Thoracic Tube Research Articles

368. THE ROLE OF PG-SGA SCORE IN PREDICTING SHORT- TERM POSTOPERATIVE COMPLICATIONS IN ESOPHAGEAL CANCER SURGERY

Abstract Background The preoperative nutritional status is increasingly recognized as a determinant of postoperative outcomes in esophageal cancer patients. This study examines the relationship between preoperative nutritional scores, particularly the Patient-Generated Subjective Global Assessment (PG-SGA), and the incidence of short-term postoperative complications. Methods A prospective cohort study was conducted on patients undergoing surgery for esophageal cancer across two Surgical Departments at University Hospitals in Athens, Greece. Preoperative nutritional status was assessed using the PG-SGA score. Patients were categorized based on the PG-SGA score into low to medium risk with score of 8 or less, and high risk with score of 9 or higher. Postoperative complications were classified according to the Clavien-Dindo system, and their association with nutritional status was statistically assessed. Results This study included 59 consecutive patients who underwent surgery for esophageal cancer with female-to-male ratio of 1:4.9 and a median age of 65.4 ± 10.4 years, 43 (72.9%) of whom had received neoadjuvant chemotherapy. Notable postoperative complications (Clavien- Dindo classification ≥III) occurred in 14 cases, including evisceration (n=1), hemorrhage (n=1), chyle leakage (n=1), anastomotic leak (n=8), pleural effusion requiring radiological intervention (n=2), and a persistent pneumothorax necessitating additional thoracic tube insertion (n=1). A statistically significant association was found between malnutrition, as indicated by the PG-SGA≥9, and the development of severe postoperative complications (Clavien- Dindo classification ≥III) (p = 0.034). Conclusion This study suggests that preoperative PG-SGA score is potentially significant predictors of short- term postoperative complications in esophageal cancer surgeries. Incorporating nutritional assessments into the preoperative evaluation may help identify high-risk patients and tailor perioperative care to improve surgical outcomes.

Effect of aggressive surgical protocol based on ERAS model on perioperative period of multiple rib fractures

ObjectiveTo explore the effect of aggressive surgical protocol based on the enhanced recovery after surgery (ERAS) model on perioperative and postoperative rehabilitation of patients with multiple rib fractures. MethodsA total of 86 patients with multiple rib fractures were selected and divided into the ERAS group and a routine group, with 43 cases in each group, according to the random number table method. The conventional group implemented the conventional surgical protocol, and the ERAS group implemented the active surgical protocol based on the concept of ERAS based on the conventional group. Intraoperative blood loss, first postoperative exhaust time, thoracic tube removal time, postoperative hospital stays, and postoperative complications were compared between the two groups, and postoperative compliance was evaluated. ResultsAll patients were cured and discharged from the hospital. The amount of intraoperative blood loss, first postoperative exhaust time, postoperative thoracic tube removal time, and postoperative hospital stay in the ERAS group were significantly less than in the conventional group. There was no significant difference in the incidence of postoperative pulmonary infection and the other five complications between the two groups (P > 0.05). The postoperative compliance of the ERAS group was better than that of the conventional group, and the difference was statistically significant (P < 0.05). ConclusionThe active surgical program based on the ERAS model is beneficial to improve the clinical symptoms of patients with multiple rib fractures, reduce postoperative pain, promote postoperative recovery as soon as possible, shorten the length of hospital stay, and significantly improve the compliance of patients in the postoperative rehabilitation stage.

Ultrasound analysis of cervical thoracic duct for patients with constrictive pericarditis and chylothorax.

To analyze ultrasound features of cervical thoracic duct for patients with constrictive pericarditis and chylothorax. Patients were retrospectively assessed. The patients were divided into a non-pleural effusion (PE) group (n = 54), a chylothorax group (n = 23), and non-chylothorax group (n = 28). Conventional ultrasound was used to obtain the maximum inner diameter and collapse of the inferior vena cava, the inner diameter of left cervical thoracic duct, and the frequency of opening of the valve at the end of the left thoracic duct. Contrast ultrasonography was used to score the reverse flow of the thoracic tube. The percentage of PE was 48.5%, and the percentage of chylothorax was 21.9%. The three groups had significant differences in five parameters. The inner diameter of left cervical thoracic duct was correlated with the degree of central venous pressure. Contrast ultrasonography was effective in quantitative assessment of the degree of intravenous-thoracic cord reverse flow which correlated with all parameters of central venous pressure. Thoracic duct dilation and regurgitation secondary to central venous pressure can lead to chyloreflux disorder and may be the mechanism of chylothorax occurrence in constrictive pericarditis.

