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Panou V, Bhatnagar R, Rahman N, Christensen TD, Pietersen PI, Arshad A, Laursen CB. Advances in the diagnosis and follow-up of pleural lesions: a scoping review. Expert Rev Respir Med 2024; 18:423-434. [PMID: 38995221 DOI: 10.1080/17476348.2024.2375421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Accepted: 06/28/2024] [Indexed: 07/13/2024]
Abstract
INTRODUCTION Pleural lesions may have heterogeneous presentation and causes. In recent years, there have been significant advances in pleural lesions diagnostics. The aim of this review is to provide an overview of the state-of-the-art, and recent updates for diagnostic modalities and monitoring regimes for pleural lesions. AREAS COVERED A literature search was conducted through PubMed and Web of Science for relevant articles published from 1 January 2000- 1 March 2023. This article critically appraises the radiological modalities and biopsy techniques that are employed in pleural lesions diagnostics, including chest radiography, thoracic ultrasound, computed tomography, F-fluorodeoxyglycose positron emission tomography, magnetic resonance imaging, percutaneous, and thoracoscopic pleural biopsies with reference to their strengths, limitations, and clinical use. The review asserts also the available literature regarding monitoring algorithms. EXPERT OPINION Despite the recent advances in the field, there are several key areas for improvement, including the development and validation of minimal invasive methods and tools for risk stratification, the integration of multi-omics technologies, the implementation of standardized, evidence-based diagnostic and monitoring guidelines and increased focus on research and patient-centric approaches. The broad establishment of dedicated pleural clinics may significantly assist toward this direction.
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Affiliation(s)
- Vasiliki Panou
- Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark
- Odense Respiratory Research Unit (ODIN) - Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Rahul Bhatnagar
- Odense Respiratory Research Unit (ODIN) - Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Respiratory Medicine Department, North Bristol National Health Service Trust, Southmead Hospital, Bristol, UK
- Academic Respiratory Unit, University of Bristol, Bristol, UK
| | - Najib Rahman
- Oxford Respiratory Trials Unit, University of Oxford, Oxford, UK
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Oxford Pleural Unit, Churchill Hospital, Oxford, UK
| | - Thomas Decker Christensen
- Department of Cardiothoracic and Vascular Surgery & Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Pia Iben Pietersen
- Department of Radiology, Odense University Hospital, Odense, Denmark
- UNIFY - Research and Innovation Unit of Radiology, University of Southern Denmark, Odense, Denmark
| | - Arman Arshad
- Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark
| | - Christian B Laursen
- Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark
- Odense Respiratory Research Unit (ODIN) - Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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Takeda K, Kasai H, Shimizu I, Hirama R, Hayama N, Shikano K, Abe M, Naito A, Suzuki T. Complications Rate and a Multidimensional Analysis of Their Causes of Tube Thoracostomy: A Mixed-Methods Study. Cureus 2024; 16:e58563. [PMID: 38765428 PMCID: PMC11102531 DOI: 10.7759/cureus.58563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2024] [Indexed: 05/22/2024] Open
Abstract
INTRODUCTION Tube thoracostomy (TT) complications are common in respiratory medicine. However, the prevalence of complications and risk factors is unknown, and data on countermeasures are lacking. METHODS This was a mixed-methods retrospective observational and qualitative study. This retrospective observational study included TT performed on patients admitted to the Department of Respiratory Medicine at our University Hospital between January 1, 2019, and August 31, 2022 (n=169). The primary endpoint was the incidence of TT-related complications. We reviewed the association between complications and patient- and medical-related factors as secondary endpoints. In this qualitative study, we theorized the background of physicians' susceptibility to TT-related complications based on the grounded theory approach. RESULTS Complications were observed in 20 (11.8%) of the 169 procedures; however, they were unrelated to 30-day mortality. Poor activities of daily living (odds ratio 4.3, p=0.007) and regular administration of oral steroids (odds ratio 3.1, p=0.025) were identified as patient-related risk factors. Physicians undergoing training caused the most complications, and the absence of a senior physician at the procedure site (odds ratio 3.5, p=0.031) was identified as a medical risk factor. Based on this qualitative study, we developed a new model for TT complication rates consistent with the relationship between physicians' professional skills, professional identity, and work environments. CONCLUSIONS Complications associated with TT are common. Therefore, it is necessary to implement measures similar to those identified in this study. Particularly, a supportive environment should be established for the training of physicians.
