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Lobdell KW, Engelman DT. Chest Tube Management: Past, Present, and Future Directions for Developing Evidence-Based Best Practices. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2023; 18:41-48. [PMID: 36803288 DOI: 10.1177/15569845231153623] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
In the field of modern cardiothoracic surgery, chest drainage has become ubiquitous and yet characterized by a wide variation in practice. Meanwhile, the evolution of chest drain technology has created gaps in knowledge that represent opportunities for new research to support the development of best practices in chest drain management. The chest drain is an indispensable tool in the recovery of the cardiac surgery patient. However, decisions about chest drain management-including those about type, material, number, maintenance of patency, and the timing of removal-are largely driven by tradition due to a scarcity of quality evidence. This narrative review surveys the available evidence regarding chest-drain management practices with the objective of highlighting scientific gaps, unmet needs, and opportunities for further research.
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Affiliation(s)
- Kevin W Lobdell
- Sanger Heart & Vascular Institute, Atrium Health, Charlotte, NC, USA
| | - Daniel T Engelman
- Heart & Vascular Program, Baystate Health, University of Massachusetts Medical School - Baystate, Springfield, MA, USA
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Schiefenhövel F, Poncette AS, Boyle EM, von Heymann C, Menk M, Vorderwülbecke G, Grubitzsch H, Treskatsch S, Balzer F. Pleural effusions are associated with adverse outcomes after cardiac surgery: a propensity-matched analysis. J Cardiothorac Surg 2022; 17:298. [PMID: 36476289 PMCID: PMC9727876 DOI: 10.1186/s13019-022-02050-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 11/27/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Pleural effusions commonly occur in patients recovering from cardiac surgery; however, the impact on outcomes is not well characterized. The purpose of this study is to characterize the clinical outcomes of cardiac surgery patients with pleural effusion. METHODS All patients undergoing cardiac surgery between 2006 and 2019 at a tertiary care university hospital were included in this observational, cross-sectional analysis using propensity matching. RESULTS Of 11,037 patients that underwent cardiac surgery during the study period, 6461 (58.5%) had no pleural effusion (Group 0), 3322 (30.1%) had pleural effusion only (Group 1), and 1254 (11.4%) required at least one secondary drainage procedure after the index operation (Group 2). After propensity matching, the mortality of patients who underwent secondary drainage procedures was 6.1% higher than in Group 1 (p < 0.001). Intensive care unit (ICU) stay was longer for those with pleural effusions (18 [IQR 9-32] days in Group 2, 10 [IQR 6-17] days for Group 1, and 7 [IQR 4-11] days for Group 0, p < 0.001). Patients with pleural effusions had a higher incidence of hemodialysis (246 [20.0%] in Group 2, 137 [11.1%] in Group 1, 98 [7.98%] in Group 0), and a longer ventilation time in the ICU (57 [IQR 21.0-224.0] hours in Group 2, 25.0 [IQR 14.0-58.0] hours in Group 1, 16.0 [IQR 10.0-29.0] hours in Group 0). CONCLUSION Pleural effusions, especially those that require a secondary drainage procedure during recovery, are associated with significantly worse outcomes including increased mortality, longer length of stay, and higher complication rates. These insights may be of great interest to scientists, clinicians, and industry leaders alike to foster research into innovative methods for preventing and treating pleural effusions with the aim of improving outcomes for patients recovering from cardiac surgery.