Export priority technique for Uni-portal thoracoscopic left upper lobectomy

BackgroundFurther explore the safety and feasibility of Uni-portal video assisted thoracoscopic (UVATS) left upper lobectomy by optimizing the treatment of incisions and blood vessels.MethodsWe conducted a retrospective analysis of data from 32 patients who underwent UVATS left upper lobectomy and systematic mediastinal lymph node dissection utilizing the Export priority technique between January 2021 and December 2022. We documented perioperative indicators, including surgical time, intraoperative blood loss, the number of lymph nodes dissected, and postoperative pathological staging.ResultsAll surgeries were conducted utilizing the Export priority technique in UVATS. The mean surgical duration was (98.93 ± 14.98) minutes, with an average intraoperative blood loss of (79.53 ± 37.96) ml. The mean count of dissected lymph nodes was (13.96 ± 2.69). The length of hospital Stay averaged (5.62 ± 1.81) days. On the first postoperative day, the thoracic drainage volume was (101.87 ± 49.46) ml. The mean duration of postoperative thoracic tube insertion was (3.1 ± 1.84) days. No occurrences of postoperative hoarseness, pulmonary infection, or complications such as bronchopleural fistula were observed.ConclusionThe application of the Export priority technique improves the safety and feasibility of UVATS left upper lobectomy.

A rare case of pulmonary complication after laparoscopic sleeve gastrectomy in an obese patient, associated with central venous catheter malposition: a case report

Introduction: Surgical intervention for morbid obesity possesses a first-line treatment and it is widespread worldwide. Obese patients have a high chance of postoperative complications and mortality is significantly raised with higher BMI levels. In addition to this, the altered anatomy of obese patients characterizes the central venous catheter insertion as a difficult procedure. Case presentation: In our case report we present a 52-year-old woman who admitted in our surgical department in order to be treated surgically for morbid obesity. All of her preoperative evaluation tests were absolutely normal. The patient was treated with laparoscopic sleeve gastrectomy. On postoperative day 2 the patient presented with acute dyspnea and low oxygen saturation. Diagnosis: After evaluation with computed tomography of the thorax an excessive right pleural effusion was diagnosed and the patient was treated with thoracic tube insertion. There was a fully recovery and the patient discharged after a couple of days. Conclusion: High mortality and morbidity after laparoscopic sleeve gastrectomy is a crucial parameter for postoperative complications in obese patients. High suspicion and wide spectrum of differential diagnosis results in early prevention and solution of the problem.

Impact of a Structured Training Program Regarding Care of Patients with Chest Tube Drainage in Terms of Knowledge and Practices of Nurses Working in a Tertiary Care Cancer Center in North India

Introduction: A chest tube (hollow, flexible drainage tube) placement is a procedure in which a tube is inserted by an aseptic technique through the side of the chest wall into the pleural space. The complication rate in patients with ICD has been found high, resulting from inadequate knowledge of thoracic anatomy or/and insufficient clinical training and experience. Objective: Assessing the efficacy of a structured Clinical training program regarding the care of patients with chest tube drainage, assessing existing and gained knowledge and practices level, and finding the association between the sociodemographic variables and knowledge and practices. Material and Methods: In this Prospective study, 200 nurses participated in the study; pre-test and Post-test research designs were applied in this study. Data collection was done by using of probability random sampling technique. Result: The Pre-test Mean knowledge score was 8.77 with a standard deviation of 2.08 and the Mean practical knowledge score was 7.6 with a standard deviation of 2. When participants' knowledge and practices were checked before the training program, 58 % (116) subjects had Good Knowledge, 22.5 % (45) had average knowledge, 17.5 % (35) had excellent knowledge, and 2 % (4) had poor knowledge scores. When participants' practical knowledge was checked before the training program, 49 % (98) subjects had good practice scores, 43 % (86) had average practice scores, 5.5 % (11) had excellent practice scores, and 2.5 % (5) had poor practice scores. Posttest mean knowledge score was 10.56 with a standard deviation of 1.86. Posttest mean Practical knowledge score was 10.57 with a standard deviation of 2.26. After the structured clinical training program, 57.5 % (23) had an adequate knowledge score, 40 % (16) had a moderate level of knowledge score, and 2.5 % (1) had inadequate knowledge. After the structured clinical training program, 50 % (100) had an excellent practice score and 42 % (84) had a good practice score, and 8 % (16) had an average practice score. An association was found between existing knowledge score and marital status, between post-test knowledge and Religion as calculated p-values of the Fisher Exact test that is 0.036, 0.017 is smaller than the alpha value 0.05. In the Practical Knowledge score, an association between pre-test practice scores and the number of previous ICD training was found, as the calculated p-value of the fisher Exact test 0.04 was smaller than the alpha value of 0.05. Conclusions: In the care of a patient who has an Inter-costal chest tube, need much attention as comparing other, because the handling of the ICD tube and bag, emptying of a bag, and transportation of the ICD patient need careful action. In our study, we found that existing knowledge and Practice of ICD care procedures are not satisfactory with the traditional teaching approach, bedside clinical training is a beneficial approach that will significantly improve the Knowledge and Knowledge in practice. Keywords: ICD Care, Intercostal drainage, Chest tube care, Thoracic tube care

