Chest drains: does size matter?

Role of Interventional Radiology in the Management of Non-aortic Thoracic Trauma

Trauma remains a leading cause of death for all age groups, and nearly two-thirds of these individuals suffer thoracic trauma. Due to the various types of injuries, including vascular and nonvascular, interventional radiology plays a major role in the acute and chronic management of the thoracic trauma patient. Interventional radiologists are critical members in the multidisciplinary team focusing on treatment of the patient with thoracic injury. Through case presentations, this article will review the role of interventional radiology in the management of trauma patients suffering thoracic injuries.

Percutaneous management of complicated parapneumonic effusion and empyema after surgical tube thoracostomy failure in children: a retrospective study

PURPOSE

We aimed to evaluate the results of percutaneous management of complicated parapneumonic effusions (PPE) and empyema after surgical tube thoracostomy failure in children.

METHODS

A total of 84 children treated percutaneously after surgical tube thoracostomy failure between 2004 and 2019 were included to this retrospective study. Technical success was defined as appropriate placement of the drainage catheter. Clinical success was defined as complete resolution of infection both clinically and radiologically. Management protocol included imaging-guided pigtail catheter insertion, fibrinolytic therapy, serial ultrasonographic evaluation, catheter manipulations as necessary (revision, exchange, or upsizing), and appropriate antibiotherapy. All patients were followed up at least 6 months.

RESULTS

Technical success rate was 100%. Unilateral single, unilateral double, and bilateral catheter insertions were performed in 73, 9, and 2 patients, respectively. Inserted catheter sizes ranged from 8 F to 16 F. Streptokinase, urokinase, and tissue plasminogen activator were used as fibrinolytic agent in 29 (34%), 14 (17%), and 41 (49%) patients, respectively. In order to maintain effective drainage, 42 additional procedures (catheter exchange, revision, reposition, or additional catheter placement) were performed in 20 patients (24%). Clinical success was achieved in 83 of 84 patients (99%). Median catheter duration was 8 days (4-32 days). Median hospital stay during percutaneous management was 11.5 days (7-45 days). Factors affecting the median catheter duration were the presence of necrotizing pneumonia (p < 0.001) and bronchopleural fistulae (p < 0.001).

CONCLUSION

Percutaneous imaging-guided catheterization with fibrinolytic therapy should be the method of choice in pediatric complicated PPE and empyema patients with surgical tube thoracostomy failure. Percutaneous treatment is useful in avoiding more aggressive surgical options.

Is Traditional Closed Thoracic Drainage Necessary to Treat Pleural Tears After Posterior Approach Thoracic Spine Surgery?

STUDY DESIGN

A prospective study.

OBJECTIVE

The aim of this study was to evaluate the outcomes and efficacy of using a 10Fr elastic tube with a regular negative pressure ball to treat the operative pleural tear in the complicated single-stage posterior approach thoracic spine surgeries.

SUMMARY OF BACKGROUND DATA

In some complicated single-stage posterior approach thoracic spine surgeries, such as total en bloc spondylectomy, pleural tear is quite inevitable. Traditional chest tube with a water-sealed bottle has many shortcomings, as pain, inconvenience, and other complications. In many thoracic surgeries, a smaller-caliber elastic tube has been used to avoid such complications and achieve quick recovery. However, there are concerns about the efficacy and safety of the smaller-caliber elastic tube.

METHODS

A prospective trial was performed in 72 patients between April 2008 and March 2012. Pleural tear occurred in 19 patients, among whom 10 patients were inserted a 10Fr elastic tube with a regular negative pressure ball (Group I), and nine were inserted a 28Fr chest tube with a water-sealed bottle (Group II). Comparative evaluation of the clinical and radiographic data was carried out.

RESULTS

The basic condition of two groups did not differ significantly. The oxygen saturation monitor, hospital length of stay, average volume, and failure rate of drainage between two groups were not statistically significant. The difference of the visual analog score was significant (1.10 ± 0.35 vs. 3.89 ± 0.59, P < 0.001).

