An Analysis of Patients who Underwent Tube Thoracostomy in the Emergency Department: A Single Center Study

Kantar, Yusuf; Durukan, Polat; Hasdıraz, Leyla; Baykan, Necmi; Yakar, Şule; Kaymaz, Nesij Doğan

doi:10.5152/turkthoracj.2018.18056

Cited by 4 publications

(4 citation statements)

References 17 publications

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“…Ultrasound can be useful to guide the placement of chest tubes. Our institutional preference for intervention on pneumothoraces in VV-ECMO-supported patients has been the placement of an 8F pericardiocentesis catheter (Cook Medical, Bloomington, IN) by an experienced provider [ 63 , 64 , 65 ].…”

Section: Resultsmentioning

confidence: 99%

A Dedicated Veno-Venous Extracorporeal Membrane Oxygenation Unit during a Respiratory Pandemic: Lessons Learned from COVID-19 Part II: Clinical Management

et al. 2021

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(1) Background: COVID-19 acute respiratory distress syndrome (CARDS) has several distinctions from traditional acute respiratory distress syndrome (ARDS); however, patients with refractory respiratory failure may still benefit from veno-venous extracorporeal membrane oxygenation (VV-ECMO) support. We report our challenges caring for CARDS patients on VV-ECMO and alterations to traditional management strategies. (2) Methods: We conducted a retrospective review of our institutional strategies for managing patients with COVID-19 who required VV-ECMO in a dedicated airlock biocontainment unit (BCU), from March to June 2020. The data collected included the time course of admission, VV-ECMO run, ventilator length, hospital length of stay, and major events related to bleeding, such as pneumothorax and tracheostomy. The dispensation of sedation agents and trial therapies were obtained from institutional pharmacy tracking. A descriptive statistical analysis was performed. (3) Results: Forty COVID-19 patients on VV-ECMO were managed in the BCU during this period, from which 21 survived to discharge and 19 died. The criteria for ECMO initiation was altered for age, body mass index, and neurologic status/cardiac arrest. All cannulations were performed with a bedside ultrasound-guided percutaneous technique. Ventilator and ECMO management were routed in an ultra-lung protective approach, though varied based on clinical setting and provider experience. There was a high incidence of pneumothorax (n = 19). Thirty patients had bedside percutaneous tracheostomy, with more procedural-related bleeding complications than expected. A higher use of sedation was noted. The timing of decannulation was also altered, given the system constraints. A variety of trial therapies were utilized, and their effectiveness is yet to be determined. (4) Conclusions: Even in a high-volume ECMO center, there are challenges in caring for an expanded capacity of patients during a viral respiratory pandemic. Though institutional resources and expertise may vary, it is paramount to proceed with insightful planning, the recognition of challenges, and the dynamic application of lessons learned when facing a surge of critically ill patients.

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Section: Resultsmentioning

confidence: 99%

A Dedicated Veno-Venous Extracorporeal Membrane Oxygenation Unit during a Respiratory Pandemic: Lessons Learned from COVID-19 Part II: Clinical Management

et al. 2021

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“…As complicações ocorrem de 5% a 35%, envolvendo falhas técnicas, mal posicionamento do dreno torácico, lesões iatrogênicas, hemotórax retido ou coagulado, não expansão do pulmão (pneumotórax residual) e empiema pleural [7][8][9][10] . Alguns fatores são associados a estas falhas, como a inexperiência do cirurgião, os erros na identificação de estruturas anatômicas, a drenagem realizada na sala de admissão, o tipo de dreno utilizado, a emergência e o estresse da equipe cirúrgica 8,9,11 .…”

Section: Introductionunclassified

Fatores preditivos de complicações pleurais em vítimas de trauma submetidas à drenagem pleural: Estudo prospectivo observacional

Nascimento

Morad

Perlingeiro

et al. 2022

Rev. Col. Bras. Cir.