3D-printed external fixation guide combined with video-assisted thoracoscopic surgery for the treatment of flail chest: a technical report and case series.

Flail chest is a common and serious traumatic condition in thoracic surgery. The treatment of flail chest often includes open reduction and internal fixation, which is relatively traumatic, complicated, and expensive. As three-dimensional (3D) printing technology is widely used in the clinical field, the application of 3D-printed products to chest trauma will become a new treatment option. To date, the use of 3D-printed external fixation guides for flail chests has not been reported. Thus, we aimed to assess the short-term efficacy of a new technology that treated flail chests with an individualized 3D-printed external fixation guide combined with video-assisted thoracoscopic surgery (VATS). A retrospective analysis was performed on patients with flail chest treated with this new technique at our center from January 2020 to December 2022. The following parameters were included: operative time, thoracic tube extraction time, intensive care unit time, thoracic volume recovery rate, visual analog scale score 1 month postoperatively, and postoperative complication rate. All patients were followed up for at least 3 months. Five patients (mean age: 45.7 years) were enrolled; they successfully underwent surgery without chest wall deformity and quickly returned to daily life. The average number of rib fractures was 8.4; all patients had lung contusion, hemopneumothorax, and anomalous respiration. The abnormal breathing of all patients was completely corrected on postoperative day 1, and the chest wall was stable. One case experienced mild loosening of the 3D-printed guide postoperatively; however, the overall stability was not affected. The other four cases did not experience such loosening because we replaced the ordinary silk wire with a steel wire. All cases were discharged from the hospital 2 weeks postoperatively and returned to normal life 1 month after the removal of the 3D-printed guide on average. Only one case developed a superficial wound infection postoperatively, and no perioperative death occurred. The 3D-printed external fixation guide combined with video-assisted thoracoscopic surgery is a novel technique in the treatment of flail chest and is safe, effective, feasible, and minimally invasive, with satisfactory clinical efficacy.

Utility of Infrared Technology in Minimally Invasive Procedures: A Novel Strategy to Identify a Esophagobronchial Fistula via Thoracoscopy

Esophagobronchial or esophagopulmonary fistulas are complications after esophageal atresia/tracheoesophageal fistula (EA/TEF) repair. Postoperative scarring and recurrent infections render surgical treatment a potentially hazardous undertaking.This report describes the use of infrared (IR) technology to locate and safely dissect a esophagobronchial fistula in a 11-year-old female with a history of EA/TEF. The patient, who had initially undergone primary repair via thoracotomy, was diagnosed with a late tracheoesophageal fistula (TEF) recurrence at the age of 6 after several pulmonary infections and was subjected to a left thoracoscopy with successful closure of the TEF. Despite both surgical procedures, she presented ongoing respiratory symptoms for several years and was referred to our center as an 11-year-old, where further examinations revealed the presence of a esophagobronchial fistula involving the right upper bronchus. After an unsuccessful attempt at endoscopic closure, surgical treatment via right thoracoscopy was planned. Initially, an endoscopic examination was performed, to catheterize the fistula tract in the mid-thoracic esophagus with the infrared probe. Subsequently, right thoracoscopy was performed in the prone position using four 5 mm trocars. Guided by the IR signal, the fistula tract was easily identified and dissected. Fistula closure was achieved using a 5 mm stapler. The staple line was reinforced with a pleural flap and a right thoracic tube was inserted. The patient was discharged after a four-day hospital stay, without complications. The patient remains asymptomatic to date and has returned to her native Ukraine.

