Chest Tube Research Articles

A New Predisposing Factor for Postoperative Atrial Fibrillation: Tube Insertion Site.

The aim of this study is to compare the insertion sites of drainage tubes placed in the left thorax after elective coronary artery bypass grafting (CABG) surgeries. Patients were divided into two groups based on the site of tube insertion into the left hemithorax: those with a tube inserted from the subxiphoid region and those with a tube inserted from the left intercostal region. Comparative analyses between these two groups and factor analyses contributing to the outcome were performed. There were no significant differences observed in terms of age, gender, height, and weight among patients undergoing coronary artery bypass surgery based on the site of drain placement. Twelve patients (5.2%) required re-drainage procedures, with five (41.7%) for pneumothorax and seven (58.3%) for pleural effusion. Atelectasis was absent in 144 patients (62.1%) while present in 88 patients (37.9%). The frequency of atrial fibrillation (AF) was significantly higher in the group with intercostal drains. Additionally, pain scale scores were significantly higher in patients with intercostal drains. Path analysis revealed that the visual pain scale value played a full mediating role in the effect of the drain site on AF. The statistically significant occurrence of pain and higher rates of postoperative AF in patients with intercostal tube placement are noteworthy. We believe that in patients undergoing elective coronary artery bypass surgery, the drain placed in the left hemithorax should be inserted from the subxiphoid region, if there are no contraindications.

FDG PET/CT Performed Prior to CT-Guided Percutaneous Biopsy of Lung Masses is Associated With an Increased Diagnostic Rate and Often Identifies Alternate Safer Sites to Biopsy.

Purpose: To determine the benefit of a FDG PET/CT scan prior to CT-guided lung biopsy on the rate of diagnosis, rate of complication, and the identification of potentially safer biopsy sites. Methods: This retrospective observational cross-sectional study evaluated consecutive adult patients who underwent CT-guided lung biopsy in 2020 or 2021 at 2 Canadian tertiary care hospitals. These patients were grouped into those that had PET/CT performed within 8 weeks prior to biopsy, within 8 weeks after biopsy, or no PET/CT scan within this time frame. Biopsy complication rates and pathology diagnostic rates were compared. The PET/CT images of those performed after biopsy were reviewed to determine if alternate safer biopsy sites could be identified. Categorical variables were compared using Pearson chi square test (P < .05 significant). Results: 547 patients who had CT-guided lung biopsy were included. Patients with lung masses (≥3 cm) who had a PET/CT scan prior to biopsy had a higher diagnostic rate (90.8%) compared to those that did not (80.2%). The overall post-biopsy pneumothorax rate was 43.3% with 11.3% overall requiring chest tube insertion and 13.9% requiring hospitalization. There was no difference in complication rate for those who had PET/CT prior to biopsy and those that did not. 28.9% to 42.1% of patients who had PET/CT after biopsy had safer sites amenable to biopsy identified retrospectively outside of the lungs. Conclusion: PET/CT prior to CT-guided lung biopsy improves the diagnostic rate in 10.6% of patients with lung masses (≥3 cm) and identifies alternate safer sites to biopsy in 28.9% to 42.1% of patients (any size lesion).

Heart Disease and Pectus Excavatum: An Underestimated Issue—Single Center Experience and Literature Review

Pectus excavatum (PE) can be associated with either congenital or acquired heart disease. This study highlights the importance of PE surgical repair in cases of severe chest depression on the heart in underlying cardiac diseases exacerbating cardiopulmonary impairment. From January 2023 to March 2024, four male patients underwent PE repair, having heart disease including pericarditis, mitral valve prolapse, ventricular fibrillation arrest and type 1 second-degree atrioventricular block. PE severity was determined by the Haller index (HI). Preoperative assessment included a pulmonary function test, chest computed tomography and cardiac evaluation. The Nuss procedure was performed in three patients, whereas, in one patient, it was performed in combination with a modified Ravitch procedure. The median HI was five. The median time of chest tube removal was 6.5 days. Postoperative complications were prolonged air leak, atrial fibrillation and atelectasis. The median length of hospital stay was 19.5 days, and no 30-day postoperative mortality was recorded. In all patients, surgical repair helped to resolve the underlying cardiological issues, and surgical follow-ups were deemed regular. PE is generally an isolated congenital chest wall abnormality, and, when associated with a heart disease, it can have severe life-threatening hemodynamic consequences due to mechanical compression on the heart for which surgical corrections should be considered.