CONCLUSION

Patients who received a 10Fr elastic tube with a regular negative pressure ball experienced less pain and a tendency of quicker recovery than those who received a 28Fr chest tube with a water-sealed bottle. The complication rate in Group I was not higher than Group II, indicating an equally good drainage efficacy.

LEVEL OF EVIDENCE

2.

Thoracic ultrasound for pleural effusion in the intensive care unit: a narrative review from diagnosis to treatment

Pleural effusion (PLEFF), mostly caused by volume overload, congestive heart failure, and pleuropulmonary infection, is a common condition in critical care patients. Thoracic ultrasound (TUS) helps clinicians not only to visualize pleural effusion, but also to distinguish between the different types. Furthermore, TUS is essential during thoracentesis and chest tube drainage as it increases safety and decreases life-threatening complications. It is crucial not only during needle or tube drainage insertion, but also to monitor the volume of the drained PLEFF. Moreover, TUS can help diagnose co-existing lung diseases, often with a higher specificity and sensitivity than chest radiography and without the need for X-ray exposure. We review data regarding the diagnosis and management of pleural effusion, paying particular attention to the impact of ultrasound. Technical data concerning thoracentesis and chest tube drainage are also provided.

Empyema from Obstructing Lung Cancer

Pleural collections on the side of an obstructing bronchial cancer pose a particular challenge. All efforts should be placed into determining whether the collection is malignant or para-malignant with its significant implications on cancer staging. This article discusses various diagnostic modalities and therapeutic interventions needed for the optimal management of patients presenting with this situation. The order of interventions is dictated by the individual circumstances that patients present with, often requiring the pleural interventions to take place ahead of the bronchial obstruction management.

Wall suction-assisted image-guided therapeutic paracentesis: a safe and less expensive alternative to evacuated bottles

OBJECTIVE

To assess the safety and cost savings of using wall suction and plastic canisters instead of evacuated bottles, currently in short supply, to drain, and collect large amounts of fluid during image-guided paracentesis procedures.

MATERIALS AND METHODS

In a hospital-based practice, 551 image-guided paracenteses were performed in 191 consecutive patients over a 10-month period, using wall suction to facilitate drainage. Total volume of fluid removed and complications were recorded. Complications were graded using Common Terminology Criteria for Adverse Events. The pressure generated from the wall suction at our institution was measured using a manometer and compared to that of an empty evacuated bottle. Cost savings per procedure were estimated by calculating the difference in the price of supplies used to collect the average volume of fluid removed per procedure for each method.

RESULTS

The mean volume of fluid removed per procedure was 3541 mL. Four (0.72%) complications occurred in 551 procedures. One grade I complication consisted of a prolonged puncture site leak of ascites. Three Grade III complications included infection, hypotension, and atrial fibrillation. All four complications appeared unrelated to the use of wall suction and were treated successfully. Maximum pressure generated from the wall suction at our institution was less than the initial pressure generated from an empty evacuated bottle. Estimated cost savings per procedure was $33.92.

CONCLUSION

The use of wall suction and plastic canisters to drain and collect fluid during image-guided therapeutic paracenteses is a safe alternative to using evacuated glass bottles and reduces per-procedure costs.

Clinical Pathway for the Treatment of Primary Spontaneous Pneumothorax in a General Surgery Department

Primary spontaneous pneumothorax is a common abnormality for which there is a variety of treatments. This study presents the results of a year's evaluation of a clinical pathway (CP). A series of 34 patients treated during 1 year before CP development was analyzed to identify the weak points. To address these weak points, the CP includes associated protocols. In the CP, 31 patients were evaluated during 1 year; the results were compared with those of the pre-CP series. The mean length of stay of the pre-CP patients and the CP patients was 7.3 days and 5.0 days, respectively. The number of radiographs fell from 4.3 to 3.2. The rate of complications and readmissions is similar in both groups. The mean cost per process dropped from 1863 [UNKNOWN] to 1168 [UNKNOWN]. The CP for pneumothorax successfully manages to reduce both the variability in care patterns and hospital costs, justifying the work involved in its development and implementation.

