Heimlich valve in the management of pneumothorax in patients with advanced AIDS

Pleural drainage using drainage bag for thoracoscopic lobectomy

Objective This study was designed to compare the effectiveness and convenience of a drainage bag and a chest bottle following thoracoscopic lobectomy. Methods We conducted a test to ensure that the drainage bag was characterized by easy drainage and an antireflux effect. Thereafter, the drainage bag was used in all thoracic operations in our service. To understand the usefulness of the drainage bag, a retrospective cohort study enrolled 30 patients who had a drainage bag after thoracoscopic lobectomy and compared them with 30 similar patients operated on previously who had chest bottles. Variables studied included total drainage volume, duration of drainage, complications, and satisfaction of the care providers. Results There was no significant difference between the chest bottle and drainage bag groups respectively in terms of total drainage (697.5 ± 89.7 vs. 614.1 ± 76.6 mL, p = 0.483) or duration of drainage (4.23 ± 0.38 vs. 4.43 ± 0.38 days, p = 0.713). No device-related complication was observed. After our experience with the drainage bag, we abandoned use of the chest bottle. The drainage bag was more convenient for patients and promoted early ambulation as well improving cost effectiveness. Most care providers preferred to use the drainage bag (p = 0.000). Conclusion The drainage bag is superior to the chest bottle for postoperative drainage.

Intrabronchial valves for treatment of alveolar-pleural fistula in a patient with Pneumocystis jirovecii pneumonia

Alveolo-pleural fistula is a common complication of severe pulmonary infection. Some patients require long-term placement of chest tubes until spontaneous closure of the fistula takes place, whereas others require surgical intervention. We report a case of a patient with alveolo-pleural fistula secondary to Pneumocystis jirovecii pneumonia who was successfully treated with the use of intrabronchial unidirectional valves inserted using flexible bronchoscopy.

Heimlich valve and pneumothorax

The Heimlich valve is a small one-way valve used for chest drainage that empties into a flexible collection device and prevents return of gases or fluids into the pleural space. The Heimlich valve is less than 13 cm (5 inches) long and facilitates patient ambulation. Currently there are several systems in the market. It can be used in many patients instead of a traditional water seal drainage system. The Heimlich chest drainage valve was developed so that the process of draining the pleural cavity could be accomplished in a safe, relatively simple, and efficient manner. This valve system has replaced the cumbersome underwater drainage bottle system. Moreover; the Heimlich valve system connects to chest tubing and allows fluid and air to pass in one direction only. This system functions in any position, and it does not ever need to be clamped, a regulated suction can be attached to it if necessary. The valve drains into a plastic bag that can be held at any level, allowing the patient undergoing chest drainage to be ambulatory simply by carrying the bag. In the current mini review we will present the Heimlich valve system and method of insertion.

Human immunodeficiency virus infection and pneumothorax

Pneumothorax is a serious and relatively frequent complication of human immunodeficiency virus (HIV) infection that may associate with increased morbidity and mortality and may prove difficult to manage, especially in patients with acquired immunodeficiency syndrome (AIDS).

An argument for the conservative management of small traumatic pneumathoraces in populations with high prevalence of HIV and tuberculosis: an evidence-based review of the literature

Background

Traumatic pneumothoraces are common. Many are managed with tube thoracostomy. However, there is a high complication rate from chest tube placement, particularly in patients with HIV, TB, or both.

Aims

We sought to investigate the literature on the conservative management of traumatic pneumothorax in patients with HIV and/or TB.

Methods

The literature search was broken into two parts. In the first part, we searched for articles comparing tube thoracostomy versus conservative management in traumatic pneumothorax. In the second part, we sought articles describing the incidence and outcome of pneumothoraces in patients with pre-existing HIV or tuberculosis. In both, relevant articles were reviewed, and citations were hand-searched.

Results

For the first portion, we identified 384 papers. From these, six studies were relevant. For the second portion, we identified 327 articles. A total of four unique articles were selected. The heterogeneity of the studies did not allow any pooled analysis. The studies of conservative management demonstrated a low percentage of patients with small pneumothoraces (most often <1.5 cm or less than 10%) later required tube thoracostomy for clinical deterioration (range 6–25%). No studies focused exclusively on pneumothoraces in patients with TB. In patients with HIV, there were no prospective trials of conservative management. Mortality for all HIV-infected patients with pneumothorax was high (25–50%), and the rate of complications from tube thoracostomy was also high. Pneumocystits carinii pneumonia (PCP) independently increased mortality.