The Effect of Acupressure on Pain Associated with Chest Tube Removal in Patients with Chest Trauma

Background: Inserting a chest tube is a life-saving procedure for patients with chest trauma, but it is often associated with significant pain. To alleviate this discomfort, non-pharmacological methods such as acupressure can be employed. Therefore, this study aimed to determine the effect of acupressure on pain during chest tube removal in patients with thoracic trauma. Methods: This quasi-experimental study involved the selection of 204 patients with chest tubes following chest trauma in Zahedan in 2022. The through patients were selected purposefully and Non-random allocation divided into two intervention and control groups of 102 people. The intervention group received acupressure treatment, while the control group did not. Pain levels of the patients were measured using a pain intensity scale on both the day of chest tube insertion and the day of removal. The data were analyzed using statistical test such as independent-t, paired-t and chi-square statistical tests within the SPSS 26 software. Results: The normality of the main variable was assessed using the Kolmogorov-Smirnov (KS) test. The significance level for the pain variable was found to be less than 0.05 (P&lt;0.001), indicating a non-normal distribution. Therefore, the Mann-Whitney U test was utilized for data analysis. The results of the Mann-Whitney test revealed that before the intervention, the mean pain scores were 9.46±0.69 in the intervention group and 9.47±0.65 in the control group. After the intervention, the mean pain scores were 7.11±0.98 in the intervention group and 9.39±0.90 in the control group. Based on the Mann-Whitney U value obtained from the comparison of the two groups before and after the intervention, it can be concluded that the intervention had a significant effect on reducing pain (Table 2). Conclusion: The insertion and removal of chest tube after trauma can be an extremely painful experiences for individuals. Considering the crucial role of nurses, non-pharmacological methods such as acupressure can be used to alleviate their pain. Acupressure is a cost-effective, accessible, and readily available approach that can be utilized in this context.

Rates of PCR Positivity of Pleural Drainage Fluid in COVID-19 Patients: Is It Expected?

Background: Tube thoracostomy, utilized through conventional methodologies in the context of pleural disorders such as pleural effusion and pneumothorax, constitutes one of the primary therapeutic interventions. Nonetheless, it is imperative to recognize that invasive procedures, including tube thoracostomy, are classified as aerosol-generating activities during the management of pleural conditions in patients afflicted with COVID-19, thus raising substantial concerns regarding the potential exposure of healthcare personnel to the virus. The objective of this investigation was to assess the SARS-CoV-2 viral load by detecting viral RNA in pleural drainage specimens from patients who underwent tube thoracostomy due to either pleural effusion or pneumothorax. Methods: In this single-center prospective cross-sectional analysis, a real-time reverse transcriptase (RT) polymerase chain reaction (PCR) assay was employed to conduct swab tests for the qualitative identification of nucleic acid from SARS-CoV-2 in pleural fluids acquired during tube thoracostomy between August 2021 and December 2021. Results: All pleural drainage specimens from 21 patients who tested positive for COVID-19 via nasopharyngeal PCR, of which 14 underwent tube thoracostomy due to pneumothorax, 4 due to both pneumothorax and pleural effusion, and 3 due to pleural effusion, were found to be negative for SARS-CoV-2 RNA. Moreover, individuals exhibiting pleural effusion were admitted to the intensive care unit with a notably higher incidence, yet demonstrated significantly more radiological anomalies in patients diagnosed with pneumothorax. Conclusions: The current findings, inclusive of the results from this study, do not furnish scientific evidence to support the notion that SARS-CoV-2 is transmitted via aerosolization during tube thoracostomy, and it remains uncertain whether the virus can be adequately contained within pleural fluids.