Percutaneous pigtail catheter in the treatment of pneumothorax in major burns: the best alternative? Case report and review of literature

Multiple factors place burn patients at a high risk of pneumothorax development. Currently, no specific recommendations for the management of pneumothorax in large total body surface area (TBSA) burn patients exist. We present a case of a major burn patient who developed pneumothorax after central line insertion. After the traditional large bore (24 Fr) chest tube failed to resolve the pneumothorax, the pneumothorax was ultimately managed by a percutaneous placed pigtail catheter thoracostomy placement and resulted in its complete resolution. We will review the current recommendations of pneumothorax treatment and will highlight on the use of pigtail catheters in pneumothorax management in burn patients.

Indications and complications of tube thoracostomy with improvised underwater seal bottles

Background:

Tube thoracostomy is a lifesaving and frequently performed procedure in hospitals where the expertise and necessary tools are available. Where the ideal drainage receptacle is unavailable, the underwater seal device can be improvised with bottled water plastic can especially in emergency situations.

Aims and Objectives:

To determine the frequencies of the various indications and complications of tube thoracostomy with improvised underwater seal.

Materials and Methods:

A cross-sectional study with a structured proforma was used for assessment over a 3-year period (May 2010-April 2013). The proforma was filled at the time of the procedure by the performing surgeon and patients were followed up with serial chest X-rays until certified cured. A 1.5 L bottled water container was used as the underwater seal receptacle. The data was analysed with SPSS 15 software program.

Results:

A total of 167 patients were managed. There were 106 (63.5%) males and 61 (36.5%) females. The mean age was 34.85 ± 16.72 with a range of 1-80 years. The most frequent indication was for malignant/paramalignant effusion, 46 (27.5%). Others were trauma, 44 (26.3%), Parapneumonic effusion, 20 (12%), postthoracotomy 14 (8.4%), empyema thoracis 12 (7.2%), heart disease and tuberculous effusion 11 (6.6%) each, pneumothorax 8 (4.8%) and misdiagnosis 1 (0.6%). A hundred and one (60.5%) of the procedures were performed by registrars, 41 (24.6%) by consultants, house officers 15 (9%) and senior registrars 10 (6%). The overall complication rate was 16.8% with the more frequent complications been empyema (5.6%) and pneumothorax (3.6%). The average duration of tube placement was 13.02 ± 12.362 days and range of 1-110 days.

Conclusion:

Tube thoracostomy can be a relatively safe procedure with acceptable complication rates even with improvised underwater seal drainage bottles.

Secondary spontaneous pneumothorax: which associated conditions benefit from pigtail catheter treatment?

OBJECTIVE

The study aimed to assess the clinical efficacy of pigtail catheter drainage for patients with a first episode of secondary spontaneous pneumothorax (SSP) and different associated conditions.

METHODS

We retrospectively reviewed the records of patients with SSP who received pigtail catheter drainage as their initial management between July 2002 and October 2009. A total of 168 patients were included in the analysis; 144 (86%) males and 24 (14%) females with a mean age of 60.3 ± 18.3 years (range, 17-91 years). Data regarding demographic characteristics, pneumothorax size, complications, treatments, length of hospital stay, and associated conditions were analyzed.