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Affiliation(s)
- Fridtjof Schiefenhövel
- grid.6363.00000 0001 2218 4662Charité – Universitätsmedizin Berlin, corporate Member of Freie Universität and Humboldt-Universität zu Berlin, Institute of Medical Informatics, Charitéplatz 1, 10117 Berlin, Germany ,grid.15474.330000 0004 0477 2438Klinikum rechts der Isar, Technical University of Munich, School of Medicine, Department of Anaesthesiology and Intensive Care, Munich, Germany ,grid.15474.330000 0004 0477 2438Klinikum rechts der Isar, Technical University of Munich, School of Medicine, Institute of Artificial Intelligence and Informatics in Medicine, Munich, Germany
| | - Akira-Sebastian Poncette
- grid.6363.00000 0001 2218 4662Charité – Universitätsmedizin Berlin, corporate Member of Freie Universität and Humboldt-Universität zu Berlin, Department of Anesthesiology and Intensive Care Medicine, Charitéplatz 1, 10117 Berlin, Germany ,grid.6363.00000 0001 2218 4662Charité – Universitätsmedizin Berlin, corporate Member of Freie Universität and Humboldt-Universität zu Berlin, Institute of Medical Informatics, Charitéplatz 1, 10117 Berlin, Germany
| | - Edward M. Boyle
- grid.416611.5Department of Cardiothoracic Surgery, St. Charles Medical Center, Bend, OR USA
| | - Christian von Heymann
- grid.415085.dDepartment of Anesthesia, Intensive Care Medicine, Emergency Medicine and Pain Therapy, Vivantes Klinikum im Friedrichshain, Berlin, Germany
| | - Mario Menk
- grid.6363.00000 0001 2218 4662Charité – Universitätsmedizin Berlin, corporate Member of Freie Universität and Humboldt-Universität zu Berlin, Department of Anesthesiology and Intensive Care Medicine, Charitéplatz 1, 10117 Berlin, Germany ,grid.6363.00000 0001 2218 4662Charité – Universitätsmedizin Berlin, corporate Member of Freie Universität and Humboldt-Universität zu Berlin, Institute of Medical Informatics, Charitéplatz 1, 10117 Berlin, Germany
| | - Gerald Vorderwülbecke
- grid.6363.00000 0001 2218 4662Charité – Universitätsmedizin Berlin, corporate Member of Freie Universität and Humboldt-Universität zu Berlin, Department of Anesthesiology and Intensive Care Medicine, Charitéplatz 1, 10117 Berlin, Germany
| | - Herko Grubitzsch
- grid.6363.00000 0001 2218 4662Charité – Universitätsmedizin Berlin, corporate Member of Freie Universität and Humboldt-Universität zu Berlin, Department of Cardiovascular Surgery, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Sascha Treskatsch
- grid.6363.00000 0001 2218 4662Charité – Universitätsmedizin Berlin, corporate Member of Freie Universität and Humboldt-Universität zu Berlin, Department of Anesthesiology and Intensive Care Medicine, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Felix Balzer
- grid.6363.00000 0001 2218 4662Charité – Universitätsmedizin Berlin, corporate Member of Freie Universität and Humboldt-Universität zu Berlin, Institute of Medical Informatics, Charitéplatz 1, 10117 Berlin, Germany
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Mason IT, Rose HJ, Williamson SF, Jowsey AT, Gorman SJ, Chittock HD, Wong CC, Dheda AJ, Turner SB, Park YE, Kollmetz T, Sonis JM, Kamm JL, May BC. Evaluation of Tissue Apposition and Seroma Prevention in an Ovine Model of Surgical Dead Space Using a Novel Air-Purged Vacuum Closure System. EPLASTY 2022; 22:e46. [PMID: 36408121 PMCID: PMC9643872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
BACKGROUND Postoperative complications associated with seroma formation resulting from surgical dead space continue to present a challenge in modern surgery. There is an unmet need for new technologies that address surgical dead space as well as prevent seroma formation and associated downstream postoperative complications. METHODS The novel implantable tissue apposition and drainage system ENIVO was developed and tested in a bilateral ovine external abdominal oblique (EAO) resection model of surgical dead space. The ENIVO system is a portable powered pump and wound interface featuring air-purged vacuum closure (APVC) that delivers a sustained level of vacuum pressure (80 and 100 mmHg) to the treatment site with an intermittent burst of sterile filtered air through the implanted wound interface. Seroma area, seroma volume, and drain migration were assessed at postoperative days 7 and 14, and all animals were euthanized at day 28 with gross assessment of treatment efficacy including the presence of residual seroma and tissue apposition. RESULTS The bilateral model created relatively uniform defects of ~120 cm2 following excision of ~30 to 50 g of EAO muscle. Median seroma area of ENIVO-treated defects was statistically smaller than standard of care (SoC)-treated defects at days 7 and 14. Median seroma volume at 14 days was significantly reduced in ENIVO-treated defects relative to SoC-treated defects [1.3 (IQR 0.0-79.5) mL and 188.5 (IQR 27.6-342.9) mL, respectively]. At postoperative day 28, 40% (n = 4/10) of SoC defects showed a residual seroma, whereas in contrast, none of the ENIVO-treated defects showed signs of a residual seroma. Median tissue apposition scoring was higher in the ENIVO treatment group [3 (IQR 3-3)] compared with the SoC group [3 (IQR 0-3)]. CONCLUSIONS The ENIVO system represents a new approach to dead space management and seroma prevention and was shown to outperform a SoC surgical drain in a challenging large defect model of surgical dead space management and seroma prevention.