A single left fourth intercostal thoracotomy approach for resolution of idiopathic chylothorax with thoracic duct ligation and pericardiectomy: a preliminary clinical study in two dogs.

Open surgical treatment of idiopathic chylothorax via thoracic duct ligation and pericardiectomy requires a lengthy procedure with two thoracotomy incisions. The objectives of this report were to describe an approach for thoracic duct ligation and pericardiectomy via a single thoracotomy at the left fourth intercostal space and to describe the clinical outcome in two dogs with idiopathic chylothorax. Dogs were prospectively enrolled in a pilot study to evaluate the clinical efficacy of thoracic duct ligation at the left fourth intercostal space, combined with subphrenic pericardiectomy performed through the same incision. Dogs had a preoperative CT lymphangiogram to evaluate the anatomy of the thoracic duct and its branching pattern prior to surgery. Recheck radiographs were performed every 2-4 weeks until effusion resolved. Pleural effusion became non-chylous by 5 days postoperatively. Pleural effusion volume decreased by day 5 postoperatively, allowing removal of thoracostomy tube and discharge from the hospital. Radiographically, effusion resolved within 6 weeks without a need for further drainage after discharge. Dogs remained symptom-free at last follow up (>11 months postoperatively). CT lymphangiograms were repeated >11 months postoperatively and revealed no recurrence of pleural effusion. No intraoperative or postoperative complications directly related to surgery were noted for either dog. Collateral lymphatic vessels were not identified on recheck CT lymphangiograms. The left fourth intercostal approach to thoracic duct ligation and pericardiectomy has potential to be a safe and effective alternative to an open approach requiring two lateral thoracotomies. Further investigation of this approach using open or minimally invasive techniques is warranted.

A structured simulation-based mastery learning curriculum in chest tube insertion results in superior skills compared to traditional training programs.

Chest tube insertions (CTI) have a high complication rate, warranting a dedicated Simulation-Based Mastery Learning (SBML) curriculum to acquire technical skills. This randomized controlled trial compares residents' skills in CTI after completing a SBML curriculum with those enrolled in a traditional residency program. Junior residents were baseline tested on cognitive and technical skills (Thiel bodies) before randomization into an intervention and control group. The former deliberately trained CTI on a porcine rib model until passing a predefined pass/fail score and were then summatively tested on Thiel bodies. The latter had no additional training opportunities and was evaluated 3months later. Seventeen residents were recruited and randomized. Following the per-protocol principle, a significant interaction effect for Group×Procedure (F(1,14)=6.2, p=0.026) was observed. Between baseline and summative assessment, both the control group (28.0±8.2 vs. 43.6±8.1, p<0.001) and the intervention group (33.2±7.7 vs. 57.6±5.7, p<0.001) significantly increased their scores. The intervention group outperformed the control group at summative assessment (43.6±8.1 vs. 57.6±5.7, p<0.001). All participants in the intervention group and one resident in the control group achieved the pass/fail score. This SBML curriculum enabled quicker and superior skill acquisition. Skills trained on a porcine model are transferred to the highly realistic Thiel bodies and reach expert level, potentially increasing resident skill in clinical practice.

Impact of a novel oxidized regenerated cellulose application method on postoperative outcomes and lung function recovery in lung volume reduction surgery for emphysema