RESULTS

In total, 118 (70%) patients were successfully treated with pigtail catheter drainage, and 50 (30%) patients required further management. Chronic obstructive lung disease was the most common underlying disease (57% of cases). Secondary spontaneous pneumothorax associated with infectious diseases had a higher rate of treatment failure than SSP associated with obstructive lung conditions (19/38 [50%] successful vs 78/104 [75%] successful, P = .004) and malignancy (19/38 [50%] successful vs 13/16 [81%] successful, P = .021). Moreover, patients with SSP associated with infectious diseases had a longer length of hospital stay than those with obstructive lung conditions (23.8 vs 14.5 days, P = .003) and malignancy (23.8 vs 12.1 days, P = .017). No complications were associated with pigtail catheter drainage.

CONCLUSIONS

A higher rate of treatment failure was noted in SSP patients with infectious diseases; thus, pigtail catheter drainage is appropriate as an initial management for patients with SSPs associated with obstructive lung conditions and malignancy.

The relationship between chest tube size and clinical outcome in pleural infection

BACKGROUND

The optimal choice of chest tube size for the treatment of pleural infection is unknown, with only small cohort studies reported describing the efficacy and adverse events of different tube sizes.

METHODS

A total of 405 patients with pleural infection were prospectively enrolled into a multicenter study investigating the utility of fibrinolytic therapy. The combined frequency of death and surgery, and secondary outcomes (hospital stay, change in chest radiograph, and lung function at 3 months) were compared in patients receiving chest tubes of differing size (chi(2), t test, and logistic regression analyses as appropriate). Pain was studied in detail in 128 patients.

RESULTS

There was no significant difference in the frequency with which patients either died or required thoracic surgery in patients receiving chest tubes of varying sizes ( < 10F, number dying or needing surgery 21/58 [36%]; size 10-14F, 75/208 [36%]; size 15-20F, 28/70 [40%]; size > 20F, 30/69 [44%]; chi(2)trend, 1 degrees of freedom [df] = 1.21, P = .27), nor any difference in any secondary outcome. Pain scores were substantially higher in patients receiving (mainly blunt dissection inserted) larger tubes ( < 10F, median pain score 6 [range 4-7]; 10-14F, 5 [4-6]; 15-20F, 6 [5-7]; > 20F, 6 [6-8]; chi(2), 3 df = 10.80, P = .013, Kruskal-Wallis; chi(2)trend, 1 df = 6.3, P = .014).

CONCLUSIONS

Smaller, guide-wire-inserted chest tubes cause substantially less pain than blunt-dissection-inserted larger tubes, without any impairment in clinical outcome in the treatment of pleural infection. These results suggest that smaller size tubes may be the initial treatment of choice for pleural infection, and randomized studies are now required.

TRIAL REGISTRATION

MIST1 trial ISRCTN number: 39138989.

A influência do uso do "clamp" ou braçadeira no acúmulo de coágulos em drenos pleurais tubulares

OBJETIVO: Conduziu-se este estudo prospectivo a fim de avaliar-se a influência do uso da braçadeira sobre o acúmulo de coágulos dentro dos drenos pleurais. MÉTODO: Os drenos pleurais foram pesados logo após sua retirada, lavados e secados e pesados novamente. A diferença entre a primeira e a segunda pesagem foi admitida como a quantidade de coágulos acumulada. RESULTADOS: Houve maior acúmulo de coágulo nos drenos temporariamente obstruídos por braçadeira em relação àqueles não obstruídos. CONCLUSÃO: Notou-se, neste estudo, maior acúmulo de coágulo dentro de drenos pleurais obstruídos, mesmo que intermitentemente, o que pode levar ao mau funcionamento de todo o sistema de drenagem. A discussão sobre o correto uso dos drenos pleurais deve ser constante e fazer parte de programas de educação continuada para médicos e enfermagem, a fim de que este sistema, amplamente utilizado e altamente eficiente, seja otimizado.

Review of management of primary spontaneous pneumothorax: is the best evidence clearer 15 years on?

In 1993 Emergency Medicine Australasia (then Emergency Medicine [Fremantle]) published a therapeutic review on the management of spontaneous pneumothorax. That review found a lack of high-quality evidence on which to base management decisions and a variety of therapeutic options without clear superiority one over another. Now, almost 15 years later, the present paper aims to revisit the evidence base to see if management choices are clearer.

