaneous pneumothorax. It was recommended by British Thoracic Society in 1993 as the treatment for spontaneous pneumothorax. This study was designed to evaluate the effectiveness of catheter aspiration in the treatment of spontaneous pneumothorax. The protocol involved catheter placement by using Seldinger technique and serial chest X-rays were used to document the degree of lung re-expansion. We report a case series study in which eight patients were recruited into the study. All patients' pneumothorax re-expanded well after the initial attempt of aspiration. However, during the observation period, 5 patients had recurrence of pneumothorax requiring further aspiration. Despite that, these 5 patients finally required chest drain insertion. The remaining 3 patients were discharged after aspiration and were followed up on the following day. Two patients had recurrent pneumothorax and required further intervention. One patient had uneventful recovery. Conclusion catheter aspiration was effective in relieving spontaneous pneumothorax but with a high recurrence rate.

Delayed Bronchial Stenosis After Blunt Chest Trauma

Delayed Bronchial Stenosis After Blunt Chest Trauma