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Advantages of applying digital chest drainage system for postoperative management of patients following pulmonary resection: a systematic review and meta-analysis of 12 randomized controlled trials. Gan To Kagaku Ryoho 2023; 71:1-11. [PMID: 36175611 DOI: 10.1007/s11748-022-01875-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 09/20/2022] [Indexed: 01/07/2023]
Abstract
OBJECTIVES This meta-analysis aimed to evaluate the value of the chest digital drainage system for the postoperative management of patients who have undergone pulmonary resection. METHODS We searched the PubMed, EMBASE, the Cochrane Library, and Web of Science databases for included randomized controlled trials (RCTs) on the application of digital drainage systems versus the analog drainage system for patients with lung disease after pulmonary resection. Dichotomous variables were evaluated using risk ratios (RRs) and 95% confidence intervals (CIs), and mean and standardized mean differences (MDs and SMDs, respectively) with 95% CIs were used to calculate continuous variables. Statistical analyses were performed using Stata and RevMan software. RESULTS In total, 12 RCTs involving 2000 patients were analyzed. Significant differences in duration of chest tube placement (SMD = -0.49; 95% CI = -0.78 to -0.20), length of hospital stay (MD =-0.79 days; 95% CI = -1.24 to -0.34), and number of chest tube clamping tests (RR = 0.74; 95% CI = 0.36-1.49) were observed between the two groups, which did not significant differ in the occurrence of prolonged air leak or cardiopulmonary complication rate. CONCLUSIONS The digital chest drainage system is mainly advantageous in the duration of chest tube placement, length of hospital stay, and number of chest tube clamping tests. Future research should evaluate the requirements and economic impact of using digital system in routine clinical practice.
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Bronstein ME, Koo DC, Weigel TL. Management of air leaks post-surgical lung resection. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:361. [PMID: 31516907 DOI: 10.21037/atm.2019.04.30] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Airleaks are one of the most common complications associated with elective lung resection. There have been many techniques and modern advancements in thoracic surgery, however airleaks persist. This review article will discuss several interventions ranging from conservative noninvasive to surgical management of the persistent airleak. These techniques include stopping of suction on the plueravac, fibrin patches, pleurodesis, use of endobronchial valves (EBVs), return to OR for operative intervention, and lastly to send patients home with mini pleuravacs.
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Affiliation(s)
| | | | - Tracey L Weigel
- Division of Thoracic Surgery, Westchester Medical Center, Valhalla, NY, USA
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Song KS, Keum D, Kim JB. Chemical Pleurodesis Using Doxycycline and Viscum album Extract. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2017; 50:281-286. [PMID: 28795034 PMCID: PMC5548205 DOI: 10.5090/kjtcs.2017.50.4.281] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 03/29/2017] [Accepted: 04/03/2017] [Indexed: 11/16/2022]
Abstract
Background In chemical pleurodesis for managing pulmonary air leak, tetracycline derivatives are commonly used, and their effectiveness has been established in many studies. Recently, a Viscum album extract was used in chemical pleurodesis. We compared the effects of V. album with those of a tetracycline derivative (doxycycline) to demonstrate the therapeutic effectiveness of the V. album extract in chemical pleurodesis for managing pulmonary air leak. Methods Between October 2010 and October 2016, chemical pleurodesis was performed using doxycycline in 40 patients and the V. album extract in 37 patients. Thirty-three patients were in the postoperative state after pulmonary resection, and 44 patients suffered from spontaneous pneumothorax. Results No statistically significant difference in the success rate was observed between the 2 groups (V. album extract and doxycycline). In both groups, chest pain was the most common complication. More patients in the doxycycline group complained of severe chest pain (42.1% vs. 13.5%, p=0.006). In the V. album extract group, 24.3% of the patients required a chest tube to drain the pleural effusion after cessation of the air leak (doxycycline group: 5%, p=0.022). Further, the amount of pleural effusion drained on the day after the last chemical pleurodesis in the V. album extract group was greater than that in the doxycycline group (162.2±170.2 mL vs. 97.0±77.2 mL, p=0.032). All patients were discharged from the hospital without complications after pleural effusion drainage. Conclusion Considering that treatment using the V. album extract was less painful, V. album might be a feasible option for chemical pleurodesis. However, pleural effusion should be monitored carefully when using V. album extract for treating patients suffering from air leak.