Efficacy and complications of small-bore, wire-guided chest drains

BACKGROUND

Small-bore Seldinger-type chest drains have become increasingly popular in recent years, but there are few data on their effectiveness.

METHODS

Data were collected prospectively at the time of drain insertion and continued until drain removal. Patients completed a visual analog score (VAS) of pain on drain insertion.

RESULTS

Fifty-two drains were inserted in 44 patients over 10 months. Drain sizes ranged from 12 to 20F. The mean (+/- SEM) patient age was 64 +/- 2 years, and mean duration of drainage was 4.5 +/- 0.5 days. Fourteen drains (27%) were inserted for pneumothoraces, 19 drains (37%) for malignant effusions, 10 drains (19%) for empyema, 5 drains (10%) for parapneumonic effusions, and 4 drains (8%) for other effusions. Pain VAS ranged from 3 to 66 mm (maximum, 100 mm; average [+/- SD], 23 +/- 16 mm). Although the overall drain failure rate was 37%, there was only one serious complication (empyema), and this compares well with historical control subjects. Success rate was highest when used to treat malignant effusions (83%) and pneumothoraces (64%); drains inserted for empyema were more likely to block (overall success rate, 20%). There was no correlation between the type of fluid or size of drain and likelihood of blockage.

CONCLUSIONS

Seldinger-type drains are a well-tolerated and effective method of draining pneumothoraces and uncomplicated effusions. They are more likely to block when draining empyemas but have a comparable failure rate in pneumothorax to large-bore drains.

Pigtail catheters vs large-bore chest tubes for management of secondary spontaneous pneumothoraces in adults

It is still uncertain if large-bore chest tubes (20F-28F) is superior to pigtail catheter (10F-14F) in terms of the management of secondary spontaneous pneumothoraces (SSP). This study was designed to compare the efficacy and safety associated with placement of large-bore chest tubes vs pigtail catheters in adults experiencing the first episode of SSP. We conducted a retrospective chart review of 91 patients experiencing the first episode of SSP in a university hospital over a 3.5-year period who received treatment by either a large-bore chest tube or a pigtail catheter. Any patient who was younger than 18 years or experiencing mechanical ventilation-related barotraumas or pyopneumothorax was excluded from this study. Various parameters including demographical characteristics, size of pneumothorax, complications, time of pigtail or chest tube extubation, and length of hospital stay were collected and analyzed. Among the enrolled 91 patients, including 76 (83.5%) men with a mean age of 60 +/- 19 years, 69 were initially treated with a pigtail, and 22 patients received conventional chest tubes. Fifty patients (72.5%) undergoing the pigtail drainage and 16 (72.7%) undergoing large-bore chest tube treatment of SSP were successfully treated (P = .88). In addition, there was no significant difference in terms of length of hospital stay, extubation time, recurrence rate, and complication. Pigtail catheters offer a safe and effective alternative for large-bore chest tubes to adult patients experiencing the first episode of SSP, and we strongly suggested that pigtail tube drainage should be considered as the initial treatment of choice.

Prevalence and clinical significance of pleural microbubbles in computed tomography of thoracic empyema

AIM

To determine the prevalence and clinical significance of pleural microbubbles in thoracic empyema.

MATERIALS AND METHODS

The charts of 71 consecutive patients with empyema were retrospectively reviewed for relevant demographic, laboratory, microbiological, therapeutic and outcome data. Computed tomography (CT) images were reviewed for various signs of empyema as well as pleural microbubbles. Two patient groups, with and without microbubbles were compared.

