Impact and Predictors of Prolonged Chest Tube Duration in Mechanically Ventilated Patients with Acquired Pneumothorax

Kao, Jiann Hwa; Kao, Hsin Kuo; Chen, Yen Wen; Yu, Wen-Kuang; Pan, Shiann; Wang, Jia Horng; Lien, Te Cheng; Ho, Ling‐Jun; Kou, Yu Ru

doi:10.4187/respcare.02273

Cited by 5 publications

(5 citation statements)

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“…Pneumothorax scored 0.04 in predictor importance. It is evident in the literature that pneumothorax and prolonged chest tube duration are associated with poor outcomes such as PMV and increased ICU length of stay and mortality [45].…”

Section: Plos Onementioning

confidence: 99%

Using trauma registry data to predict prolonged mechanical ventilation in patients with traumatic brain injury: Machine learning approach

et al. 2020

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We aimed to build a machine learning predictive model to predict the risk of prolonged mechanical ventilation (PMV) for patients with Traumatic Brain Injury (TBI). Methods This study included TBI patients who were hospitalized in a level 1 trauma center between January 2014 and February 2019. Data were analyzed for all adult patients who received mechanical ventilation following TBI with abbreviated injury severity (AIS) score for the head region of � 3. This study designed three sets of machine learning models: set A defined PMV to be greater than 7 days, set B (PMV > 10 days) and set C (PMV >14 days) to determine the optimal model for deployment. Patients' demographics, injury characteristics and CT findings were used as predictors. Logistic regression (LR), Artificial neural networks (ANN) Support vector machines (SVM), Random Forest (RF) and C.5 Decision Tree (C.5 DT) were used to predict the PMV. Results The number of eligible patients that were included in the study were 674, 643 and 622 patients in sets A, B and C respectively. In set A, LR achieved the optimal performance with accuracy 0.75 and Area under the curve (AUC) 0.83. SVM achieved the optimal performance among other models in sets B with accuracy/AUC of 0.79/0.84 respectively. ANNs achieved the optimal performance in set C with accuracy/AUC of 0.76/0.72 respectively. Machine learning models in set B demonstrated more stable performance with higher prediction success and discrimination power.

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Section: Plos Onementioning

confidence: 99%

Using trauma registry data to predict prolonged mechanical ventilation in patients with traumatic brain injury: Machine learning approach

et al. 2020

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“…Leaving it in place longer than 7 days raise the risks for infection along the chest tube tract. 1 A number of clinical indicators will determine when a patient is ready for his chest tube to be removed. If the chest tube was inserted because of excess fluid, it can be safely removed when the drainage is less than 200 ml in 24 hours.…”

Section: Introductionmentioning

confidence: 99%

Is Bedside Ultrasound Useful for Chest Tube Removal? Description of an Initial Experience

Dorigatti¹,

Melek²,

Schmid³

et al. 2017

Emerg Med Open J

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Introduction: Point-of-care ultrasound is a propaedeutic modality more often used in a daily basis practice. Since the establishment of sonography bases for lung ultrasound, it has become a valuable extension of physical examination, providing new information about lungs, pleural structures and volume status. Currently, the removal of chest tubes is based on clinical data, associated with chest X-ray control. The objective of this manuscript is to describe two cases that ultrasound was used in order to test whether it could be an alternative control tool on these specific scenarios. Methods: Bedside ultrasound was daily performed on two patients with iatrogenic pneumothorax until they met clinical criteria for chest tube removal. Ultrasound exam was performed before and after chest tube removal. Results: In both cases patients were submitted to chest tube placement due to iatrogenic pneumothorax. One of the patients had a pneumothorax during diagnostic thoracocentesis for pleural effusion and the other patient during the placement of a central venous line. In both the cases, bedside ultrasound presented similar results to the chest X-ray. Bedside ultrasound was able to adequately identify chest tube placement and lung expansion. In none of the present cases was possible to see residual pneumothorax also unidentified by the chest X-ray. Conclusion: Even though there is extensive data showing ultrasound superiority when compared to chest X-ray in the diagnosis of pneumothorax, there is little or no data using this method as image criteria for chest tube removal. This article shows two suggestive cases that lung ultrasound could be a simple, bedside manner, to show adequate lung expansion and serve as useful tool for chest tube removal. A prospective study is necessary to provide evidencebased data on the subject.