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RESUMO Objetivo: identificar as variáveis relacionadas às complicações pleurais em vítimas de trauma submetidas a drenagem torácica. Método: estudo observacional prospectivo entre maio/2019 e janeiro/2021, incluindo adultos submetidos a drenagem torácica após a admissão hospitalar para tratamento de lesões traumáticas. Pacientes que desenvolveram COVID19 foram excluídos. As complicações pleurais foram caracterizadas como: pneumotórax residual, hemotórax residual / coagulado e empiema pleural. Comparamos as variáveis coletadas entre os grupos de pacientes com e sem estas complicações. Os testes t de Student, Mann Whitney, Chi quadrado e Fisher foram utilizados para análise estatística. Foram considerados significativos valores de p<0,05. Resultados: analisamos 68 casos, com média etária de 36,0 + 12,6 anos, de RTS de 7,0 ± 1,6 e ISS de 15,9 ± 7,6, sendo 62 (91,2%) do sexo masculino. Trinta e quatro pacientes (50,0%) foram vítimas de ferimento por arma branca. O AIS das lesões torácicas foi classificado como 2 (4,4%), 3 (80,9%), 4 (13,2%), e 5 (1,5%). As complicações pleurais ocorreram em 14 casos (20,5%), sendo hemotórax residual / coagulado em 8 casos (11,8%), pneumotórax residual em 3 (4,4%), o empiema pleural em 2 (2,9%) e associações em 1 (1,4%). Estas complicações foram tratadas por videotoracoscopia (5 casos), toracotomia (3), redrenagem de tórax (3) e medidas clínicas apenas (3). A redrenagem de tórax (p<0,001) e o tempo de permanência do dreno (p<0,001) tiveram relação significativa com a presença de complicações pleurais. Conclusão: a redrenagem do tórax e o maior tempo de permanência do dreno foram associados às complicações pleurais.

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“…Complications occur in 5% to 35%, involving technical failures, malposition of the chest tube, iatrogenic injuries, retained or clotted hemothorax, non-expansion of the lung (residual pneumothorax), and pleural empyema [7][8][9][10] . Some factors are associated with these failures, such as the surgeon's inexperience, errors in the identification of anatomical structures, the drainage performed in the admission room, the type of drain used, emergency, and the stress of the surgical team 8,9,11 .…”

Section: Introductionmentioning

confidence: 99%

“…The most common injuries are hemothorax, pneumothorax, and rib fractures 4,5 .Chest drainage is the most frequent surgical procedure in the treatment of chest injuries, being performed in 40% to 66% of cases 4-6 . It is considered technically simple and capable of saving lives.Complications occur in 5% to 35%, involving technical failures, malposition of the chest tube, iatrogenic injuries, retained or clotted hemothorax, non-expansion of the lung (residual pneumothorax), and pleural empyema [7][8][9][10] . Some factors are associated with these failures, such as the surgeon's inexperience, errors in the identification of anatomical structures, the drainage performed in the admission room, the type of drain used, emergency, and the stress of the surgical team 8,9,11 .Pleural complications that can result from chest drainage increase the length of hospital stay, costs, the frequency of unscheduled reoperations, and deaths.…”

mentioning

confidence: 99%

Predictors of pleural complications in trauma patients undergoing tube thoracostomy: A prospective observational study

Nascimento

Morad

Perlingeiro

et al. 2022

Rev. Col. Bras. Cir.

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Objective: to identify variables related to pleural complications in patients undergoing tube thoracostomies due to traumatic injuries. Method: we conducted a prospective observational study from May/2019 to January/2021 including adult trauma patients submitted to tube thoracostomies after hospital admission. Patients undergoing thoracotomies as the initial treatment were not included. We excluded patients with suspected and confirmed COVID-19 diagnosis during the hospitalization. Pleural complications were defined as clotted hemothorax, residual pneumothorax and empyema. Students t, Mann Whitneys, Chi square and Fishers exact test were used to compare variables between groups. We considered p<0.05 as significant. Results: we analyzed 68 patients. The mean age was 36.0 + 12.6 years and 91.2% were male. The mean RTS and ISS were, respectively, 7.0 ± 1.6 and 15.9 ± 7.6. The most frequent trauma mechanism was stab wounds in 50.0%, followed by blunt trauma in 38.2%. The severity of thoracic injuries was stratified (AIS) as 2 (4.4%), 3 (80.9%), 4 (13.2%), e 5 (1.5%). Pleural complications happened in 14 (20.5%) patients, being clotted / residual hemothorax (11.8%), residual pneumothorax (4.4%), empyema (2.9%) and miscellaneous (1.4%). These patients were treated by thoracoscopy (5), thoracotomy (3), chest re-drainage (3) and clinical measures alone (3). There was a significant association between pleural complications with the time of permanence (p<0,001) and the necessity of relocation (p<0,001) of the drain. Conclusion: the predictors of pleural complications in this series were time of permanence and the necessity of relocation of the drain.

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An Analysis of Patients who Underwent Tube Thoracostomy in the Emergency Department: A Single Center Study

Cited by 4 publications

References 17 publications

A Dedicated Veno-Venous Extracorporeal Membrane Oxygenation Unit during a Respiratory Pandemic: Lessons Learned from COVID-19 Part II: Clinical Management

A Dedicated Veno-Venous Extracorporeal Membrane Oxygenation Unit during a Respiratory Pandemic: Lessons Learned from COVID-19 Part II: Clinical Management

Fatores preditivos de complicações pleurais em vítimas de trauma submetidas à drenagem pleural: Estudo prospectivo observacional

Predictors of pleural complications in trauma patients undergoing tube thoracostomy: A prospective observational study

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