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Affiliation(s)
- Kyung Sub Song
- Department of Thoracic and Cardiovascular Surgery, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine
| | - DongYoon Keum
- Department of Thoracic and Cardiovascular Surgery, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine
| | - Jae Bum Kim
- Department of Thoracic and Cardiovascular Surgery, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine
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Primary and Secondary Spontaneous Pneumothorax: Prevalence, Clinical Features, and In-Hospital Mortality. Can Respir J 2017; 2017:6014967. [PMID: 28386166 PMCID: PMC5366759 DOI: 10.1155/2017/6014967] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Accepted: 02/05/2017] [Indexed: 11/17/2022] Open
Abstract
Background. Optimal treatment practices and factors associated with in-hospital mortality in spontaneous pneumothorax (SP) are not fully understood. We evaluated prevalence, clinical characteristics, and in-hospital mortality among Japanese patients with primary or secondary SP (PSP/SSP). Methods. We retrospectively reviewed and stratified 938 instances of pneumothorax in 751 consecutive patients diagnosed with SP into the PSP and SSP groups. Factors associated with in-hospital mortality in SSP were identified by multiple logistic regression analysis. Results. In the SSP group (n = 327; 34.9%), patient age, requirement for emergency transport, and length of stay were greater (all, p < 0.001), while the prevalence of smoking (p = 0.023) and number of surgical interventions (p < 0.001) were lower compared to those in the PSP group (n = 611; 65.1%). Among the 16 in-hospital deceased patients, 12 (75.0%) received emergency transportation and 10 (62.5%) exhibited performance status (PS) of 3-4. In the SSP group, emergency transportation was an independent factor for in-hospital mortality (odds ratio 16.37; 95% confidence interval, 4.85–55.20; p < 0.001). Conclusions. The prevalence and clinical characteristics of PSP and SSP differ considerably. Patients with SSP receiving emergency transportation should receive careful attention.
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Chang CC, Chen YY, Chang JM, Tseng YL, Lin CY, Chuang MT, Yen YT. Pleural tenting as an effective adjunct in patients with pneumothorax secondary to emphysema evaluated with computed tomography scan. J Thorac Dis 2017; 8:S652-S658. [PMID: 28066665 DOI: 10.21037/jtd.2016.09.37] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND The efficacy of thoracoscopic blebectomy and pleurodesis for secondary spontaneous pneumothorax (SSP) is often attenuated by diffuse emphysematous parenchyma. In this study, we reviewed our surgical results of pleural tenting and its association with preoperative chest computed tomography (CT) in patients with SSP. METHODS From September 2005 to December 2014, there were 96 surgeries on 84 patients with SSP due to pulmonary emphysema. The data was collected on age, sex, smoking status, preoperative chest CT scan image, surgical procedure, blood loss, operative time, duration of tube thoracostomy, and hospital stay. We used Goddard score, a visual scoring system, to evaluate the severity of emphysema. Multivariable regression and logistic regression were performed to identify the factors associated with outcomes. RESULTS The patients were separated according to the Goddard score, where patients with Goddard score ≤2 were in group 1 and those with Goddard score >2 in group 2. Goddard score and pleural tenting both significantly influenced the duration of tube thoracostomy in group 2 (P=0.026 and 0.003) but not in group 1. The Goddard score had significant impact on recurrence (P=0.019, OR =2.525), the risk of secondary procedure (P=0.033, OR =4.754), and complication (P=0.002, OR =2.913). Pleural tenting was found to decrease the risk of secondary procedure (P=0.034, OR =0.059). For complication and mortality rate, age was an important risk factor (P<0.001, OR =1.110 and P=0.028, OR =1.146). CONCLUSIONS In patients with moderate and severe emphysema, pleural tenting significantly reduced the duration of tube thoracostomy and the risk of secondary procedure.
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Affiliation(s)
- Chao-Chun Chang
- Division of Thoracic Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medical College, National Cheng Kung University, Tainan, Taiwan
| | - Ying-Yuan Chen
- Division of Thoracic Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medical College, National Cheng Kung University, Tainan, Taiwan
| | - Jia-Ming Chang
- Division of Thoracic Surgery, Department of Surgery, Chia-Yi Christian Hospital, Chia-Yi, Taiwan
| | - Yau-Lin Tseng
- Division of Thoracic Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medical College, National Cheng Kung University, Tainan, Taiwan
| | - Chia-Ying Lin
- Department of Diagnostic Radiology, National Cheng Kung University Hospital, College of Medical College, National Cheng Kung University, Tainan, Taiwan
| | - Ming-Tsung Chuang
- Department of Diagnostic Radiology, National Cheng Kung University Hospital, College of Medical College, National Cheng Kung University, Tainan, Taiwan
| | - Yi-Ting Yen
- Division of Thoracic Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medical College, National Cheng Kung University, Tainan, Taiwan
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Case Studies. Obstet Med 2007. [PMCID: PMC7124088 DOI: 10.1007/978-1-84628-582-0_5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Ms A was a 28 year old woman in her second pregnancy (she had one previous termination of pregnancy) who booked-in at 19 weeks’ gestation. She was known to have sickle cell disease (specifically sickle cell anaemia [HbSS]), and her last crisis had occurred 3 years before this pregnancy.