Conclusions

A review of the literature suggests that selected small pneumothoraces may be managed conservatively and that there is a high rate of complications related to tube thoracostomy in HIV patients. We propose a trial of the safety of conservative management of traumatic pneumothoraces in an area with a high prevalence of HIV and TB.

[Pneumothorax in human immunodeficiency virus infected patients]

INTRODUCTION

The respiratory system still continues to be a common place which deteriorates in HIV patients. Among the signs and symptoms, is the occurrence of a pneumothorax due to trauma and infections and is a cause of aggravation for these patients. The present study attempts to identify and characterise the behaviour of a group of variables in HIV patients with this complication.

MATERIAL AND METHOD

An observational, descriptive case series study was carried out. The desired variables were obtained from clinical records.

RESULTS

Of the total number, 91.67% were males, and the mean age was 32.17 years. The main causes of pneumothorax were infections, particularly due to Pneumocystis jirovecii and deep venous catheterisation. A persistent statistically significant air leak was present in 33.3% of patients and two cases of pleural sepsis. Four patients died, all with acute respiratory failure and bacterial bronchopneumonia.

CONCLUSIONS

The majority were males in the third decade of life, AIDS patients. The main causes of the pneumothorax were infections and catheterisation of the subclavian vein. Immunodepression played a significant prognostic role in the progression and outcome of the patient. Minimum pleurotomy continues to be the first treatment option in these patients, due to their precarious general state which contraindicates a major procedure. The most frequent complication was the persistent air leak, being a significant indicator of a poor prognosis in the progress of these patients. Causes of death such as acute respiratory failure and bilateral bronchopneumonia prevailed.

[Pleural disease and acquired immunodeficiency syndrome]

Respiratory infections are among the most common complications in patients infected with human immune deficiency virus (HIV) and can occur at all CD4 level. Pleural complications are uncommon but they have some distinctive aspects from HIV-negative patients. The PTX occurrence in HIV-positive patients was described for the first time in 1984. The total incidence of pneumothorax (PTX) in patients with acquired immune deficiency syndrome (AIDS) varies from 2.7% to 4.9%. The great majority occurs in patients with current or previous Pneumocystis carinii infection, who present subpleural pulmonary cavities with necrosis. The treatment of spontaneous PTX in patients with AIDS is difficult, with an increased tendency to bronchopleural fistula persistence. The use of tube thoracostomy, with or without pleural sclerose, can be insufficient to resolve PTX. Other therapeutic options are attachment of a Heimlich valve or surgical intervention. The prevalence and the etiology of pleural effusion (PE) among hospitalized patients with AIDS varies widely. One reason that can contribute to this variability is the difference on risk factors associated with HIV infection, in the studied population. Parapneumonic effusions, tuberculosis and Kaposi's sarcoma are the most common causes. Empyemas are a rare pleural complication. Although Pneumocystis carinii pneumonia is a common cause of pneumonias in AIDS patients, it is an unusual cause of pleural effusion. Other possible causes of pleural effusion are non-Hodgkin's lymphoma, namely body cavity-based lymphoma.

Pigtail tube drainage in the treatment of spontaneous pneumothorax

We report our experience in using pigtail tube drainage in the treatment of spontaneous pneumothorax compared with traditional chest tube thoracotomy. One hundred two patients were included and analyzed. Fifty patients were treated with the pigtail tube and 52 patients were treated with the traditional chest tube. The extubation time, mean hospital stay, evacuation rate, and total cost were similar without a significant statistical difference. Among the chest tube group, 15 underwent surgical intervention as a result of delayed resolution and hemopneumothorax; and among the pigtail group, 15 had other procedures for pneumothorax, including chest tube insertion and surgical intervention. This verifies our initial suspicion that the effectiveness of the pigtail drainage system is no less than that of the chest tube. Therefore, when considering ambulatory ability and good patient compliance, the pigtail tube drainage system can be considered as the treatment of choice for spontaneous pneumothorax.

Mobile chest drainage: coming soon to a home near you

Home care nurses are seeing more patients with chest drainage devices than ever before. This article reviews the conditions that may be treated at home with mobile chest drainage devices, specific devices nurses are likely to see in the home, focused nursing assessments, tips for monitoring the devices, and key aspects of patient and caregiver teaching.