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - J Lacy Kamm
- Vet Associates Equine, Auckland, New Zealand
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Obafemi OO, Wang H, Bajaj SS, O'Donnell CT, Elde S, Boyd JH. An automated line-clearing chest tube system after cardiac surgery. JTCVS OPEN 2022; 10:246-253. [PMID: 36004272 PMCID: PMC9390781 DOI: 10.1016/j.xjon.2022.02.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 02/17/2022] [Indexed: 11/22/2022]
Abstract
Objective To complete the first in-human study of the automated line clearance Thoraguard chest tube system. The study focuses on the viability and efficacy of the device in comparison with conventional models as well as secondary matters such as patient experience and ease of use. Methods This was a single-center, prospective, open-label study involving adult patients (n = 27) who underwent nonemergent, first-time, cardiac surgery. Patients received automated clearance chest tubes for surgical drainage in both the mediastinal and pleural spaces. The control group was retrospective (n = 80); individuals received conventional chest tubes placed and secured in locations determined at the surgeon's discretion. Results The automated-clearance tubes exhibited a similar drainage profile at 1, 3, 6, 12, and 24 hours compared with the conventional chest tubes. The final output at the time of tube removal was also similar (1150 [750-1590] vs 1289 [766.3-1890] mL, respectively, P = .76). The number of patients readmitted for drainage of an effusion was similar in both groups (1/27 [3.7%] vs 3/80 [3.75%], P > .99). Conclusions This study has shown that the Centese Thoraguard chest tube system is a viable option for surgical chest drainage and effective when used in routine cardiac surgery operations.
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Affiliation(s)
| | - Hanjay Wang
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford University, Stanford, Calif
| | - Simar S. Bajaj
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford University, Stanford, Calif
| | - Christian T. O'Donnell
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford University, Stanford, Calif
| | - Stefan Elde
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford University, Stanford, Calif
| | - Jack H. Boyd
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford University, Stanford, Calif
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5
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A Method for Monitoring the Working States of Drainage Tubes Based on the Principle of Capacitance Sensing. SENSORS 2020; 20:s20072087. [PMID: 32276312 PMCID: PMC7180847 DOI: 10.3390/s20072087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 04/02/2020] [Accepted: 04/03/2020] [Indexed: 12/17/2022]
Abstract
The real-time monitoring of the working status of drainage tubes is crucial for successful surgical drainage and for informing clinicians of the drainage conditions of patients at different stages, to enable objective diagnosis and treatment. In this study, a method for monitoring the drainage condition of drainage tubes was proposed. The method was based on the principle of capacitance and was developed by analyzing the major states of drainage tubes in the process of drainage. Meanwhile, the principle of interdigital capacitance monitoring drainage was analyzed, and an interdigital capacitance device for the real-time monitoring of the working status of drainage tubes was designed. Ultimately, an experimental system for drainage simulation was established on the basis of the interdigital capacitance device and method for drainage monitoring. Results showed that the interdigital capacitance device for drainage monitoring can identify unobstructed or blocked drainage tubes effectively in real time. The device has a hydrophobic surface, so its electrodes do not undergo electrolysis and pollution due to adhesion. Hence the proposed capacitance-based method for monitoring the working states of drainage tubes has good application prospects in the postoperative drainage of abdominal and thoracic cavities.