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Tsai WK, Chen W, Lee JC, Cheng WE, Chen CH, Hsu WH, Shih CM. Pigtail catheters vs large-bore chest tubes for management of secondary spontaneous pneumothoraces in adults. Am J Emerg Med 2006; 24:795-800. [PMID: 17098099 DOI: 10.1016/j.ajem.2006.04.006] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2006] [Revised: 04/23/2006] [Accepted: 04/25/2006] [Indexed: 10/23/2022] Open
Abstract
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.
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Affiliation(s)
- Wen-Kai Tsai
- Department of Internal Medicine, Division of Chest Medicine, China Medical University Beigang Hospital, Yulin 651, Taiwan
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Abstract
Management of patients with a spontaneous pneumothorax continues to challenge clinicians. Recent guidelines help provide care pathways for these patients and highlight the many areas in need of additional study. Management options for spontaneous pneumothoraces should be selected based primarily upon a patient's clinical status. Observation or pleural air drainage, in selected patients, plays a significant role in patients with primary spontaneous pneumothorax. By contrast, pleural air drainage plays the central role in patients with a secondary spontaneous pneumothorax. Surgically directed recurrence prevention and air leak management are preferred for both primary and secondary spontaneous pneumothorax patients.
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Affiliation(s)
- Michael H Baumann
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS 39216, USA.
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Abstract
Chest pain is one of the most common presenting symptoms in healthcare settings and one of the most difficult diagnostic challenges. A comprehensive history is the cornerstone of evaluation and diagnosis and one of the most important skills in distinguishing among the many causes of chest pain. Because the differential diagnosis for chest pain ranges from conditions as minor as muscle strain to life-threatening conditions, such as an acute myocardial infarction or dissecting thoracic aortic aneurysm, the advanced practice nurse must quickly and systematically assess the patient.
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Affiliation(s)
- Juanita Reigle
- Heart and Vascular Center, University of Virginia Health System, Charlottesville, VA 22908, USA.
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¿Es necesario realizar radiografía de tórax tras la retirada de tubo de drenaje torácico en el neumotórax espontáneo? Rev Clin Esp 2004. [DOI: 10.1016/s0014-2565(04)71479-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Morimoto T, Fukui T, Koyama H, Noguchi Y, Shimbo T. Optimal strategy for the first episode of primary spontaneous pneumothorax in young men. A decision analysis. J Gen Intern Med 2002; 17:193-202. [PMID: 11929505 PMCID: PMC1495024 DOI: 10.1046/j.1525-1497.2002.10636.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Primary spontaneous pneumothorax (PSP) is not uncommon in young men and is associated with frequent recurrence. The frequent recurrence after conservative treatment and resultant anxiety for recurrence are sources of disability. We explored which procedure is more appropriate as the initial therapy in terms of quality-adjusted life expectancy (QALE). DESIGN Decision analysis using a Markov model. DATA SOURCES Structured literature review for clinical probability. Utility derived from patients and medical staff using time trade-off method. SETTING Hypothetical cohort. PATIENTS Twenty-year-old men with a first episode of PSP for which simple aspiration was ineffective. INTERVENTIONS One of the following treatment options: 1) thoracoscopic surgery, 2) pleural drainage followed by thoracoscopic surgery for recurrence, 3) pleural drainage followed by thoracoscopic surgery for the second recurrence, 4) pleurodesis followed by thoracoscopic surgery for recurrence, 5) pleurodesis followed by thoracoscopic surgery for the second recurrence, 6) pleural drainage followed by pleurodesis for the first recurrence and thoracoscopic surgery for the second recurrence. MEASUREMENTS AND MAIN RESULTS During the 1-year period after one of the initial treatments, the QALE was 9.49 months for thoracoscopic surgery, 9.47 for pleurodesis, and 7.80-7.99 for pleural drainage. The QALE for thoracoscopic surgery was the longest among the 6 strategies during the period from 5 to 24 months. None of the variables in sensitivity analyses altered the main results except for thoracoscopic surgical death rate. When it exceeds 0.3%, pleurodesis becomes the preferred strategy. CONCLUSION On the basis of the current best available data and patients' preference, thoracoscopic surgery can be considered the treatment of choice for the first episode of PSP.
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Affiliation(s)
- Takeshi Morimoto
- Department of Clinical Epidemiology, Kyoto University Graduate School of Medicine, Japan
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Manes N, Hernandez-Rodriguez H, Lopez-Martin S, Sanchez-Gascon F. Pneumothorax--guidelines of action. Chest 2002; 121:669. [PMID: 11834696 DOI: 10.1378/chest.121.2.669] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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