Thoracostomy Research Articles

Comparison of Different Tube Materials and Use of Chinese Finger Trap or Four Friction Suture Technique for Securing Gastrostomy, Jejunostomy, and Thoracostomy Tubes in Dogs

To compare Chinese finger trap (CFT) and 4 friction suture (FFS) techniques to secure gastrostomy (GT), jejunostomy (JT), and thoracostomy (TT) tubes of different materials. Prospective experimental study. Canine cadavers (n=20). Randomly, GT (n=20), JT (20), and TT (20) were inserted using 2 different suture techniques (10 for each tube type) and either silicone or another material (10 for each type). Axial distraction was applied to each tube until failure. Force and displacement to failure and failure mode were recorded and compared between techniques and materials for GT, JT, and TT. CFT failed most commonly by suture breakage whereas FFS failed mainly by tube slippage (P=.003). For GT, failure occurred more commonly by tube slippage (n=15; P<.001) whereas tube breakage was more common for JT (n=10; P<.001) and suture breakage for TT (n=14; P=.022). Silicone had higher force to failure than latex with GT, lower force to failure than red rubber with JT, and lower displacement to failure than polyvinylchloride with TT. Different failure modes occurred for CFT (suture breakage) and FFS (tube slippage) and among different tube types (tube slippage with GT, tube breakage with JT, and suture breakage with TT). Based on study results, CFT is preferred to FFS for anchoring silicone GT and TT. Silicone GT, red rubber JT, and polyvinylchloride TT were more secure than latex GT, silicone JT, and silicone TT, respectively. CFT should be preferred over FFS based on force and displacement to failure, but tube type and tissue reaction could influence anchoring strength.

Thoracic trauma: presentation and management outcome.

To determine the presentation and management outcome of thoracic trauma in a tertiary care setting. Case series study. The study was carried out in the Department of Surgery, Pakistan Institute of Medical Sciences (PIMS), Islamabad from January to December 2005. A total of 143 patients, who presented with chest trauma, were included in the study. All the patients were assessed by the history, physical examination and ancillary investigations. Appropriate managements were instituted as required. Data was described in percentages. Out of 143 patients, 119 (83%) were males and 24 (17%) were females. Most of the patients belonged to the age group of 21-50 years. Ninety seven (66%) patients were admitted for indoor management. Blunt injury was found in 125 (87.4%) patients, while penetrating injuries in only 18 (12.6%) patients. Road Traffic Accidents (RTAs) were the commonest cause of trauma (n=103, 72%). Rib fracture was the commonest chest injury (74% patients). Head injury was the most frequently associated injury (18% of the patients). Tube thoracostomy was the commonest intervention undertaken in 65 (45%) patients. Seventeen (11.88%) patients were managed with mechanical ventilation. There were 17 deaths with a mortality rate of 11.88%. Thoracic trauma is an important cause of hospitalization, morbidity and mortality in the younger population. RTAs constitute the leading cause of thoracic trauma in our setup. Tube thoracostomy is the most frequent and at times the only invasive procedure required as a definitive measure in thoracic trauma patients. A policy of selective hospitalization helps to avoid unnecessary hospital admissions.

Intrapleural Thrombolytics for Undrained Traumatic Hemothorax

Approximately 5% of patients with traumatic hemothorax treated with tube thoracostomy have residual effusions, usually from tube malposition,

The Accuracy of Thoracic Ultrasound for Detection of Pneumothorax is not Sustained Over Time: a Preliminary Study

Ultrasound has proven to be very accurate in the diagnosis of pneumothorax in the trauma suite. It is unknown whether this accuracy is maintained over time in patients with a thoracostomy (TT) in place. Hospitalized patients with a TT placed to treat a traumatic pneumothorax underwent serial daily bedside surgeon-performed ultrasound by 1 of 2 experienced surgeon sonographers who were unaware of concomitant X-ray findings. Results were compared with daily chest X-ray films. Data collected included size and day of placement of the chest tube, as well as the results of the serial ultrasounds and the comparative X-ray films. Fourteen patients (78% men, mean age 33 years) sustained traumatic pneumothorax. The causes included stab wound (9), gunshot wound (3), and rib fracture (2). They underwent 126 (median 7) ultrasound evaluations and were followed between 4 and 26 (median 7) days after injury. Of these exams, 95 had a concomitant chest X-ray film within 1 hour of the ultrasound, thus 190 hemithoraces could be analyzed. Eighty-two ultrasounds were performed for hemithoraces that had no injury or TT in place and all 82 revealed normal pleural sliding. No pneumothoraces were noted on concomitant chest X-ray films (100% accuracy). One hundred eight ultrasounds were performed for hemithoraces that had a TT in place. For the first 24 hours, accuracy remained 100%. After 24 hours, however, sensitivity of ultrasound diagnosis of pneumothorax fell to 55%, specificity fell to 70%, positive predictive value to 43%, and negative predictive value to 79%. This led to an overall accuracy rate for ultrasound examination after 24 hours of 65%. Ultrasound evaluation for pneumothorax is very accurate for the first 24 hours after insertion of a TT, but the accuracy, especially the positive predictive value, is not sustained over time, possibly as a result of the formation of intrapleural adhesions.