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Baribeau Y, Westbrook B, Baribeau Y, Maltais S, Boyle EM, Perrault LP. Active clearance of chest tubes is associated with reduced postoperative complications and costs after cardiac surgery: a propensity matched analysis. J Cardiothorac Surg 2019; 14:192. [PMID: 31703606 PMCID: PMC6842236 DOI: 10.1186/s13019-019-0999-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 09/20/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Chest tubes are routinely used to evacuate shed mediastinal blood in the critical care setting in the early hours after heart surgery. Inadequate evacuation of shed mediastinal blood due to chest tube clogging may result in retained blood around the heart and lungs after cardiac surgery. The objective of this study was to compare if active chest tube clearance reduces the incidence of retained blood complications and associated hospital resource utilization after cardiac surgery. METHODS Propensity matched analysis of 697 consecutive patients who underwent cardiac surgery at a single center. 302 patients served as a baseline control (Phase 0), 58 patients in a training and compliance verification period (Phase 1) and 337 were treated prospectively using active tube clearance (Phase 2). The need to drain retained blood, pleural effusions, postoperative atrial fibrillation, ICU resource utilization and hospital costs were assessed. RESULTS Propensity matched patients in Phase 2 had a reduced need for drainage procedures for pleural effusions (22% vs. 8.1%, p < 0.001) and reduced postoperative atrial fibrillation (37 to 25%, P = 0.011). This corresponded with fewer hours in the ICU (43.5 [24-79] vs 30 [24-49], p = < 0.001), reduced median postoperative length of stay (6 [4-8] vs 5 [4-6.25], p < 0.001) median costs reduced by $1831.45 (- 3580.52;82.38, p = 0.04) and the mean costs reduced by an average of $2696 (- 6027.59;880.93, 0.116). CONCLUSIONS This evidence supports the concept that efforts to actively maintain chest tube patency in early recovery is useful in improving outcomes and reducing resource utilization and costs after cardiac surgery. TRIAL REGISTRATION Clinicaltrial.gov, NCT02145858, Registered: May 23, 2014.
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Affiliation(s)
- Yvon Baribeau
- Department of Cardiac Surgery, New England Heart and Vascular Institute, Catholic Medical Center, 100 McGregor St, Manchester, NH, 03102, USA.