BackgroundOne of the significant complications associated with Lung volume reduction surgery (LVRS), which is a critical intervention for patients with advanced emphysema, is the development of postoperative air leaks. We have found that oxidized regenerated cellulose (ORC) can be used in LVRS to minimize postoperative air leaks and enhance recovery in our clinical work. This study evaluates the efficacy of a novel ORC application method in improving lung function and reducing complications in patients undergoing LVRS for emphysema. MethodsA comparative analysis was conducted on 83 patients who underwent LVRS, divided into two groups: 41 received ORC (ORC group), and 42 did not (No-ORC group). Lung function parameters, including Forced Expiratory Volume in One Second (FEV1), Forced Vital Capacity (FVC), FEV1/FVC ratio, and FEV1% predicted, were measured preoperatively and at 3, 6, and 12 months postoperatively. Postoperative outcomes, such as the duration of chest tube placement, hospital stay, and the incidence of air leaks, were also compared. ResultsPreoperative characteristics, including age, sex, smoking history, Body Mass Index (BMI), and baseline lung function, were similar between the two groups. Postoperatively, both groups showed improvements in lung function. By 12 months, lung function parameters between the groups were comparable. The ORC group had a shorter duration of chest tube placement (mean 4.41 days vs. 6.76 days, P < 0.01) and hospital stay (mean 6.78 days vs. 9.12 days, P < 0.01). Additionally, the incidence of postoperative air leaks was lower in the ORC group compared to the No-ORC group (P < 0.01). ConclusionsThe novel application method of ORC in LVRS is associated with enhanced early postoperative recovery, reflected in shorter chest tube duration, reduced hospital stays, and a lower incidence of postoperative air leaks. And, long-term lung function outcomes between ORC and No-ORC groups are similar.

Necrotizing pneumonia-a rare but complex complication in bronchiectasis patients.

Pneumonia occurs commonly in bronchiectasis patients with exacerbation, though necrotizing pneumonia remains rare. This report presents two cases of bronchiectasis complicated by necrotizing pneumonia. The first case involves a 39-year-old female with bronchiectasis due to primary ciliary dyskinesia. She presented with severe chest pain and persistent fever unresponsive to oral antibiotics. Chest computed tomography (CT) revealed necrotizing pneumonia with associated empyema, necessitating prolonged antibiotic therapy, pleural drainage and ultimately surgical decortication. The second case is a 39-year-old male with bronchiectasis following ammonia inhalation injury, presenting with pleuritic chest pain and productive cough, with a CT scan showing consolidation with low attenuation areas. Intensive antibiotic treatment was required, alongside corticosteroids and inhaled antibiotics afterward. These cases demonstrate the importance of identifying risk factors for necrotizing pneumonia in bronchiectasis patients. Tailoring treatment strategies, including extending antibiotic regimens, using inhaled antibiotics, and administering corticosteroids, is essential to mitigate poor outcomes.

Management of malignant pleural effusions and drainage care: a hospital in the home and palliative care service

Management of malignant pleural effusions and drainage care: a hospital in the home and palliative care service

A Pilot Study of a Simulation-Based Mastery Learning Procedural Curriculum for Pediatric Emergency Medicine Fellows.

Pediatric emergency medicine (PEM) fellows are expected to perform high-risk procedures across a wide range of patient age, size, and physiology including procedures that are no longer required during pediatric residency training. Examples include central venous catheter (CVC) placement, endotracheal intubation of children and adolescents, and tube thoracostomy placement. Simulation-based mastery learning has demonstrated decreased patient morbidity. In this study, we describe implementation of a simulation-based mastery learning (SBML) procedural curriculum for PEM fellows. Our PEM fellows underwent an SBML procedural curriculum for lumbar puncture (LP), CVC placement, endotracheal intubation, and tube thoracostomy placement. These procedures are mandatory for fellows to learn, have known association with potential iatrogenic injury, and are widely available commercial task trainers. Fellows underwent baseline assessments, group demonstration, deliberate practice, and then postassessments. For both pre- and postassessments, we used internally developed checklists with minimum passing scores (MPSs) calculated by the Mastery-Angoff technique. Nineteen pediatrics residency-trained PEM fellows underwent this curriculum over a 2-year period. Six fellows (31.58%) achieved the MPS on all four procedures during their first posttest attempt. All fellows achieved the MPS on all four procedures by the second posttest attempt. Most fellows (17/19 or 89.47%) did not achieve the MPS on baseline LP assessments, despite inclusion of this procedure as an Accreditation Council of Graduate Medical Education (ACGME) requirement during their pediatric residency training. All participating PEM fellows demonstrated competency after training on four procedures associated with iatrogenic injuries. Using an SBML framework is a feasible method to teach procedural skills to PEM fellows, allowing them to demonstrate objective measures of competency in the simulation laboratory.