Clinical observation and nursing of injecting tramadol by micro pump after tube thoracostomy

目的 观察胸腔闭式引流术后微量泵输注曲马多镇痛的效果,指导临床护理工作.方法将80例胸腔闭式引流术后患者随机分为观察组和对照组.观察组术后使用微量泵静脉输注曲马多持续镇痛,对照组疼痛难忍时给予肌肉注射曲马多.结果 2组患者术后疼痛程度、开始下床活动时间、引流时间等均有显著性差异(P＜0.01).结论胸腔闭式引流术后应用微量泵镇痛,能有效减轻术后疼痛,阻断了因术后疼痛产生的一系列影响康复的因素,缩短病程,促进患者早日康复。

Pleural injury during laparoscopic renal surgery: early recognition and management.

Injury to the diaphragm is an uncommon yet recognized complication of several laparoscopic procedures, including laparoscopic renal surgery. As these procedures increase in popularity and use, laparoscopic surgeons should be aware of techniques for avoiding this complication as well as methods of identifying pleural injury and managing it appropriately. We report our experience with the detection and intraoperative management of pleural injury sustained during laparoscopic renal surgery and its subsequent treatment. From July 1993 to April 2001 at 4 institutions 1,765 patients underwent laparoscopic renal surgery for benign and malignant disease as well as for live renal donation. We retrospectively reviewed the charts and interviewed the primary surgeons to determine the etiology of pleural injury, intraoperative detection and management, and possible future prevention. Pleural injury occurred in 10 cases (0.6%). In 2 cases injury involved inadvertent trocar placement through the pleural cavity. These cases were managed by intraoperative chest tube placement. In 8 cases the diaphragm was injured in iatrogenic fashion during kidney dissection, including during splenic mobilization in 2, liver mobilization in 2, ascending colon mobilization in 1, dissection of the upper renal pole in 2 and dissection of a large renal cyst off of the diaphragm in 1. In all patients injury was detected intraoperatively and repaired via laparoscopy. In 1 patient residual pneumothorax postoperatively necessitated tube thoracostomy. Pleural injury sustained during laparoscopic surgery is an uncommon but potentially serious complication of laparoscopic renal procedures. The experienced laparoscopic surgeon can identify and repair the injury intraoperatively, minimizing patient morbidity postoperatively.

No Need for Presumptive Antibiotics Following Tube Thoracostomy for Trauma

Prophylactic antibiotics for wound infection are given with sufficient lead time to allow adequate tissue levels of antibiotics at the time of

The Safety andEfficacy of Prehospital Needle andTube Thoracostomy by Aeromedical Personnel

Background.Aeromedical crews routinely use needle thoracostomy (NT) andtube thoracostomy (TT) to treat major trauma victims (MTVs) with potential tension pneumothorax; however, the efficacy of prehospital NT andTT is unclear.Objectives.To explore the efficacy of aeromedical NT andTT in MTVs.Methods.A retrospective chart review was performed using prehospital medical records andthe county trauma registry over a seven-year period. All MTVs undergoing placement of NT or TT by aeromedical personnel were included; patients with incomplete data were excluded. Descriptive statistics were used to report the incidence of air release, clinical improvement (improved breath sounds or compliance if intubated, decreased dyspnea if nonintubated), andvital signs improvements (systolic blood pressure [SBP] increase to ≥90 mm Hg or increase by 5 mm Hg if < 90 mm Hg; heart rate improvement to 60–100 beats/min, increase by 10 beats/min if < 60 BPM, or decrease by 10 beats/min if > 100 beats/min; oxygen saturation increase if < 95%) for both NT andTT as documented in prehospital medical records. Survival andimprovement in SBP based on trauma registry data were recorded for patients stratified by initial SBP.Results.A total of 136 procedures (89 NTs and47 TTs) in 81 patients were identified using prehospital medical records over a four-year period. Response rates to NT (60% overall, 32% vital signs) andTT (75% overall, 60% vital signs) were high. Vital signs improvements were observed more often in patients with a pulse andin nonintubated patients. A total of 168 patients were identified in the trauma registry over the seven-year study period. Normalization of SBP was observed in two-thirds of patients with a field SBP ≤ 90 mm Hg andone-third of patients in whom field SBP could not be obtained. A small but significant proportion of patients undergoing prehospital NT andTT, including some with prehospital hypotension andhigh injury severity, survived to hospital discharge. The incidence of complications was low.Conclusions.Aeromedical crews appear to appropriately select MTVs to undergo field NT or TT. A low incidence of complications anda small but significant group of unexpected survivors support continued use of this procedure by aeromedical personnel.Key words:aeromedical crews; trauma; needle thoracostomy; tube thoracostomy; survival; pneumothorax; efficacy.

