Chest closure without drainage after open patent ductus arteriosus ligation in Ugandan children: A non blinded randomized controlled trial

Abstract

BackgroundThere is clinical equipoise regarding post-operative management of patients with patent ductus arteriosus (PDA) without insertion of a chest drain. This study evaluated post operative outcomes of chest closure with or without a drain following Patent Ductus Arteriosus ligation among childen at Uganda Heart Instritute (UHI).MethodsThis was an open label randomized controlled trial of 62 children 12 years of age and below diagnosed with patent ductus arteriosus at Mulago National Teaching and Referral Hospital, Uganda. Participants were randomized in the ratio of 1:1 with surgical ligation of patent ductus arteriosus to either thoracotomy closure with a chest tube or without a chest tube. All participants received standard care and were monitored hourly for 24 hours then until hospital discharge. The combined primary endpoint consisted of significant pleural space accumulation of fluid or air, higher oxygen need or infection of the surgical site. Analysis was conducted by multivariable logistic regression analysis at 5 % significance level.ResultsWe enrolled 62 participants, 46 (74 %) of whom were females. Their median age was 12 months (IQR: 8–36). Participants in the no-drain arm significantly had less post-operative complications compared to the drain arm (Unadjusted odds ratio [uOR]: 0.21, 95 % CI: 0.06–0.73, p = 0.015). This “protective effect” remained without statistical significance in the multivariable regression model (Adjusted odds ratio [aOR]: 0.07, 95 % CI: 0.00–2.50, p = 0.144).ConclusionChildren aged below 6 years with patent ductus arterious can safely and effectively have thoracotomy closure without using a drain in uncomplicated surgical ligation of the PDA. Chest drain was associated with post-operative complications.Trial registrationThe trial was registered in the Pan African Clinical Trials registry on 1st/July/2012, retrospectively registered. Identifier number PACTR201207000395469.Electronic supplementary materialThe online version of this article (doi:10.1186/s12893-016-0182-x) contains supplementary material, which is available to authorized users.

Transaxillary Surgical Ligation of Patent Ductus Arteriosus in Paediatric Group of Patient

“…Chest closure without drainage following PDA ligation is safe and effective and less postoperative complication. 12 In our study, about one third of the patients, chest were closed without chest drainage tube.…”

Efficiency and Safety of Patent Ductus Arteriosus Surgical Ligation in Extremely Low Birth Weight Infants Without Chest Tube Placement

“…These include, but are not limited to, incorrect placement; unresolved pneumothorax; infection both uncomplicated and complicated (empyema); obstruction due to the presence of clots, fibrin or pleura adherence to the side holes of the chest tube; perforation of the lung or esophagus; phrenic nerve damage; prolonged narcotic use for persistent pain; poor respiratory effort; and pneumothorax after chest tube removal, and significant pleural inflammatory reaction with fibrin accumulation leading to trapped lung syndrome. [6][7][8] Since these potential complications could add significantly to overall morbidity of ELBW infants, we performed PDA SL without chest tube placement, unless otherwise indicated, such as the presence of visceral pleura trauma, unintentional lung parenchyma injury or hemorrhage. Our experience shows this practice to be safe and effective as noted by the absence of any chest tube placement during the first postoperative week.…”

Clinical study of stand-alone transthoracic echocardiography-guided percutaneous occlusion of patent ductus arteriosus

“…Such surgical methods are more suitable for the premature and newborn infants. However, these methods inevitably leave large surgical scars; furthermore, intraoperative pulmonary oppression may cause pulmonary damage, and cardiopulmonary bypass may cause certain complications ( 6 , 7 ). In recent years, improvements have been made in percutaneous occlusion techniques to achieve satisfactory outcomes in older children and adults; however, during the procedure, the operators and patient are exposed to X-ray radiation, and these techniques require large, expensive X-ray equipment, which is not available in grass-roots hospitals in China.…”