Comparison of thoracostomy tube size with pleural fluid dynamics in serous and hemorrhagic fluid models: an experimental study

Comparison of thoracostomy tube size with pleural fluid dynamics in serous and hemorrhagic fluid models: an experimental study

Pleural Space Management in Thoracic Trauma

Summary: Thoracic injuries are common, occurring in up to 60% of polytrauma patients and represent 25% of trauma deaths. Thoracic trauma frequently involves injury to the pleural space resulting in hemothorax and pneumothorax—effective management of the pleural space is essential. Reviewed in this article is management of the pleural space in chest wall trauma (including pneumothorax and hemothorax), and chest tube placement, indications for video-assisted thoracoscopic surgery, management, and complications.

Apixaban removal during emergency surgery for type A acute aortic dissection: a prospective cohort study

Background: Acute type A aortic dissection (ATAAD) has a high mortality, and acute aortic repair is the only curative treatment. In patients treated with factor Xa (FXa) inhibitors, the risk of severe disease-related complications such as cardiac tamponade and hemodynamic shock must be balanced against the potential for severe perioperative bleeding. The aim was to study intraoperative changes in plasma levels of the FXa inhibitor apixaban when using hemoadsorption during acute thoracic aortic repair. Materials and methods: This is a single-center prospective cohort study. Eight apixaban-treated patients presenting with ATAAD underwent acute thoracic aortic repair with intraoperative hemoadsorption with CytoSorb. Apixaban concentrations were measured at the start of cardiopulmonary bypass (CPB) and after 5, 15, 30, 60, and 90 min of CPB, at CPB weaning, 30 min after CPB weaning and 24 h postoperatively, using ultraperformance liquid chromatography–mass spectrometry (UPLC-MS). Results: After 30 min of CPB with hemoadsorption, mean apixaban concentration (±SD) was reduced by 59% from 108 (±69) µg/l to 44 (±20) µg/l (P=0.009). There was a further reduction to 37 (±17) µg/l at CPB weaning (P=0.008). Apixaban concentration displayed an increase to 56 (±29) µg/l 24 h postoperatively (P=0.01). In-hospital mortality was 25%. The mean 24H chest tube drainage volume was 621 (±136) ml. Conclusion: Intraoperative hemoadsorption lowers apixaban levels in patients undergoing emergency surgery for ATAAD. Further research is needed to determine its impact on perioperative bleeding complications and mortality.

Assessing the Outcomes and Complications of Small-Bore Wire-Guided Chest Drains in Treatment of Pneumothorax, Malignant Effusions, and Pleural Empyema

Background: Pleural effusion, empyema, and pneumothorax are clinical disorders associated with high mortality rates. Initially, treatment is medical; however, percutaneous drainage using small wire-guided chest drains is considered a suitable method for patients with pleural fluid accumulation, empyema, or pneumothorax. Objectives: This study aimed to investigate the effectiveness of small-bore wire-guided chest drains (SBWGD) in patients with empyema and pleural effusion. Methods: A total of 101 patients with pneumothorax, empyema, or malignant pleural effusion who underwent thoracocentesis for palliative or symptomatic treatment using an SBWGD were enrolled. Demographic and clinical data, as well as the duration of the drain’s stay, outcomes, and complications, were recorded in a checklist. Data were analyzed at a significance level of less than 0.05 using SPSS software version 24. Results: The mean age of the patients was 73.08 ± 15.63 years (range 21 - 99 years), and 58 patients (57.4%) were male. The most common indication for placing a pleural catheter was pleural effusion. The most prevalent underlying diseases were hypertension in 42 patients (42.6%), ischemic heart disease in 37 patients, and diabetes in 35 patients. Sixteen patients (15.8%) died during the follow-up period, and 5 patients (4.9%) experienced various complications, including catheter blockage (n = 2), pneumothorax (n = 2), and hemothorax (n = 1). The occurrence of complications was not significantly associated with gender (P = 0.902) or age (P = 0.630). Conclusions: Our findings showed that this method was associated with few complications, and these complications were not related to the gender or age of the patients. Although the mortality rate during the follow-up period was relatively high, most deaths occurred in elderly patients and those with multiple underlying diseases. The use of an SBWGD in cases of malignant effusion and pleural empyema is a safe and low-risk method, and it can be recommended for managing pleural effusion.