| | - Benjamin Westbrook
- Department of Cardiac Surgery, New England Heart and Vascular Institute, Catholic Medical Center, 100 McGregor St, Manchester, NH, 03102, USA
| | - Yanick Baribeau
- Department of Anesthesia and Critical Care, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Simon Maltais
- Department of Cardiothoracic Surgery, Centre Hospitalier Universitaire de Montréal, Montreal, Canada
| | - Edward M Boyle
- Department of Thoracic Surgery, St. Charles Medical Center, Bend, OR, USA
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St-Onge S, Perrault LP, Demers P, Boyle EM, Gillinov AM, Cox J, Melby S. Pericardial Blood as a Trigger for Postoperative Atrial Fibrillation After Cardiac Surgery. Ann Thorac Surg 2018; 105:321-328. [DOI: 10.1016/j.athoracsur.2017.07.045] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 07/17/2017] [Accepted: 07/17/2017] [Indexed: 02/07/2023]
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Active Clearance of Chest Tubes Reduces Re-Exploration for Bleeding After Ventricular Assist Device Implantation. ASAIO J 2017; 62:704-709. [PMID: 27556153 PMCID: PMC5098460 DOI: 10.1097/mat.0000000000000437] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Chest tubes are utilized to evacuate shed blood after left ventricular assist device (LVAD) implantation, however, they can become clogged, leading to retained blood. We implemented a protocol for active tube clearance (ATC) of chest tubes to determine if this might reduce interventions for retained blood. A total of 252 patients underwent LVAD implantation. Seventy-seven patients had conventional chest tube drainage (group 1), whereas 175 patients had ATC (group 2). A univariate and multivariate analysis adjusting for the use of conventional sternotomy (CS) and minimally invasive left thoracotomy (MILT) was performed. Univariate analysis revealed a 65% reduction in re-exploration (43-15%, p < 0.001), and an 82% reduction in delayed sternal closure (DSC; 34-6%, p <0.001). In a sub-analysis of CS only, there continued to be statistically significant 53% reduction in re-exploration (45% vs. 21%, p = 0.0011), and a 77% reduction in DSC (35% vs. 8%, p < 0.001) in group 2. Using a logistic regression model adjusting for CS versus MILT, there was a significant reduction in re-exploration (odds ratio [OR] = 0.44 [confidence interval {CI} = 0.23-0.85], p = 0.014) and DSC (OR = 0.20 [CI = 0.08-0.46], p <0.001) in group 2. Actively maintaining chest tube patency after LVAD implantation significantly reduces re-exploration and DSC.
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Examining the impact of active clearance of chest drainage catheters on postoperative atrial fibrillation. J Thorac Cardiovasc Surg 2017; 154:501-508. [DOI: 10.1016/j.jtcvs.2017.03.046] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 03/01/2017] [Accepted: 03/14/2017] [Indexed: 12/25/2022]
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Vistarini N, Gabrysz-Forget F, Beaulieu Y, Perrault LP. Tamponade Relief by Active Clearance of Chest Tubes. Ann Thorac Surg 2016; 101:1159-63. [PMID: 26897195 DOI: 10.1016/j.athoracsur.2015.10.098] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 10/23/2015] [Accepted: 10/27/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE Chest tubes are used in every case of cardiac surgery to evacuate shed blood from around the heart and lungs. Chest tubes can become partially or totally occluded, leading to tamponade. The purpose of this article is to discuss a novel method of maintaining chest tube patency in the early recovery after cardiothoracic surgery. DESCRIPTION The PleuraFlow Active Clearance Technology is a system to prevent chest tube clogging that can be used to help routinely maintain chest tube patency at the bedside in the intensive care unit. EVALUATION A patient exhibited physiologic tamponade that was confirmed by transthoracic echocardiography. The chest tube was successfully reopened by actively clearing the chest tube using Active Clearance Technology, resulting in resolution of the tamponade. CONCLUSIONS The present study reports the case of a patient with massive postoperative pericardial effusion with tamponade, successfully managed by active clearance chest tube. Further studies will help define the role for this technology in routine cardiac surgery.
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Affiliation(s)
- Nicola Vistarini
- Department of Cardiac Surgery, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Fanny Gabrysz-Forget
- Department of Cardiac Surgery, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Yanick Beaulieu
- Department of Cardiac Surgery, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Louis P Perrault
- Department of Cardiac Surgery, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada.
