Survey of major complications of intercostal chest drain insertion in the UK

Harris, Ann H.; O’Driscoll, B R; Turkington, Peter M

doi:10.1136/pgmj.2009.087759

Cited by 106 publications

(80 citation statements)

References 11 publications

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“…Thoracostomy complications have a relatively high incidence (ϳ25-30% 8,9 ) and may worsen outcomes. [3][4][5][6][7][8][9] Subcutaneous emphysema is usually thought to be only a cosmetic issue. 16,20 Jones et al enrolled 134 subjects, and 17 (12.6%) of them were mechanically ventilated.…”

Section: Discussionmentioning

confidence: 99%

“…1,2 Complications of tube thoracostomy include infection, tube malpositioning, laceration, and hemothorax, all of which may worsen outcome. [3][4][5][6][7][8][9] Several studies have compared the safety and efficacy of different chest tube sizes 3,[10][11][12] and various methods of chest tube removal. 13,14 Chest tube duration would seem to be an important management issue that might impact outcome, but there is a paucity of data on the impact of and risk factors affecting prolonged chest tube duration in patients with pneumothorax.…”

Section: Introductionmentioning

confidence: 99%

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

Kao

Chen

et al. 2013

Respir Care

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BACKGROUND: Prolonged chest tube duration is less well studied in patients who are supported by mechanical ventilation and have acquired pneumothorax. We investigated the impact of prolonged chest tube duration on patient outcomes and the risk factors associated with prolonged chest tube duration. METHODS: This retrospective observational study included 106 ventilated subjects who had been treated with thoracostomy for pneumothorax between May 2004 and December 2011. We analyzed 61 subjects and 63 events. The subjects were divided into a prolonged chest tube duration group (> 18 d) and a non-prolonged group (< 18 d). RESULTS: Subjects with prolonged chest tube duration had significantly higher ICU mortality (P ‫؍‬ .006), longer ICU stay (P ‫؍‬ .001), longer hospitalization (P ‫؍‬ .004), longer mechanical ventilation after development of pneumothorax (P ‫؍‬ .003), higher maximum peak inspiratory pressure (P ‫؍‬ .03), and a higher rate of surgical emphysema (P ‫؍‬ .009). High peak inspiratory pressure and surgical emphysema remained independent predictors of prolonged chest tube duration after multivariate logistic regression analysis. The probability of chest tube removal within 28 days was significantly lower in subjects with both high peak inspiratory pressure and surgical emphysema, compared to subjects without any risk factors (log rank P ‫؍‬ .001). CONCLUSIONS: High peak inspiratory pressure and surgical emphysema are independent predictors of prolonged chest tube duration and negatively impact clinical outcomes in this patient group. These findings may provide information for better chest tube management.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Kao

Chen

et al. 2013

Respir Care

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“…This is driven by the requirement to improve the safety of pleural procedures. 15,16 Our data show that fewer than one-third of responders have achieved level 1 ultrasound competency; indeed only 44.4% of trainees at grade ST6 or above have achieved this level of competency. Furthermore, only one-quarter of trainees reported access to thoracic ultrasound training sessions, with 20.2% and 9.6% of trainees reporting the availability of regular dedicated training sessions in teaching hospitals and DGHs, respectively.…”

Section: Frequency Of Ultrasound Scanning For Other Departments or Spmentioning

confidence: 99%

UK national survey of thoracic ultrasound in respiratory registrars

et al. 2013

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-Thoracic ultrasound training has become part of the respiratory medicine curriculum. Data on training, access to teaching and achievement of competency in thoracic ultrasound by respiratory specialty trainees are scarce. Using the web-based kwiksurveys, we surveyed current respiratory specialty trainees (STs) in the UK. 177 responses were recorded. Nearly three-quarters of trainees had access to bedside ultrasound but only 15.3% had regular ultrasound training. Overall, 28.8% had achieved level 1 competency but only 44.4% of trainees at ST6 and above were level 1 competent. The majority of respiratory trainees have access to thoracic ultrasound but structured training is limited, with only a small proportion of trainees attaining level 1. More structured training and mentoring is needed to enable trainees to achieve the required competencies.

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“…A total of 67 responding trusts reported major complications, including lung or chest wall injury (47 cases), wrong side procedures (6 cases), lost guidewires (3 cases), and drain misplacement (31 cases). Eight deaths were reported as a result of these complications [44].…”

Section: Drain Malpositionmentioning

confidence: 99%

Common iatrogenic pleural complications

Dunscombe

Maskell

2012

Curr Respir Care Rep

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All invasive pleural procedures have the potential to cause harm. Complications from pleural procedures include empyema, intercostal artery laceration, hemothorax, and pneumothorax as well as other organ puncture. Many of these complications will be life threatening and will increase morbidity and hospital length of stay. An understanding of iatrogenic pleural disease helps clinicians to appreciate how these risks can be minimized and complications managed promptly and effectively. This review systematically evaluates the current evidence and guidelines regarding iatrogenic pleural complications and their management. Whilst impossible to eliminate procedural risk entirely, complications will be reduced to a minimum by ensuring adequate medical training, use of pleural ultrasound, and adherence to guidelines and standard operating procedures (SOPs).

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Survey of major complications of intercostal chest drain insertion in the UK

Cited by 106 publications

References 11 publications

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

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

UK national survey of thoracic ultrasound in respiratory registrars

Common iatrogenic pleural complications

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