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Affiliation(s)
- Kenichiro Takeda
- Department of Respirology, Chiba University Graduate School of Medicine, Chiba, JPN
| | - Hajime Kasai
- Department of Respirology, Chiba University Graduate School of Medicine, Chiba, JPN
- Department of Medical Education, Chiba University Graduate School of Medicine, Chiba, JPN
| | - Ikuo Shimizu
- Department of Medical Education, Chiba University Graduate School of Medicine, Chiba, JPN
- Department of Quality and Patient Safety, Chiba University Hospital, Chiba, JPN
| | - Ryutaro Hirama
- Department of Respirology, Chiba University Graduate School of Medicine, Chiba, JPN
| | - Nami Hayama
- Department of Respirology, Chiba University Graduate School of Medicine, Chiba, JPN
| | - Kohei Shikano
- Department of Respirology, Chiba University Graduate School of Medicine, Chiba, JPN
| | - Mitsuhiro Abe
- Department of Respirology, Chiba University Graduate School of Medicine, Chiba, JPN
| | - Akira Naito
- Department of Respirology, Chiba University Graduate School of Medicine, Chiba, JPN
| | - Takuji Suzuki
- Department of Respirology, Chiba University Graduate School of Medicine, Chiba, JPN
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Enemoh O, Iwunna O. Hydropneumothorax and Pulmonary Embolism in a Patient With Shortness of Breath. Cureus 2022; 14:e27986. [PMID: 36127990 PMCID: PMC9481189 DOI: 10.7759/cureus.27986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2022] [Indexed: 11/30/2022] Open
Abstract
This is a case of hydropneumothorax in an elderly man presenting to the emergency department with worsening respiratory symptoms one month after treatment for a chest infection and pleural effusion. Computerized tomography pulmonary angiogram (CTPA) showed an encysted hydropneumothorax and chronic pulmonary emboli. He was anticoagulated, had a chest drain with a good outcome and was discharged for a multidisciplinary team follow-up. This report highlights hydropneumothorax occurring as a result of therapeutic or diagnostic pleural interventions. It also reiterates the importance of identifying the probable cause of a pleural effusion, with pulmonary embolism as a cause that should be ruled out.
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Small Drainage Volumes of Pleural Effusions Are Associated with Complications in Critically Ill Patients: A Retrospective Analysis. J Clin Med 2021; 10:jcm10112453. [PMID: 34205925 PMCID: PMC8197788 DOI: 10.3390/jcm10112453] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 05/26/2021] [Accepted: 05/29/2021] [Indexed: 11/29/2022] Open
Abstract
Pleural effusions are a common finding in critically ill patients and small bore chest drains (SBCD) are proven to be efficient for pleural drainage. The data on the potential benefits and risks of drainage remains controversial. We aimed to determine the cut-off volume for complications, to investigate the impact of pleural drainage and drained volume on clinically relevant outcomes. Medical records of all critically ill patients undergoing insertion of SBCD were retrospectively examined. We screened 13,003 chest radiographs and included 396 SBCD cases in the final analysis. SBCD drained on average 900 mL, with less amount in patients with complications (p = 0.003). A drainage volume of 975 mL in 24 h represented the optimal threshold for complications. Pneumothorax was the most frequent complication (4.5%), followed by bleeding (0.8%). Female and lighter-weighted patients experienced a higher risk for any complication. We observed an improvement in the arterial partial pressure of oxygen and respiratory quotient (p < 0.001). We conclude that the small drainage volumes are associated with complications in critically ill patients—the more you drain, the safer the procedure gets. The use of SBCD is a safe and efficient procedure, further investigations regarding the higher rate of complications in female and lighter-weighted patients are desirable.