Surgical management of infected emphysema bulla: A case series.

An emphysema bulla is defined as a distension greater than 1cm of an airspace beyond the terminal bronchioles. Infection of an emphysema bulla is a common and serious complication of chronic obstructive pulmonary disease (COPD), which can lead to significant morbidity. Surgical intervention may be necessary in severe cases to prevent further complications. We present a case series of seven male patients with an average age of 46years, all diagnosed with infected emphysema bullae. The predominant clinical symptom was chest pain, often accompanied by fever and chills. Chest X-rays revealed hyperclarity occupying more than two-thirds of the pulmonary field in all patients. A follow-up CT scan confirmed the presence of large bullous emphysema. All patients received antibiotics for one to two weeks before surgery. Surgical management was performed in all cases due to the severity of the infection and the size of the bullae. Postoperative recovery was uneventful in four patients. Two patients experienced prolonged air leaks requiring extended chest drainage, and one patient developed atelectasis, which resolved favorably with conservative management. This case series highlights the role of timely surgical intervention in the treatment of infected emphysema bullae and the associated postoperative complications. Infected emphysema bullae represent a significant complication in patients with COPD. Surgical intervention, alongside antibiotic therapy, offers a safe and effective treatment option, resulting in favorable outcomes for most patients. Prompt diagnosis and management are crucial to avoiding severe complications.

Successful Management of Refractory Chylothorax in Preterm Infants Using Hypertonic Glucose Pleurodesis

Neonatal chylothorax is a potentially fatal respiratory condition caused by a congenital or traumatic etiology. Conventional therapies, such as fasting, total parenteral nutrition, and intravenous octreotide, are generally successful in such cases; however, more invasive therapeutic measures, such as pleurodesis, should be considered in refractory cases. This case report presents two preterm infants with refractory chylothorax who were non-responsive to conventional treatment but were successfully managed using hypertonic glucose pleurodesis. The first case was that of a female infant born at 24&lt;sup&gt;+5&lt;/sup&gt; weeks of gestation (585 g) and diagnosed with postsurgical chylothorax at 68 days of life. Even after the initiation of fasting and intravenous octreotide administration, pleural drainage did not reduce. Therefore, the patient underwent three intermittent procedures of 50% glucose pleurodesis, which resulted in the resolution of the chylothorax and subsequent chest tube removal after 37 days. The second case was a female infant born at 34&lt;sup&gt;+6&lt;/sup&gt; weeks (3,040 g), who was diagnosed with congenital chylothorax immediately after birth. Fasting and intravenous octreotide failed to show any clinical effects; therefore, the patient underwent pleurodesis for 3 consecutive days. After the procedure, the amount of pleural drainage substantially decreased, and the chest tube was removed after 14 days. In both cases, a temporal relation between pleurodesis and chylothorax resolution was observed, suggesting that hypertonic glucose pleurodesis may be an effective and safe alternative for treating refractory chylothorax in preterm infants with minimal side effects. Further studies are needed to establish the optimal protocol for this procedure and to compare its efficacy with that of other pleurodesis agents.

Effectiveness of non-pharmacological interventions for pain reduction following chest tube removal: A systematic review and network meta-analysis