A case–control study on early removal of thoracic drainage tube and gastric tube after MIE

ObjectiveTo investigate the feasibility and safety of early removal of gastric tube and thoracic drainage tube after minimally invasive esophagectomy.MethodsA retrospective analysis was performed on 93 patients undergoing thoraco-laparoscopic assisted esophagectomy between January 2022 and September 2022. All patients were divided into two groups, the early group and the conventional group. The differences in drainage volume on the first day after operation, days of thoracic drainage tube indwelling, thoracic drainage tube replacement, incidence rate of pleural effusion, atelectasis, pneumothorax as well as pulmonary infection, respiratory insufficiency, and postoperative hospital stay were compared between the two groups. The criteria for thoracic drainage tube removal is the daily thoracic drainage volume of less than 250 ml in the early group. The gastric fluid volume on the first day after operation, the number of days of gastric tube indwelling, the rate of gastric tube replacement after removal, and the time of intestinal exhaust were compared between the two groups. In the meantime, the incidence of complications, such as anastomotic leakage and pulmonary infection, was observed in the two groups.ResultsThe removal time of gastric tube and thoracic drainage tube was significantly earlier in the early group than in the control group (P < 0.05). There was no significant difference in the gastric fluid volume and pleural fluid between the early group and the conventional group. P > 0.05), but there were significant differences in postoperative anastomotic leakage between the two groups (P < 0.05). There was no significant difference in the incidence of pleural effusion, atelectasis, pneumothorax, and pulmonary infection (P > 0.05), nor in thoracentesis rate and gastric tube replacement (P > 0.05). The postoperative hospital stay was significantly shorter in the early group than in the conventional group (P < 0.05)ConclusionThe early removal of the thoracic drainge tube and gastric tube is safe and effective, which does not increase the incidence of postoperative complications.

Effective application of indocyanine green for visualization of the thoracic duct during video-assisted thoracoscopic surgery for chylothorax: a case report

BackgroundChylothorax is an accumulation of typically milky-appearing lymphatic fluid within the pleural cavity. High-output chylothorax may lead to a severe risk of death if not treated promptly. Several studies have reported the effectiveness of indocyanine green (ICG) for chylothorax following lung cancer surgery, esophagectomy, and congenital and recurrent idiopathic chylothorax. Here, we report a case of a successful treatment of idiopathic chylothorax in an adult by identifying and ligating the thoracic duct (TD) using fluorescent thoracoscopy with inguinal lymph node injection of ICG.Case presentationA 79-year-old man with nephrotic syndrome presented with a massive right pleural effusion. Based on the pleural effusion examination, the patient was diagnosed with idiopathic chylothorax. He underwent 26 days of conservative treatments, including intercostal chest tube drainage, subcutaneous injection of a somatostatin analog (octreotide), and diet control (low-fat diet, fasting). However, the conservative treatments failed. Therefore, thoracoscopic TD ligation using a combination of ICG and near-infrared (NIR) light was performed. Ultrasound-guided inguinal lymph node injection of ICG was performed before thoracoscopy. Although standard-mode thoracoscopy could not identify leakage points, when observed under NIR light, the TD could be detected using fluorescence contrast. The TD was clipped to the deepest level on the thoracic side. Furthermore, a fluorescence hotspot of ICG on the cranial side of the clipped TD, likely a leakage point, was confirmed, and the lesion was clipped. ICG fluorescence did not disappear during surgery. The thoracic tube was removed on postoperative day 7. To date, chylothorax has not recurred.ConclusionsWe report the effectiveness of intraoperative NIR fluorescence with ICG in identifying the TD’s running. This technique can lead us to identify and ligate the TD with assurance and accurately treat chylothorax.