RESULTS

Mean patient age was 49 years and 72% were males. Microbubbles were detected in 58% of patients. There were no significant differences between patients with and without microbubbles in regard to pleural fluid chemistry. A causative organism was identified in about 75% of cases in both. There was no difference in the rates of pleural thickening and enhancement, increased extra-pleural fat attenuation, air-fluid levels or loculations. Microbubbles were diagnosed after a mean of 7.8 days from admission. Thoracentesis before CT was performed in 90 and 57% of patients with and without microbubbles (p=0.0015), respectively. Patients with microbubbles were more likely to require repeated drainage (65.9 versus 36.7%, p=0.015) and surgical decortication (31.7 versus 6.7%, p=0.011). Mortalities were 9.8 and 6.6% respectively (p=0.53).

CONCLUSION

Pleural microbubbles are commonly encountered in CT imaging of empyema but have not been systematically studied to date. Microbubbles may be associated with adverse outcome such as repeated drainage or surgical decortication. The sensitivity and specificity of this finding and its prognostic implications need further assessment.

Imaging of Pleural Disease

Imaging plays an important role in the diagnosis and subsequent management of patients with pleural disease. The presence of a pleural abnormality is usually suggested following a routine chest x-ray, with a number of imaging modalities available for further characterization. This article describes the radiographic and cross-sectional appearances of pleural diseases, which are commonly encountered in every day practice. The conditions covered include benign and malignant pleural thickening, pleural effusions, empyema and pneumothoraces. The relative merits of CT, MRI and PET in the assessment of these conditions and the role of image-guided intervention are discussed.

Optimal design of small-diameter silicone chest drain devices

To overcome the complications due to the use of noncompliant large diameter conventional chest drain devices, a flexible small diameter chest drain device was designed and simulated based on computational fluid dynamics (CFD) techniques. It was clearly shown that the pressure drop and velocity increase of the most distal drainage holes, which are located near the suction end, are dominant over other drainage holes. A conventional chest drain device with circular side holes showed higher mass flow rate due to larger cross sectional area. It also showed less dependency on the side hole placement compared to open channel, closed cavity chest drain with rectangular side holes. When all holes are opened the conventional chest drain showed 6% increase in flow rate while the open channel, closed cavity drain device showed 47% increase in flow rate reflecting a better design performance. These results provide an insight into the CFD-based optimal design of chest drain devices for potential applications in clinical intraoperative procedures.

[Clinical pathway for the treatment of primary spontaneous pneumothorax in a general surgery department]

INTRODUCTION

Primary spontaneous pneumothorax (PSP) is a common entity. Treatment varies widely across different health systems and even among doctors in the same department. In our general surgery department 30 to 40 patients with PSP are treated each year and there is significant variability in care delivery. This prompted the development of a clinical pathway (CP) based on analysis of the process, a search for studies with the greatest scientific evidence and professional consensus. The aim of this study was to present the results after 1 year's evaluation of the CP.

PATIENTS AND METHOD

A series of 34 patients treated in the year prior to the design of the pathway was analyzed to identify weak points and areas for improvement. To address these weak points the CP included associated protocols and principal documents. Thirty-one patients included in the CP were treated over 1 year and the results were compared with those of the pre-pathway series.

RESULTS

The mean length of stay in the pre-pathway patients was 7.3 days compared with 5.0 days in the pathway patients. The number of radiographs also fell from 4.3 to 3.2. The rate of complications and re-admissions was similar in both groups. The mean cost per process decreased from 1863 Euro to 1168 Euro.

CONCLUSION

The CP for pneumothorax reduced both variability in professional care patterns and hospital costs, justifying the work involved in its development and implementation.

Percutaneous management of parapneumonic effusions

Parapneumonic effusions continue to be a significant source of morbidity and mortality. Treatment at earlier stages before fibrous peel and loculations occur has a much better prognosis. Using image guidance, addition of intracavitary fibrinolytic instillation, close follow-up with drainage of residual or new collections are some of the other factors that improve prognosis. In this article, we discussed treatment strategies, percutaneous management of parapneumonic effusions, its alternatives and results.