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Williams E, Hanna N, Menard A, Mussari B, Nasirzadeh R, Tarulli E, Dhillon GR, Reid K, Petsikas D, Pereira J, Heffernan P, Chung W. Study protocol for DICE trial: Video-assisted thoracoscopic surgery decortication versus interventional radiology guided chest tube insertion for the management of empyema. Contemp Clin Trials Commun 2021; 22:100777. [PMID: 33997464 PMCID: PMC8105624 DOI: 10.1016/j.conctc.2021.100777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 04/06/2021] [Accepted: 04/11/2021] [Indexed: 12/01/2022] Open
Abstract
Background Empyema is a common thoracic surgery presentation, defined as pus in the pleural space. Despite the commonality of empyema, consensus on initial management remains ambiguous. Two standard of care treatment options include inserting a chest tube (thoracostomy) and the administration of intrapleural fibrinolytics, or an initial surgical approach, surgical decortication. Due to the complexity of this pleural space infection, often repeat interventions are required after initial management in order to achieve source control and resolution of clinical symptoms. This study aims to identify the most effective initial management option for empyema. Study design We present a study protocol for a randomized control trial (RCT) comparing adult individuals with empyema to one of two standard of care initial management options. Participants will be randomized into either interventional radiology guided chest tube insertion with intrapleural fibrinolytics (Dornase 5 mg and Alteplase 10 mg intrapleural twice daily for three days) or video-assisted thoracoscopic surgery (VATS) decortication. Methods All adults with empyema meeting inclusion criteria will be invited to participate. They will be randomized into one of two intervention groups; interventional radiology guided chest tube insertion with fibrinolytics or initial VATS decortication. Each intervention will take place within 48 hours of randomization. The primary outcome will be the rate of re-intervention within 30 days. Re-intervention is defined as repeat chest tube insertion, VATS decortication, or decortication via thoracotomy. Secondary outcomes include a change in the size of empyema, length of stay, morbidity, as well as 30-day and 90-day mortality, as well as quality of life measurements. Anticipated impact This study is aimed at identifying the most effective initial management option for individuals with empyema.
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Affiliation(s)
- Erin Williams
- Division of Thoracic Surgery, Department of Surgery, Queen's University, 76 Stuart Street, Kingston, ON, K7L 2V7, Canada
| | - Nader Hanna
- Division of Thoracic Surgery, Department of Surgery, Queen's University, 76 Stuart Street, Kingston, ON, K7L 2V7, Canada
| | - Alex Menard
- Division of Interventional Radiology, Department of Radiology, Queen's University, 76 Stuart Street, Kingston, ON, K7L 2V7, Canada
| | - Benedetto Mussari
- Division of Interventional Radiology, Department of Radiology, Queen's University, 76 Stuart Street, Kingston, ON, K7L 2V7, Canada
| | - Reza Nasirzadeh
- Division of Interventional Radiology, Department of Radiology, Queen's University, 76 Stuart Street, Kingston, ON, K7L 2V7, Canada
| | - Emidio Tarulli
- Division of Interventional Radiology, Department of Radiology, Queen's University, 76 Stuart Street, Kingston, ON, K7L 2V7, Canada
| | - Gurmohan Rob Dhillon
- Division of Interventional Radiology, Department of Radiology, Queen's University, 76 Stuart Street, Kingston, ON, K7L 2V7, Canada
| | - Ken Reid
- Division of Thoracic Surgery, Department of Surgery, Queen's University, 76 Stuart Street, Kingston, ON, K7L 2V7, Canada
| | - Dimitri Petsikas
- Division of Thoracic Surgery, Department of Surgery, Queen's University, 76 Stuart Street, Kingston, ON, K7L 2V7, Canada
| | - Jennifer Pereira
- Division of Thoracic Surgery, Department of Surgery, Queen's University, 76 Stuart Street, Kingston, ON, K7L 2V7, Canada
| | - Paul Heffernan
- Division of Respirology, Department of Medicine, Queen's University, 76 Stuart Street, Kingston, ON, K7L 2V7, Canada
| | - Wiley Chung
- Division of Thoracic Surgery, Department of Surgery, Queen's University, 76 Stuart Street, Kingston, ON, K7L 2V7, Canada
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Li M, Zhao L, Zhou X, Zhang K, Yin P, Liu S, Zou Y, Li Q. Detection of carcinoma in serous effusions: a review. Am J Cancer Res 2021; 11:43-60. [PMID: 33520359 PMCID: PMC7840719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 11/20/2020] [Indexed: 06/12/2023] Open
Abstract
A malignant serous effusion is one of the most common complications of advanced tumors, indicating a poor prognosis and having a profound impact on diagnosis, treatment, and prognosis. It is of great significance to identify benign and malignant effusions quickly and accurately. Both cellular and non-cellular components in the effusion can be employed for detection, diagnostic methods are necessary to obtain a definite diagnosis and more relevant information such as tumor classification. In this review, we focus on the comparison of several widespread cytological preparation methods, enrichment technology of exfoliated cells, and present tests for serous effusions, mainly including routine and special stains, immunocytochemistry, electron microscopy, enzyme-linked immunosorbent assay, flow cytometry, and molecular analysis.