Association between intrapleural urokinase monotherapy and treatment failure in patients with pleural infection: a retrospective cohort study

BackgroundPleural infection, an infection of the pleural space, is frequently treated with antibiotics and thoracic tube drainage. In case of insufficient drainage, an intrapleural fibrinolytic agent is considered before surgical intervention. However, the effectiveness of fibrinolytic monotherapy is still controversial. Therefore, we aimed to examine the association between urokinase monotherapy and treatment failure in patients with pleural infection.MethodsIn this retrospective observational study, patients with pleural infection underwent chest tube insertion were divided into two groups including patients treated with or without intrapleural instillation of urokinase. The propensity score overlap weighting was used to balance the baseline characteristics between the groups. Treatment failure was defined by the composite primary outcome of in-hospital death and referral for surgery.ResultsAmong the 94 patients, 67 and 27 patients were in the urokinase and non-urokinase groups, respectively. Urokinase monotherapy improved the composite outcome between the groups (19.4% vs. 48.1%, p = 0.01). After adjusting using propensity score overlap weighting, urokinase monotherapy improved the composite outcome compared to the non-urokinase group (19.0% vs. 59.5%, p = 0.003).ConclusionsUrokinase monotherapy can be an important nonsurgical treatment option for patients with pleural infection.Trial registrationThe participants were retrospectively registered.

Complications and associated risk factors of image guided biopsies of thoracic lesions

Aims: The aim of this study is to determine the complications and associated risk factors of image guided percutaneus transthoracic biopsies of throracic lesions. Methods: Fifty-seven patients who had an ultrasound and computed tomography-guided percutaneous fine needle and tru-cut biopsy between 2006-2008 were evaluated retrospectively. Sixty biopsies were performed. Sensitivity and accuracy were calculated, and each patient was reviewed for complications, including pneumothorax and thoracic tube insertion. Results: Fine needle aspiration and tru-cut biopsy results in sensitivities and accuracies were similar to those in the literature. Pneumothorax was the most frequent complication. Length of normal lung parenchyma between the lesion and pleura and repeated puncture of the pleura more than two times were associated with an increased rate of pneumothorax and the results were statistically significant. Conclusion: Transthoracic computed tomography and ultrasound-guided biopsies are found to be cheap, easily achievable, and safe processes.

COVID-19-Related life-threatening complications: pneumothorax, pneumo mediastinum and subcutaneous emphysema

Complications of COVID-19-related pneumothorax, subcutaneous emphysema, and pneumomediastinum are frequently observed in moderate and severe pneumonia cases. The aim of this study is to determine the incidence and potential risk factors of life-threatening complications such as pneumothorax, pneumo-mediastinum, and subcutaneous emphysema that develop in patients received in the tertiary ICUs of our hospital, which serves as a pandemic hospital and to analyze their relationship with mortality. Patients' demographic characteristics, comorbid diseases, length of hospital stay, day and duration of thoracic tube placement, discharge status, and hospitalization laboratory findings were recorded, and the relationship of these parameters with mortality due to pneumothorax, subcutaneous emphysema, and pneumomediastinum were investigated. Of these patients, 33 had pneumothorax, 12 had pneumomediastinum, and 28 had subcutaneous emphysema. Male and female patients were equally represented, and mortality rates were similar. While the rate of pneumothorax in the study patients was 2.21 %, the rate of all life-threatening sequelae such as pneumothorax, pneumomediastinum, and subcutaneous emphysema was 4.7 %, with a high mortality rate (90 %) in 70 patients with these complications. Patients diagnosed with COVID-19 pneumonia should be constantly monitored for life-threatening complications such as pneumothorax, pneumomediastinum, and subcutaneous emphysema during their long-term follow-up.

Thoracoscopic Partial Pneumonectomy with and without Postoperative Thoracic Drainage Tube.