Radiology in pleural disease: State of the art

Diseases of the pleura and pleural space are common and present a significant contribution to the workload of the chest radiologist. The radiology department plays a crucial role in the imaging and management of pleural disease. This review aims to describe and illustrate the appearances of common pleural pathologies on various radiological modalities including plain film, ultrasound, CT, magnetic resonance imaging and positron emission tomography. The review will also address the state-of-the-art techniques used to image pleural disease and discuss image-guided intervention in the management of pleural disease.

Spontaneous Pneumothorax Outcome Study (SPOT phase I): a 2-year review

OBJECTIVE

We aim to describe the incidence of spontaneous pneumothorax presenting to the Emergency Department, the treatment given and the outcomes of treatment.

METHODS

We conducted a retrospective review of patients with spontaneous pneumothorax presenting to the Emergency Department of the Singapore General Hospital from 1 January 2000 to 31 December 2001.

RESULTS

Of a total of 159 patients, with a mean age of 36.1 years (standard deviation 19.3), 94.3% were men, 75 (47.2%) were treated in the Emergency Department with chest-tube insertion, 28 (17.6%) were treated with needle aspiration, and 56 (35.2%) were observed. Significantly more patients had complete re-expansion with chest-tube (65.3%) compared with needle aspiration (17.9%) (P<0.001). Patients with needle aspiration or those being observed were more likely to have a second procedure (P<0.001), whereas patients with chest tubes were more likely to have definitive treatment subsequently (pleurodesis, thoracotomy). The mean duration of hospitalization was significantly longer for chest-tube insertion (7.4 days) compared with other groups (needle aspiration 4 days). There was no significant difference in the complication rates between treatment groups at one year.

CONCLUSION

We found a male predominance locally. Treatment with chest-tube insertion is still the most popular method in the Emergency Department. Needle aspiration results in a shorter hospitalization, but a high proportion require a second procedure. Complication rates do not seem to differ from chest-tube insertion.

High vacuum drainage of the chest using a miniature double lumen chest tube

The purpose of this study was to test the safety and efficacy of a high vacuum pressure drainage system with a 7F double lumen chest tube. Methods included animal experiments, where seven rabbits were subjected to bilateral tube thoracostomies, using a 7F double lumen chest tube at 340 torr on one side and more than 500 torr on the other for 30 minutes. Then, a preliminary clinical study was done. Three patients were treated with a 7F double lumen chest tube and a vacuum box at 340 torr after a thoracoscopic sympathectomy for approximately 60 minutes. An additional 460 patients were treated with a conventional system, using a 20F single lumen chest tube and chest drainage system at 14.7 torr following the same operation. All animals tolerated the test well. Suction injury of the lung was noted on the control side. In the clinical study, the air leaks stopped within 15 minutes, and no patients showed a radiologic sign of lung suction injury. Six patients in the control group developed subcutaneous emphysema. In conclusion, high vacuum pressure drainage of the chest using the 7F double lumen chest tube is safe and effective.

Transthoracic US of the chest: clinical uses and applications

Transthoracic ultrasound (US) of the chest is useful in the evaluation of a wide range of peripheral parenchymal, pleural, and chest wall diseases. Furthermore, it is increasingly used to guide interventional procedures of the chest and pleural space. The technique lends itself to bedside use in the intensive care unit, where suboptimal radiography may mask or mimic clinically significant abnormalities. The authors discuss the uses, techniques and applications of US of the chest. The sonographic appearances of pleural diseases (pleural effusion, pneumothorax, pleural mass, and mesothelioma), parenchymal diseases (pneumonia, neoplasms, heart failure, infarct, and rounded atelectasis), chest wall abnormalities (chest wall tumor and rib fracture), and diaphragmatic paralysis are discussed. The use of US in guiding biopsy, thoracocentesis, and other interventional procedures of the lung, pleural space, and mediastinum are also reviewed.