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Affiliation(s)
- Min Li
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Xi’an Jiaotong UniversityXi’an 710061, China
| | - Lanbo Zhao
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Xi’an Jiaotong UniversityXi’an 710061, China
| | - Xue Zhou
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Xi’an Jiaotong UniversityXi’an 710061, China
| | - Kailu Zhang
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Xi’an Jiaotong UniversityXi’an 710061, China
| | - Panyue Yin
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Xi’an Jiaotong UniversityXi’an 710061, China
| | - Shuhua Liu
- College of Chemistry Engineering, Tianjin UniversityTianjin 300350, China
| | - Yuliang Zou
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Xi’an Jiaotong UniversityXi’an 710061, China
| | - Qiling Li
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Xi’an Jiaotong UniversityXi’an 710061, China
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Menziletoglu D, Guler AY, Cayır T, Isik BK. Binaural beats or 432 Hz music? which method is more effective for reducing preoperative dental anxiety? Med Oral Patol Oral Cir Bucal 2021; 26:e97-e101. [PMID: 33247575 PMCID: PMC7806348 DOI: 10.4317/medoral.24051] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 11/09/2020] [Indexed: 11/05/2022] Open
Abstract
Background The aim of this prospective clinical study was to investigate the effectiveness of binaural beats and music at a frequency of 432 Hz and compare which method is more effective for reducing preoperative dental anxiety in impacted third molar surgery.
Material and Methods Ninety patients were randomly selected to the binaural beats group, music group and control group. Visual analog scale used to evaluate dental anxiety before the local anesthesia in the first measurement. Local anesthesia was applied to the all patients. Patients in the music group listened to 432 Hz tuned music using earphones for 10 minutes. Patients in the binaural beats group listened to binaural beats using earphones (for the right ear, 220 Hz and for the left ear 210 Hz) for 10 minutes. No special treatment was applied to the patients in control group. In the second measurement, dental anxiety was measured again in all three groups. For analysis of differences between three groups was used One way Anova and Kruskal Wallis test.
Results Twenty seven male and 53 female patients included the study. In the first measurement, the same level of anxiety was recorded in all three groups. (p=0.811) There was a significant decrease in anxiety in both the binaural beats and music group in the second measurement. (p<0.001).
Conclusions Binaural beats and 432 Hz tuned music are a valid non pharmacological adjuvant to reduce dental anxiety in impacted third molar surgery. They have a positive effect to reduce the dental anxiety. Key words:Binaural beats, 432 Hz music, dental anxiety.
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Affiliation(s)
- D Menziletoglu
- Necmettin Erbakan University, Faculty of Dentistry Department of Oral and Maxillofacial Surgery Karacigan Mah. Ankara Cad No: 74 Karatay, Konya-Türkiye
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Shang LH, Xiao ZN, Zhao YL, Long B. Analgesic Effect of Serratus Anterior Plane Block After Thoracoscopic Surgery: A Randomized Controlled Double-Blinded Study. Ther Clin Risk Manag 2020; 16:1257-1265. [PMID: 33376335 PMCID: PMC7755330 DOI: 10.2147/tcrm.s285244] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Accepted: 11/30/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose Fast-track surgery is a developing trend in medical care. It is a core challenge for clinical anesthesia to reasonably reduce the dosage of opioids and relieve postoperative pain. Serratus anterior plane block (SAPB) is a novel analgesic technique with such advantages as easy operation, good safety, and few side effects. Patients and Methods In total, 60 patients aged 18 to 65 years who were diagnosed with lung cancer and scheduled for thoracoscopic resection were randomly assigned to receive SABP or local infiltration anesthesia. We analyzed the time within 48 hrs after operation to visual analogue scale (VAS) pain score of 4 or higher and the number of patients requiring additional analgesics at 6 hrs and 12 hrs after operation. Results The estimated median time to VAS ≥4 was 4 hrs (1.32 to 6.68) in the control group and 11 hrs (6.71 to 15.29) in the SAPB group (log-rank test: P=0.008). The number of patients requiring additional analgesics at 6- and 12 hrs after operation was significantly lower in the SAPB group than that in the control group (P<0.05). Conclusion Compared with local infiltration, SAPB provided extended postoperative analgesia after thoracoscopic surgery with reduced consumption of additional analgesics in the early postoperative stage.