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Active clearance of chest drainage catheters reduces retained blood. J Thorac Cardiovasc Surg 2016; 151:832-838.e2. [DOI: 10.1016/j.jtcvs.2015.10.015] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Revised: 10/01/2015] [Accepted: 10/10/2015] [Indexed: 11/23/2022]
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Retained Blood Syndrome after Cardiac Surgery: A New Look at an Old Problem. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2015; 10:296-303. [DOI: 10.1097/imi.0000000000000200] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Retained blood occurs when drainage systems fail to adequately evacuate blood during recovery from cardiothoracic surgery. As a result, a spectrum of mechanical and inflammatory complications can ensue in the acute, subacute, and chronic setting. The objectives of this review were to define the clinical syndrome associated with retained blood over the spectrum of recovery and to review existing literature regarding how this may lead to complications and contributes to poor outcomes. To better understand and prevent this constellation of clinical complications, a literature review was conducted, which led us to create a new label that better defines the clinical entity we have titled retained blood syndrome. Analysis of published reports revealed that 13.8% to 22.7% of cardiac surgical patients develop one or more components of retained blood syndrome. This can present in the acute, subacute, or chronic setting, with different pathophysiologic mechanisms active at different times. The development of retained blood syndrome has been linked to other clinical outcomes, including the development of postoperative atrial fibrillation and infection and the need for hospital readmission. Grouping multiple objectively measurable and potentially preventable postoperative complications that share a common etiology of retained blood over the continuum of recovery demonstrates a high prevalence of retained blood syndrome. This suggests the need to develop, implement, and test clinical strategies to enhance surgical drainage and reduce postoperative complications in patients undergoing cardiothoracic surgery.
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A New Use of Fogarty Catheter: Chest Tube Clearance. Heart Lung Circ 2014; 23:e229-30. [DOI: 10.1016/j.hlc.2014.04.255] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Revised: 03/04/2014] [Accepted: 04/16/2014] [Indexed: 11/19/2022]
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Tavlasoglu M, Kurkluoglu M, Gurbuz HA, Durukan AB. The fanfolding modification for removing chest tube clogging after cardiac surgery. Eur J Cardiothorac Surg 2013; 45:589. [PMID: 23824933 DOI: 10.1093/ejcts/ezt340] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Murat Tavlasoglu
- Department of Cardiovascular Surgery, Diyarbakir Military Medical Hospital, Diyarbakir, Turkey
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The PleuraFlow Active Chest Tube Clearance System: Initial Clinical Experience in Adult Cardiac Surgery. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2012; 7:354-8. [DOI: 10.1097/imi.0b013e31827e2b4d] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Objective To address the clinical consequences related to chest tube clogging, a novel chest drainage apparatus, the PleuraFlow Active Tube Clearance System (Clear Catheter Systems, Bend, OR), was developed. The aim of this world's first clinical experience study was to follow clinicians using the PleuraFlow system to assess usability issues and potential areas of improvement in the heart surgery setting. Methods A user preference study was conducted to assess how specified users (surgeons, nurses, and intensive care physicians) used the PleuraFlow system to achieve specified goals in an efficient manner. Data were collected from patient charts and by a questionnaire that they had filled. Results All the surgeons (n = 7) noted that the device was not any more difficult to insert than a conventional chest tube and was easy to assemble and use. There were no reports of malfunction or complications related to the installation or use of the system. A majority, 77% (24/31), of nurses felt that the device was more time efficient than stripping, milking, or tapping the chest tubes to keep them open. A majority (16/19, 84%) of the PleuraFlow chest tubes and guide tubes were removed together in one piece within 1 day of surgery (on postoperative day 1). Conclusions Overall, the physicians and nurses rated the PleuraFlow system positively for its ability to be incorporated into the postoperative workflow of managing the drainage of patients after heart surgery. This device may be useful to allow caregivers to be certain that chest tubes are functioning in the early hours after surgery, when active bleeding is resolving and when complications from undrained blood can ensue.
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Superior Chest Drainage With an Active Tube Clearance System: Evaluation of a Downsized Chest Tube. Ann Thorac Surg 2011; 91:580-3. [DOI: 10.1016/j.athoracsur.2010.10.018] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2010] [Revised: 10/05/2010] [Accepted: 10/07/2010] [Indexed: 11/24/2022]
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Shiose A, Takaseya T, Fumoto H, Arakawa Y, Horai T, Boyle EM, Gillinov AM, Fukamachi K. Improved drainage with active chest tube clearance☆☆☆. Interact Cardiovasc Thorac Surg 2010; 10:685-8. [DOI: 10.1510/icvts.2009.229393] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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