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“…Aquino et al relataram que pacientes no período pós-operatório de cirurgia cardíaca apresentaram diminuição dos volumes e capacidades pulmonares, os quais reduziram a quantidade de inspirações profundas e efetividade da tosse, devido a dor provocada pela inserção do dreno 44 . A diminuição da inspiração profunda e tosse predispõem complicações respiratórias, sendo que a atelectasia é a mais frequente das complicações, atingindo 64% dos pacientes no período pós-operatório 13 . Segundo alguns autores, a indicação terapêutica do Reanimador de Muller nas primeiras horas, de pós-operatório, parece restabelecer mais rapidamente os volumes pulmonares 25,28,45 .…”

Section: Discussionunclassified

“…Este método de tratamento é usado aproximadamente em 133.000 pacientes hospitalizados por ano nos Estados Unidos 12 . O objetivo principal da utilização da drenagem torácica é a remoção de acúmulo de fluídos tais como o ar, sangue e líquido da cavidade pleural para que os sinais e sintomas, possam melhorar e restaurar a função respiratória e pulmonar 13 .…”

Section: -Introduçãounclassified

“…As complicações da drenagem torácica incluem as infecções, dor, lesão tecidual do tórax, enfisema subcutâneo, trombose, embolia pulmonar e pneumotórax. Essas complicações estão associadas ao aumento dos dias de permanência do dreno, tempo de internação hospitalar e mortalidade 8,13,14 . Por estas razões, estratégicas cirúrgicas e clínicas são adotadas para reduzir o tempo de utilização do dreno torácico nos pacientes.…”

Section: -Introduçãounclassified

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Fisioterapia respiratória com pressão positiva intermitente

Anjos¹

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Introdução: Uma das estratégicas clínicas que pode ser adotadas para acelerar a remoção do dreno torácico é a reabilitação respiratória com técnicas de reexpansão pulmonar, sendo este um dos critérios para remoção do dreno. Objetivo: Comparar a utilização do equipamento Reanimador de Muller como recurso fisioterapêutico em relação às técnicas fisioterapêuticas convencionais no tratamento de pacientes submetidos ao uso de dreno de tórax. Método: Estudo prospectivo, randomizado, descritivo e comparativo. O estudo foi composto por 40 pacientes, sendo elegíveis acima de 18 anos, hemodinamicamente estável, presença de tórax de dreno, orientado e consciente. Foi comparado dois grupos, sendo o grupo convencional composto por técnicas fisioterapêuticas com incentivador inspiratório e manobras manuais de reexpansão. O outro grupo denominado de estudo, teve como principal técnica a pressão positiva intermitente com o equipamento Reanimador de Muller. A análise estatística foi realizada para comparar as variáveis categóricas entre os 2 grupos, porém foram usados o teste quiquadrado ou, na presença de valores esperados menores que 5, o teste exato de Fisher, Mann-Whitney, ANOVAs, sendo o nível de significância adotado para os testes estatísticos foi P<0.05 . Resultado: Houve diferença estatísticas entre os valores pré e pós intervenção fisioterapêutica intra grupos da variável de volume minuto, volume corrente e dispneia (p<0.001). O valor de frequência respiratória no momento pós intervenção foi maior no grupo estudo (p=0.031).Quanto a variável de saturação periférica de oxigênio apresentaram diferença (p<0.001) intra grupos antes e após sessão de fisioterapia. A percepção de dor, tempo de internação e tempo de dreno não foram observadas diferenças estatísticas.Conclusão: Ambas as técnicas de fisioterapia respiratória em indivíduos com dreno de tórax foram efetivas na melhora do volume minuto, volume corrente, redução da dispneia.Palavras chaves: fisioterapia, respiração pressão positiva intermitente, doenças pleurais ABSTRACT Introduction: Introduction: One of the clinical strategies that can be adopted to accelerate the removal of the chest tube is respiratory rehabilitation with pulmonary re-expansion techniques, being one of the criteria for removal of the drain. Objective: To compare the use of Muller Resuscitator equipment as a physical therapy resource in relation to conventional physical therapy techniques in the treatment of patients with the use of chest drain. Methods: A prospective, randomized, descriptive and comparative. The study consisted of 40 patients, being eligible over 18 years, hemodynamically stable, the presence of chest drain, oriented and aware. two groups were compared, and the conventional group consisting of physical therapy techniques with inspiratory encourager and manual maneuvers to re-expansion. The other group called the study was mainly technical intermittent positive pressure with Muller Resuscitator equipment. Statistical analysis was performed to compare categorical variables between t...

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Impact and Predictors of Prolonged Chest Tube Duration in Mechanically Ventilated Patients with Acquired Pneumothorax

Cited by 5 publications

References 25 publications

Using trauma registry data to predict prolonged mechanical ventilation in patients with traumatic brain injury: Machine learning approach

Using trauma registry data to predict prolonged mechanical ventilation in patients with traumatic brain injury: Machine learning approach

Is Bedside Ultrasound Useful for Chest Tube Removal? Description of an Initial Experience

Fisioterapia respiratória com pressão positiva intermitente

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