To compare thoracic drainage tube placement on clinical outcomes and serum CRP, IL-6, cortisol in patients undergoing thoracoscopic partial pneumonectomy. Analytical study. Yulin Second Hospital, China, between January 2017 and January 2022. Methodology: Eighty-four patients with lung cancer who underwent thoracoscopic partial pneumonectomy were studied. A thoracic drainage tube was placed postoperatively (Group A, n=41). Otherwise, a thoracic drainage tube was not placed if an air leak was not detected in the suction-induced leak test postoperatively (Group B, n=43). Difference effect was compared. Postoperative hospitalisation time and incidence of postoperative subcutaneous emphysema in Group A were lower than those in Group B (p<0.001 and p=0.038 respectively). On the 1st day before surgery, the differences in serum CRP, IL-6, and cortisol were not significant between the two groups (p= 0.443, 0.644, and 0.738 respectively); on the 1st day after surgery, levels of serum CRP, IL-6, and cortisol in Group A were lower than those in Group B (p<0.001, p<0.001, and p=0.001 respectively). Postoperative hospitalisation time and the frequency of postoperative subcutaneous emphysema were lower in patients of thoracoscopic partial pneumonectomy without placing thoracic drainage tubes. The degree of surgery-induced stress was also lower. The decision not to leave the thoracic drainage tube may be considered reasonable and safe if the criteria are carefully selected. Thoracoscopy, Thoracic tube drainage, Partial pneumonectomy, Cortisol, IL-6, CRP level.

Use of a Compact, Lightweight X-ray Unit to Reduce the Risk of Five Invasive Procedures in the Emergency Room.

Many invasive procedures performed in the emergency room (ER) have potential risks and complications. Because of their limitations, in particular size, portable X-ray devices are generally not used during such procedures. However, miniaturized units enable physicians to obtain X-ray images without assistance. We developed a safe, compact, and lightweight X-ray unit that was used during five invasive procedures in the ER. In all procedures, a chest X-ray image was obtained, to confirm the utility of the unit. Case 1 (central venous catheter placement): After needle and guidewire insertion and catheter placement, the location of the catheter could be confirmed. Case 2 (chest tube insertion): During insertion of a chest tube into the pleural space, the tip of the thoracic tube was confirmed to be at the correct location. Case 3 (percutaneous tracheostomy or cricothyroidotomy): After needle and guidewire insertion, the guidewire was visualized in the right main bronchus and was inserted into the trachea. Case 4 (resuscitative endovascular aortic balloon of the aorta): The captured image revealed that the catheter was located in zone I before balloon inflation. Case 5 (Sengstaken-Blakemore tube): The image revealed that the balloon was located in the stomach. The portable X-ray unit improved medical safety during invasive procedures frequently performed in the ER.

Preserving Spontaneous Breathing Without Intubation and Endotracheal Intubation with One Lung Ventilation in Single-hole Thoracoscopic Bulla Suture

Objective: To explore the situation of patients and the compare the effect between two methods, which are preserving spontaneous breathing without intubation and endotracheal intubation with one lung ventilation in the single-hole thoracoscopic bulla suture. Method: 42 patients who received single-hole thoracoscopic pulmonary bullae suture in our hospital from January 2020 to December 2021 were selected as the study subjects, including 19 patients who underwent endotracheal intubation and one lung ventilation as the control group and 23 patients who underwent single-hole thoracoscopic pulmonary bullae suture without intubation as the study group. The relevant indexes, postoperative general conditions, complications and pneumothorax recurrence of the two groups were analyzed and observed. Results: In the control group, the scores of anesthesia time (points), resuscitation time (points), surgical visual field score (points), surgical time (points), and surgical bleeding volume (points) were 20.8 ± 4.6, 19.9 ± 7.9, 1.7 ± 0.5, 44.9 ± 7.9, and 11.4 ± 2.4 respectively. In the study group, the scores of anesthesia time (points), resuscitation time (points), surgical visual field score (points), surgical time (points), and scores of surgical bleeding (points) were 17.9 ± 4.3, 15.4 ± 3.4, 1.9 ± 0.4, 48.4 ± 7.1, 10.9 ± 2.2, respectively. There was no statistical difference in surgical visual field score, surgical time and surgical bleeding whereas there was a statistical difference between anesthesia time and resuscitation time. In the control group after operation, VAS score at 6 hours after operation, SaO2 (%) after operation, PaCO2 (mmHg) after operation, drainage volume (ML) after operation, feeding time (H) after operation, retention time of thoracic tube after operation (H), WBC (109) on the first day after operation, hospitalization time (d), and total hospitalization cost (RMB 1000) were 2.1 ± 0.7, 98.2 ± 1.4, 42.4 ± 4.9, 139.1 ± 23.1, 6.9 ± 1.6, 37.1 ± 5.4, 7.9 ± 2.1, 6.6 ± 1.3, and 2.6 ± 0.3 respectively. As for the study group, the VAS score at 6 hours after operation, SaO2 (%) after operation, PaCO2 (mmHg) after operation, drainage volume (ML) after operation, feeding time (H) after operation, retention time of thoracic tube after operation (H), WBC (109) on the first day after operation, hospitalization time (d), and total hospitalization cost (RMB 1000) were 1.9 ± 0.4, 97.9 ± 1.2, 42.8 ± 5.1, 151.8 ± 21.9, 4.3 ± 1.4, 15.3 ± 2.6, 5.2 ± 2.3, 4.2 ± 1.2, and 1.8 ± 0.4 respectively. Among them, there were no significant differences in visual analog scale (VAS) score at 6 hours after operation, SaO2 after operation and PaCO2 after operation between the two groups, but there were significant differences in other factors. The complication rate of the control group was 36.84%, which was significantly higher than that of the study group (4.35%), with statistical difference. The recurrence rate of the control group was 21.05%, which was not significantly different from that of the study group (4.35%). Conclusion: The single-hole thoracoscopic bullae suture without intubation can reduce the anesthesia time and resuscitation time of patients, reduce the hospitalization cost of patients, reduce the treatment burden, shorten the first feeding time, and reduce the complication rate of patients. Therefore, it is worthy of clinical promotion.