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Affiliation(s)
- Li Hua Shang
- Department of Anesthesiology, Shengjing Hospital of China Medical University, Shenyang 110004, People's Republic of China
| | - Zhen Nan Xiao
- Department of Anesthesiology, Shengjing Hospital of China Medical University, Shenyang 110004, People's Republic of China
| | - Ya Li Zhao
- Department of Anesthesiology, Shengjing Hospital of China Medical University, Shenyang 110004, People's Republic of China
| | - Bo Long
- Department of Anesthesiology, Shengjing Hospital of China Medical University, Shenyang 110004, People's Republic of China
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Santos C, Gupta S, Baraket M, Collett PJ, Xuan W, Williamson JP. Outcomes of an initiative to improve inpatient safety of small bore thoracostomy tube insertion. Intern Med J 2020; 49:644-649. [PMID: 30230151 PMCID: PMC6851751 DOI: 10.1111/imj.14110] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 08/23/2018] [Accepted: 08/26/2018] [Indexed: 12/14/2022]
Abstract
Background Intercostal chest catheter (ICC) insertion is a common hospital procedure with attendant risks including life‐threatening complications such as pneumothorax and visceral damage. Aim To investigate the effect of a quality improvement (QI) initiative on complications associated with inpatient thoracostomy tube insertion. Methods Following an audit of ICC complications in inpatients over a 2‐year period we implemented a comprehensive QI programme. This involved formal training in and mandatory use of thoracic ultrasound, standardisation of the procedure and documentation, a dedicated procedure room with nurses trained in assisting ICC insertion and senior supervision for medical staff. An audit over 2 years post‐implementation of the QI protocol was compared with pre‐implementation results. Results A total of 103 cases were reviewed pre‐implementation and 105 cases were reviewed post‐implementation of the QI programme. All procedures following the QI initiative were image guided compared to 23.3% of cases pre‐implementation. The rate of developing a pneumothorax requiring intervention post‐implementation was less than pre‐implementation (1.9% vs 5.8% (P = 0.023). Post‐implementation, there were no instances of dry taps, viscera perforation, clinically significant bleeding or wrong side ICC insertion and documentation improved. Conclusion QI initiative applied to thoracostomy tube insertion in hospital inpatients can reduce complications and improve procedure documentation.
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Affiliation(s)
- Conceição Santos
- Department of Respiratory and Sleep Medicine, Campbelltown Hospital, Sydney, New South Wales, Australia
| | - Saurabh Gupta
- Department of General and Acute Care Medicine, Liverpool Hospital, Sydney, New South Wales, Australia
| | - Melissa Baraket
- Department of Respiratory and Sleep Medicine, Liverpool Hospital, Sydney, New South Wales, Australia.,Department of Respiratory, Sleep and Environmental and Occupational Health (RSEOH), Sydney, New South Wales, Australia
| | - Peter J Collett
- Department of Respiratory and Sleep Medicine, Liverpool Hospital, Sydney, New South Wales, Australia.,Department of Respiratory, Sleep and Environmental and Occupational Health (RSEOH), Sydney, New South Wales, Australia
| | - Wei Xuan
- South West Clinical School, University of New South Wales, Sydney, New South Wales, Australia.,The Ingham Institute of Applied Medical Research, Sydney, New South Wales, Australia
| | - Jonathan P Williamson
- Department of Respiratory and Sleep Medicine, Liverpool Hospital, Sydney, New South Wales, Australia.,Department of Respiratory, Sleep and Environmental and Occupational Health (RSEOH), Sydney, New South Wales, Australia
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Vetrugno L, Guadagnin GM, Barbariol F, D'Incà S, Delrio S, Orso D, Girometti R, Volpicelli G, Bove T. Assessment of Pleural Effusion and Small Pleural Drain Insertion by Resident Doctors in an Intensive Care Unit: An Observational Study. CLINICAL MEDICINE INSIGHTS-CIRCULATORY RESPIRATORY AND PULMONARY MEDICINE 2019; 13:1179548419871527. [PMID: 31516312 PMCID: PMC6724497 DOI: 10.1177/1179548419871527] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 07/30/2019] [Indexed: 12/19/2022]
Abstract