ObjectiveThis study aimed to determine the most effective non-pharmacological intervention for pain relief following chest tube removal in adult patients. MethodsWe performed a systematic review with network meta-analysis, searching electronic databases for randomized controlled trials up to January 20, 2024. Compared to control or placebo groups, the trials included adult patients receiving non-pharmacological interventions, such as cold therapy, relaxation exercises, music therapy, transcutaneous electrical nerve stimulation, or aromatherapy. Data analysis utilized a random-effects model, reporting standardized mean differences (SMD) with 95% confidence intervals (CI), and treatment ranking was determined through surface under the cumulative ranking analysis and forest plots. ResultsSixteen studies enrolling 1,342 patients were included, with moderate to high heterogeneity. Cold therapy and relaxation exercises effectively reduced pain after chest tube removal, with SMD of −1.84 (95 % CI: −2.81 to −0.87) and −2.04 (95 % CI: −3.43 to −0.65), respectively, from baseline to immediately post-removal. From baseline to ten to twenty minutes after removal, both therapies continued to show significant pain reduction, with SMD of −1.96 (95 % CI: −3.14 to −0.77) for cold therapy and −2.01 (95 % CI: −3.75 to −0.28) for relaxation exercises. Sensitivity analysis supported these findings, and cold therapy’s efficacy appeared unaffected by obesity. However, publication bias, possibly due to small study samples, was noted. ConclusionsCold therapy and relaxation exercises proved most effective for reducing pain immediately and up to ten to twenty minutes after chest tube removal. Given their cost-effectiveness, lack of side effects, and ease of use, we recommend relaxation exercises as a practical alternative to cold therapy. Nonetheless, further studies are needed to comprehensively assess non-pharmacological options for managing chest tube removal pain. Implications for clinical practiceIncorporate cold therapy and relaxation exercises into post-chest tube removal pain management to improve patient comfort and minimize reliance on pharmacological interventions.

"Efficacy of needle tract embolization using gelfoam in reducing incidence of Pneumothorax in CT-guided transthoracic Lung Biopsies: A Systematic Review and Meta-analysis."

Transthoracic CT-guided lung biopsy is associated with risk of pneumothorax, requiring chest tube placement at times. From available literature, we tried to compare the incidence rate of pneumothorax in cases undergoing CT-guided lung biopsy with versus without use of gelfoam slurry for tract occlusion. Databases like SCOPUS, PubMed, Google Scholar and EMBASE were searched for original studies analyzing the efficacy of gelfoam for needle tract embolization following CT-guided lung biopsy till September 2023. Bias in the selected studies was assessed using the Risk Of Bias In Non-randomized Studies of Interventions (ROBINS-I) tool. Pooled odds ratio of the effect of gelfoam slurry on the rate of pneumothorax and chest tube placement following CT-guided lung biopsy was calculated and represented with 95% confidence intervals (95% CI) and Prediction interval (PI). Pooled analysis of six studies, revealed that patients undergoing needle tract embolization when compared to non-embolized patients had a significantly decreased risk of pneumothorax with odds reduced by 59% (OR = 0.41, 95% CI = 0.25-0.66, p = 0.01; PI=-1.694-0.094). Also, it led to a significant reduction in severe pneumothorax requiring chest tube placement with reduced odds by 63% (OR = 0.37, 95%CI= 0.20-0.69, p = 0.01; PI=-1.855-0.115). Needle tract embolization using gelfoam has a significant protective effect against pneumothorax as well as chest tube insertion in patients undergoing CT-guided lung biopsy. Gelfoam needle tract embolization can effectively reduce the risk of pneumothorax and chest tube requirement after lung biopsy.

Navigating the Needles: Unveiling the Risks of Acupuncture: A Case Report.

Acupuncture, an increasingly popular alternative medical therapy, has heightened the demand for information on its safety profile. This is a case report involving a 28-year-old female who presented with intense right-sided chest pain and breathlessness after an acupuncture session where needles were inserted into her chest wall. The immediate medical evaluation revealed a tension pneumothorax with radiographic evidence of a mediastinal shift, compelling, urgent intervention via chest tube insertion. The patient's symptoms persisted for 2 days before the pneumothorax diminished, facilitating the removal of the chest tube. This case emphasizes the atypical presentation of pneumothorax after acupuncture, suggesting a delayed onset of symptoms possibly related to the size of the bronchopleural fistula formed by the acupuncture needle. While acupuncture-related adverse events are uncommon, serious life-threatening complications like tension pneumothorax underscore the necessity for rigorous safety standards. Amidst the growing popularity of acupuncture, this report urges healthcare professionals to be aware of and report such incidents for enhanced patient education and safety. Trial Registration: This is not an interventional study. We only reported the patient's findings from our database as a case report.