Risk Factors for Retained Hemothorax after Trauma: A 10-Years Monocentric Experience from First Level Trauma Center in Italy.

Thoracic trauma occurs in 20–25% of all trauma patients worldwide and represents the third cause of trauma-related mortality. Retained hemothorax (RH) is defined as a residual hematic pleural effusion larger than 500 mL after 72 h of treatment with a thoracic tube. The aim of this study is to investigate risk factors for the development of RH in thoracic trauma and predictors of surgery. A retrospective, observational, monocentric study was conducted in a Trauma Hub Hospital in Milan, recording thoracic trauma from January 2011 to December 2020. Pre-hospital peripheric oxygen saturation (SpO2) was significantly lower in the RH group (94% vs. 97%, p = 0.018). Multivariable logistic regression analysis identified, as independent predictors of RH, sternum fracture (OR 7.96, 95% CI 1.16–54.79; p = 0.035), pre-admission desaturation (OR 0.96; 95% CI 0.77–0.96; p = 0.009) and the number of thoracic tube maintenance days (OR 1.22; 95% CI 1.09–1.37; p = 0.0005). The number of tubes placed and the 1° rib fracture were both significantly associated with the necessity of surgical treatment of RH (2 vs. 1, p = 0.004; 40% vs. 0%; p = 0.001). The risk of developing an RH in thoracic trauma should not be underestimated. Variables related to RH must be taken into account in order to schedule a proper follow-up after trauma.

The relationship between chest tube position in the thoracic cavity and treatment failure in patients with pleural infection: a retrospective cohort study

BackgroundPleural infection is an infection of the pleural space that is usually treated with antibiotics and source control. Chest tube insertion is the most popular and widely used drainage technique. We typically attempt to place the tube at the bottom of the thoracic cavity to consider the effects of gravity; however, the effectiveness of this practice is not well-defined. Therefore, we aimed to examine whether the position of the tip of the thoracic tube affects treatment failure in patients with pleural infection.MethodsIn this retrospective observational study, patients with pleural infection who underwent thoracic tube insertion were divided into two groups: those with the tip of the tube positioned below the 10th thoracic vertebra at the level of the diaphragm (lower position group) and those with the tip placed above the 9th thoracic vertebra (upper position group). We compared whether the position of the tube tip affected treatment failure. Stabilized inverse probability treatment weights (SIPTW) were used to balance the baseline characteristics between the groups. Treatment failure showed a composite outcome of hospital death, referral to surgeons for surgery, and additional chest tube insertion.ResultsAmong the 87 patients, 41 and 46 patients were in the lower and upper groups, respectively. No significant difference was observed in the composite outcomes between the groups (46.3% vs. 54.3%, P = 0.596). There was also no significant difference in the composite outcome between both groups after adjusting for SIPTW (52.3% vs. 68.8%, P = 0.286).ConclusionsThere were no significant differences in the treatment failure in this study addressing pleural infection treatment, in which the drain tip position was stratified by the 9th and 10th thoracic vertebrae. The position of the tip of the thoracic tube may not be important for pleural infection treatment providing that it is in the thoracic cavity.Trial registration The participants were registered retrospectively.