Small-bore pleural drainage device insertion has become a first-line therapy for the treatment of pleural effusions (PLEFF) in the intensive care unit; however, no data are available regarding the performance of resident doctors in the execution of this procedure. Our aim was to assess the prevalence of complications related to ultrasound-guided percutaneous small-bore pleural drain insertion by resident doctors. In this single-center observational study, the primary outcome was the occurrence of complications. Secondary outcomes studied were as follows: estimation of PLEFF size by ultrasound and postprocedure changes in PaO2/FiO2 ratio. In all, 87 pleural drains were inserted in 88 attempts. Of these, 16 were positioned by the senior intensivist following a failed attempt by the resident, giving a total of 71 successful placements performed by residents. In 13 cases (14.8%), difficulties were encountered in advancing the catheter over the guidewire. In 16 cases (18.4%), the drain was positioned by a senior intensivist after a failed attempt by a resident. In 8 cases (9.2%), the final chest X-ray revealed a kink in the catheter. A pneumothorax was identified in 21.8% of cases with a mean size (±SD) of just 10 mm (±6; maximum size: 20 mm). The mean size of PLEFF was 57.4 mm (±19.9), corresponding to 1148 mL (±430) according to Balik’s formula. Ultrasound-guided placement of a small-bore pleural drain by resident doctors is a safe procedure, although it is associated with a rather high incidence of irrelevant pneumothoraces.
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Affiliation(s)
- Luigi Vetrugno
- Anesthesiology and Intensive Care Clinic, Department of Medicine, University of Udine, Udine, Italy
| | - Giovanni M Guadagnin
- Anesthesiology and Intensive Care Clinic, Department of Medicine, University of Udine, Udine, Italy
| | - Federico Barbariol
- Anesthesiology and Intensive Care 1, Department of Anesthesia and Intensive Care Medicine, University Hospital of Udine, Udine, Italy
| | - Stefano D'Incà
- Anesthesiology and Intensive Care, A.A.S. n. 3 Alto Friuli-Collinare-Medio Friuli, Sant'Antonio Abate Hospital, Tolmezzo, Italy
| | - Silvia Delrio
- Anesthesiology and Intensive Care Clinic, Department of Medicine, University of Udine, Udine, Italy
| | - Daniele Orso
- Anesthesiology and Intensive Care Clinic, Department of Medicine, University of Udine, Udine, Italy
| | - Rossano Girometti
- Institute of Radiology, Department of Medicine, University of Udine, University Hospital of Udine, Udine, Italy
| | | | - Tiziana Bove
- Anesthesiology and Intensive Care Clinic, Department of Medicine, University of Udine, Udine, Italy
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Semyonov M, Fedorina E, Grinshpun J, Dubilet M, Refaely Y, Ruderman L, Koyfman L, Friger M, Zlotnik A, Klein M, Brotfain E. Ultrasound-guided serratus anterior plane block for analgesia after thoracic surgery. J Pain Res 2019; 12:953-960. [PMID: 30881105 PMCID: PMC6417847 DOI: 10.2147/jpr.s191263] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Background Patients who undergo surgical procedures that impair the integrity of the chest wall frequently experience extremely severe postoperative pain. Opiates and weaker analgesics, such as nonsteroidal anti-inflammatory drugs (NSAIDs), are not sufficiently effective in achieving control of severe pain and might cause respiratory and gastrointestinal complications. In the past decade, there has been an increased interest in the use of regional nerve blocks for post-thoracoscopy and post-thoracotomy analgesia. Methods This is a prospective, randomized, double-blind and single-center study. We recruited 104 patients who underwent elective thoracoscopy. Prior to surgery, the participating patients were randomized into one of two study groups: Group 1- the “standard control group” that received standard postoperative pain control with intravenous opioids, NSAIDs and acetaminophen (paracetamol) and Group 2- the “block group” that was treated by ultrasound-guided serratus anterior plane (SAP) block (a single injection of 0.25% bupivacaine hydrochloride 2 mg/kg plus dexamethasone 8 mg) with standard postoperative pain control regimen. We compared the clinical, laboratory, and postoperative pain assessment data of both groups. Results Patients in the SAP block Group 2 reported significantly lower levels of pain after thoracic surgery as assessed by their visual analog scale scores, as compared to the patients in the standard pain control Group 1 (P<0.001). The total dosage of morphine and tramadol required for pain relief during the first hours after surgery was significantly lower in the patients who received SAP block. Also, the incidence of vomiting after surgery was significantly lower among the patients who received SAP block than among the patients who received standard pain control. Conclusion The results of the present study suggest that SAP block is an effective adjuvant treatment option for post-thoracic surgery analgesia. Compared to the current methods used for post-thoracic surgery pain relief, SAP block has some significant merits, particularly its ease of use and its low potential for side effects.