Use of Capsule Tetracycline for Pleurodesis in Breast Cancer Patients with Malignant Pleural Effusion

Background: Pleurodesis is an effective treatment for malignant pleural effusion but the ideal agent that will combine efficacy with safety and ease of administration remains under debate. Injectable tetracycline used to be the preferred agent for sclerosis for many clinicians but it has been withdrawn from the market. There is thus an ongoing search for suitable and better alternatives. In a third world environment, cost is a major determinant of use of some agents. Some patients have already been heavily pretreated with systemic cytotoxic drugs while some are too weak for agents with cytotoxic activity. All these limit the choice of agents available to us. Patients and Methods: Capsules of tetracycline were dissolved in sterile water and this was injected through a thoracostomy tube in patients with malignant pleural effusion from breast cancer. The efficacy was measured by its ability to the control effusion for at least 30 days as evidenced by non recurrence of clinical features of effusion necessitating re-treatment and/or chest radiology showing more than 50% fluid re-accumulation. Results: Twelve pleural effusions were treated with capsule tetracycline pleurodesis. Eleven effusions satisfied evaluation criteria. Eight of eleven evaluable pleural effusions (72.7%) were controlled for at least 30 days or until patient's death or loss to follow up. The reactions following the use of the agent were minimal comprising only of mild to moderate chest pain, an episode of fever, body aches and vomiting. All the symptoms were controlled by simple measure like analgesics. Conclusion: Capsule tetracycline has shown good promise as a sclerosing agent for pleurodesis. A prospective randomized trial comparing it with other known agents is warranted. Key Words: Malignant pleural effusion, pleurodesis, capsule tetracycline. Journal of College of Medicine 2005: 9(2): 82-84

Spontaneous pneumothorax in children.

Sixteen consecutive children diagnosed with spontaneous pneumothorax (SP) and admitted to Chang Gung Children's Hospital between July 1994 and June 1999 were retrospectively studied. The presenting features, radiographic abnormalities, and indications of surgery were reviewed. All patients were exclusively adolescents and were aged between 12 and 17 years. Six patients received chest tube drainage only. Nine patients underwent ablation of blebs or bullae using video-assisted thoracoscopic surgery (VATS) with good results. One patient had a bullous emphysema removed by wedge resection. One patient with spontaneous hemopneumothorax required a blood transfusion and emergent thoracotomy for stabilization. Computed tomographic (CT) scans of the chest detected all seven (100%) cases with apical bulla formations. First episodes of spontaneous pneumothorax were treated conservatively using closed-tube thoracostomy if the plain chest radiographs and CT scans were negative for apical bleb or bulla formations. In summary, SP occurred exclusively in adolescents in this study, commonly they had no underlying pulmonary abnormalities except for bulla or bleb formations. SP can be safely and effectively managed using VATS and abrasive pleurodesis in children without recurrence at follow-up. SP may be treated surgically even in the first event of pneumothorax when subpleural blebs are demonstrated by high-resolution computed tomographic scans.

Tube Thoracostomy for Traumatic Hemopneumothorax: Are Antibiotics Needed?

Empyema associated with tube thoracostomy (TT) following blunt or penetrating torso trauma has several potential sources: iatrogenic infection due to

EMLA Cream for Chest Tube Removal

Thoracostomy tube (TT) removal can be quite painful, and analgesic medication is often administered. This study compared EMLA cream and IV morphine for pain relief in this setting. EMLA cream is a eutectic mixture (one that has a lower melting point than any of its …

A SIMPLER TREATMENT FOR SPONTANEOUS PNEUMOTHORAX.

The standard approach to spontaneous pneumothorax -- even in patients with normal lungs -- has been insertion of a thoracostomy tube until the

Open thoracotomy for pneumothorax in cystic fibrosis.

The results of open thoractomy and pleurectomy or pleural abrasion for 17 episodes of pneumothorax in patients with cystic fibrosis were compared with the results of observation, closed thoracostomy, and closed thoracostomy with sclerosing agents. Open thoracotomy had the advantage of insuring prompt resolution of the pneumothorax. A small incision minimized postoperative morbidity. The average hospital stay was 15 days after open thoracotomy and 19 days after closed thoracostomy, with or without sclerosing agents. Complications of all treatments were infrequent. A limited symptomatic recurrence was observed in 2 of 17 pneumothoraces successfully treated with open thoracotomy. Recurrence also occurred in 1 of 8 treated with observation, 3 of 9 treated with closed thoracostomy, and 1 of 14 treated with closed thoracostomy and sclerosing agents. A loss of vital capacity was usually noted 4 to 18 months after resolution, regardless of treatment. Forty per cent of patients in both operative and nonoperative groups survived 3 years. In our experience, open thoracotomy can be used safely for treatment of unresolved or recurrent pneumothorax and warrants further evaluation as a primary therapy for pneumothorax in patients with cystic fibrosis.

So-called “liver death” syndrome following thoracostomy

So-called “liver death” syndrome following thoracostomy