Endobronchial tuberculosis in children: Defining the role of interventional bronchoscopy.

Endobronchial tuberculosis (EBTB) can lead to bronchopulmonary complications when diagnosis is delayed. Bronchoscopic treatment in children can be challenging due to small airway size. We report our experience treating children with EBTB. Retrospective study (2014-2020) of patients diagnosed with EBTB. Flexible bronchoscopy (FB) was performed in patients with previous diagnosis of pulmonary tuberculosis (PTB), after respiratory/radiological worsening was observed in spite of medical treatment. Treatment consisted in oral corticotherapy in all patients, and interventional bronchoscopy in selected cases. Our aim is to describe the endoscopic findings, interventional bronchoscopy alternatives, and outcome. Of 45 patients with PTB, 13 (28.9%, 7M/6F) were diagnosed with EBTB, with a mean age of 3.9 years (0.4-12.8). Four bronchoscopic patterns were observed. Endobronchial granuloma (N:9; 69.2%): Excision with rigid bronchoscopy was achieved in five (1-5 procedures per patient), while corticotherapy alone was preferred in the remaining four due to small size/distal location of the granuloma. Caseum obstruction (2; 15.4%): dense mucous molds were removed with flexible/rigid bronchoscopy (6 and 8 procedures, respectively). Bronchial stenosis (1; 7.7%): two balloon dilatations with mitomycin-C application were performed. Extrinsic compression (1; 7.7%): oral corticotherapy alone was initiated. One patient developed bronchoscopy-related complications (pneumothorax requiring thoracic tube 48 h). With a medium follow-up of 4.6 years (1.8-7.6), three patients developed bronchiectasis while the remaining 10 improved clinically and radiologically. Bronchoscopic findings in EBTB include granuloma, stenosis, caseum obstruction and external compression. In selected cases, interventional bronchoscopy can minimize long-term bronchopulmonary complications.

Clinically focused multi-cohort benchmarking as a tool for external validation of artificial intelligence algorithm performance in basic chest radiography analysis

Artificial intelligence (AI) algorithms evaluating [supine] chest radiographs ([S]CXRs) have remarkably increased in number recently. Since training and validation are often performed on subsets of the same overall dataset, external validation is mandatory to reproduce results and reveal potential training errors. We applied a multicohort benchmarking to the publicly accessible (S)CXR analyzing AI algorithm CheXNet, comprising three clinically relevant study cohorts which differ in patient positioning ([S]CXRs), the applied reference standards (CT-/[S]CXR-based) and the possibility to also compare algorithm classification with different medical experts’ reading performance. The study cohorts include [1] a cohort, characterized by 563 CXRs acquired in the emergency unit that were evaluated by 9 readers (radiologists and non-radiologists) in terms of 4 common pathologies, [2] a collection of 6,248 SCXRs annotated by radiologists in terms of pneumothorax presence, its size and presence of inserted thoracic tube material which allowed for subgroup and confounding bias analysis and [3] a cohort consisting of 166 patients with SCXRs that were evaluated by radiologists for underlying causes of basal lung opacities, all of those cases having been correlated to a timely acquired computed tomography scan (SCXR and CT within < 90 min). CheXNet non-significantly exceeded the radiology resident (RR) consensus in the detection of suspicious lung nodules (cohort [1], AUC AI/RR: 0.851/0.839, p = 0.793) and the radiological readers in the detection of basal pneumonia (cohort [3], AUC AI/reader consensus: 0.825/0.782, p = 0.390) and basal pleural effusion (cohort [3], AUC AI/reader consensus: 0.762/0.710, p = 0.336) in SCXR, partly with AUC values higher than originally published (“Nodule”: 0.780, “Infiltration”: 0.735, “Effusion”: 0.864). The classifier “Infiltration” turned out to be very dependent on patient positioning (best in CXR, worst in SCXR). The pneumothorax SCXR cohort [2] revealed poor algorithm performance in CXRs without inserted thoracic material and in the detection of small pneumothoraces, which can be explained by a known systematic confounding error in the algorithm training process. The benefit of clinically relevant external validation is demonstrated by the differences in algorithm performance as compared to the original publication. Our multi-cohort benchmarking finally enables the consideration of confounders, different reference standards and patient positioning as well as the AI performance comparison with differentially qualified medical readers.