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Affiliation(s)
- Michael Semyonov
- Department of Anesthesiology and Critical Care, General Intensive Care Unit, Soroka Medical Center, Ben-Gurion University of the Negev, Beer Sheva, Israel,
| | - Ekaterina Fedorina
- Department of Anesthesiology and Critical Care, General Intensive Care Unit, Soroka Medical Center, Ben-Gurion University of the Negev, Beer Sheva, Israel,
| | - Julia Grinshpun
- Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Michael Dubilet
- Department of Anesthesiology and Critical Care, General Intensive Care Unit, Soroka Medical Center, Ben-Gurion University of the Negev, Beer Sheva, Israel,
| | - Yael Refaely
- Department of Cardiothoracic Surgery, Soroka Medical Center, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Leonid Ruderman
- Department of Cardiothoracic Surgery, Soroka Medical Center, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Leonid Koyfman
- Department of Anesthesiology and Critical Care, General Intensive Care Unit, Soroka Medical Center, Ben-Gurion University of the Negev, Beer Sheva, Israel,
| | - Michael Friger
- Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Alexander Zlotnik
- Department of Anesthesiology and Critical Care, General Intensive Care Unit, Soroka Medical Center, Ben-Gurion University of the Negev, Beer Sheva, Israel,
| | - Moti Klein
- Department of Anesthesiology and Critical Care, General Intensive Care Unit, Soroka Medical Center, Ben-Gurion University of the Negev, Beer Sheva, Israel,
| | - Evgeni Brotfain
- Department of Anesthesiology and Critical Care, General Intensive Care Unit, Soroka Medical Center, Ben-Gurion University of the Negev, Beer Sheva, Israel,
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Hashmi U, Nadeem M, Aleem A, Khan FUHH, Gull R, Ullah K, Khan IH. Dysfunctional Closed Chest Drainage - Common Causative Factors and Recommendations for Prevention. Cureus 2018; 10:e2295. [PMID: 29750136 PMCID: PMC5943031 DOI: 10.7759/cureus.2295] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction Dysfunctional closed chest drainage unit (CDU) dysfunction is a common but serious clinical problem associated with tube thoracostomy and results in a significant rise in morbidity, prolonged hospital stays, and increased economic burden. This observational study examines the proximate factors of closed CDU dysfunction in addition to their relative frequency. Based on our findings, we suggest logical recommendations for preventing the factors that contribute to closed chest drainage unit dysfunction. Method The study target population consists of all those individuals who had experienced tube thoracostomy for any pathology related to the chest cavity treated in the Department of Thoracic Surgery, Nishter Medical University, Multan, Pakistan, from February 2015 to January 2017. The study population was not restricted by age or gender. Of the 727 examined cases, only those patients who had experienced tube thoracostomy and had significant failure in draining the pleural collection were included in the study. Detailed histories were collected, and thorough physical examinations were carried out for each participant. Chest x-rays and, if needed, computed tomography (CT) scans were obtained to properly examine the placement of the chest tubes and detect the causative factor of the closed CDU dysfunction. Results A total of 139 cases were included in the study. The most common cause of closed CDU dysfunction was the use of the wrong CDU connection (n = 24, 17.3%). Other common problems included inadequate prime fluid use, loose connections, kinked tubes, and overly full bottles. Conclusion Closed CDU dysfunction may be prevented by adopting and following proper protocols for tube thoracostomy.
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Affiliation(s)
- Usman Hashmi
- Thoracic Surgery, Nishtar Medical University/hospital Multan, Pakistan
| | | | - Abdul Aleem
- Thoracic Surgery, Nishtar Medical University/hospital Multan, Pakistan
| | | | - Rabeea Gull
- Thoracic Surgery, Nishtar Medical University/hospital Multan, Pakistan
| | - Kaleen Ullah
- Thoracic Surgery, Nishtar Medical University/hospital Multan, Pakistan
| | - Iftikhar H Khan
- Thoracic Surgery, Nishtar Medical University/hospital Multan, Pakistan
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Pang YL, Jones Q. An unexpected finding in a man with multiple pulmonary nodules, a pleural effusion and respiratory failure. Respir Med Case Rep 2017; 20:198-200. [PMID: 28331796 PMCID: PMC5345974 DOI: 10.1016/j.rmcr.2017.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Revised: 02/28/2017] [Accepted: 03/03/2017] [Indexed: 11/30/2022] Open
Abstract
We report the case of a 47-year old Caucasian man with a history of depression and high alcohol intake who presented with a one-month history of weight loss, dry cough and abdominal pain. He had no smoking history of note. The patient was treated for a suspected chest infection, however developed respiratory failure and was intubated. A CT showed multiple pulmonary nodules, left pleural thickening extending to the mediastinum and bilateral pleural effusions-larger on the left, suggestive of disseminated malignancy. A broncho-alveolar lavage surprisingly contained numerous acid-fast bacilli and no malignant cells. Treatment for tuberculosis was initiated and the patient recovered gradually. After several weeks, a pyrazinamide-resistant organism was cultured and subsequently identified to be Mycobacterium Bovis. We discuss this unexpected finding and review the literature on Bovine Tuberculosis in humans.
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Affiliation(s)
- Yik Lam Pang
- Corresponding author. Respiratory Department, Royal United Hospital, Combe Park, Avon, BA1 3NG, United Kingdom.Respiratory DepartmentRoyal United HospitalCombe ParkAvonBA1 3NGUnited Kingdom
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14
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Porcel JM, Statophoulos G, Lee YCG. Advances and controversies in pleural diseases. J Thorac Dis 2015; 7:961-3. [PMID: 26150909 DOI: 10.3978/j.issn.2072-1439.2015.04.29] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 04/09/2015] [Indexed: 12/12/2022]
Affiliation(s)
- José M Porcel
- 1 Pleural Medicine Unit, Department of Internal Medicine, Arnau de Vilanova University Hospital, Biomedical Research Institute of Lleida, Lleida, Spain ; 2 Laboratory for Molecular Respiratory Carcinogenesis, Department of Physiology, Faculty of Medicine, University of Patras, Patras, Greece ; 3 Respiratory Department, Sir Charles Gairdner Hospital, & Centre for Asthma, Allergy & Respiratory Research, University of Western Australia, Perth, Australia
| | - Georgios Statophoulos
- 1 Pleural Medicine Unit, Department of Internal Medicine, Arnau de Vilanova University Hospital, Biomedical Research Institute of Lleida, Lleida, Spain ; 2 Laboratory for Molecular Respiratory Carcinogenesis, Department of Physiology, Faculty of Medicine, University of Patras, Patras, Greece ; 3 Respiratory Department, Sir Charles Gairdner Hospital, & Centre for Asthma, Allergy & Respiratory Research, University of Western Australia, Perth, Australia
| | - Yun Chor Gary Lee
- 1 Pleural Medicine Unit, Department of Internal Medicine, Arnau de Vilanova University Hospital, Biomedical Research Institute of Lleida, Lleida, Spain ; 2 Laboratory for Molecular Respiratory Carcinogenesis, Department of Physiology, Faculty of Medicine, University of Patras, Patras, Greece ; 3 Respiratory Department, Sir Charles Gairdner Hospital, & Centre for Asthma, Allergy & Respiratory Research, University of Western Australia, Perth, Australia
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