Chest drainage systems in use

Pneumothorax in a term newborn

With the advent of surfactant and gentle ventilation, the incidence of neonatal pneumothorax has decreased over the last two decades. Pneumothorax associated with respiratory distress syndrome is more common in preterm infants, but term infants often present with isolated pneumothorax. The use of CPAP or non-invasive respiratory support in the delivery room for a term infant with respiratory distress increases transpulmonary pressures and increases the risk of pneumothorax. Prompt diagnosis with a high index of suspicion, quick evaluation by transillumination, chest X-ray or lung ultrasound is critical. Management includes observation, needle thoracocentesis and if necessary, chest tube placement. This manuscript reviews the incidence, pathogenesis, diagnosis and management of a term infant with isolated pneumothorax, summarizing the combination of established knowledge with new understanding, including data on diagnostic modes such as ultrasound, reviewing preventative measures, and therapeutic interventions such as needle thoracocentesis and a comparison of pigtail vs. straight chest tubes.

Patients' Perceptions of Experiences of Postoperative Chest Drain Tube Insertion: A Pilot Survey

BACKGROUND

Pleural drainage is a routine procedure conducted after thoracotomy and thoracoscopy. It is used to remove air or excess fluid from a pleural cavity and enables proper lung expansion. Essential elements of care provided during hospitalization and treatment include meeting patients' growing expectations and continually improving quality while optimizing safety.

AIM

This study aimed to explore patients' experiences with pleural drainage after thoracic surgery and their correlation with socio-demographic data.

METHODS

A pilot survey with an exploratory design was conducted at a large teaching hospital in Poland, in the Department of Thoracic Surgery at the University Clinical Centre in Gdansk. The study involved the analysis of 100 randomly selected subjects with a chest tube drain. A self-designed questionnaire was used to collect social, demographic, and clinical data. Twenty-three questions related to experiences with pleural drainage, ailments, limitations in daily functioning, and security with a chest tube were evaluated using a 5-point Likert scale. Patients completed the questionnaire on the third postoperative day.

RESULTS

Individuals fitted with a traditional water-seal drainage system felt safer than those from the digital drainage group (p = 0.017). Statistically significant differences were found in the assessment of nursing assistance (p = 0.025); the number of satisfied patients was greater in a group of unemployed people. No correlation was found between demographic and social factors and the patients' sense of security (gender: p = 0.348, age: p = 0.172, education level: p = 0.154, professional activity: p = 0.665).

CONCLUSIONS

Demographic and social characteristics did not significantly affect patients' sense of safety with chest drainage types. Patients with traditional drainage felt significantly safer than patients with digital drainage. Patient knowledge of pleural drainage management was not satisfactory, with a number of patients indicating a lack of knowledge in this area. This is important information that should be considered when planning measures to improve the quality of care.

Chest Drainage Therapy: What Comes out of Pandora's Box Can Affect Patient Outcomes

Background: Over the last 100 years, the original three-bottle chest drainage system has been variously engineered into compact disposables and electronic units. Clinicians are now surrounded by a plethora of different types of systems, but little is known about the way that they work and perform. Thus, we sought to test the performance of the most commonly used chest drainage units under conditions that are relevant to clinical practice. Methods: A pleural space environment simulator was built. Thirty-two units were tested under four clinical scenarios: air leak interpretation during quiet breathing and after obstructed inspiration (−5 to −150 cmH2O), a buildup of negative pressure (−100 cmH2O), a bronchopleural fistula (10 L/min) and the need for effective external suction in the presence of air leakage. Twenty-five units were “traditional” thoracic drainages, five were “digital” low-flow/low-vacuum pumps and two were hybrids (a combination of the two). According to the design of the seal and of the suction control, the units were classified as wet-wet, wet-dry and dry-dry. Results: All wet units showed reverse air flow, with the potential to mimic an air leak when there was none. Ten wet units showed no automatic negative pressure relief features, while five dry-dry did but were slow to react. Ten wet and five dry-dry units showed no capability to handle a 10 L/min leak, as they were restrictive to flow (peak pressure up to 55 cmH2O). Only seven dry-suction units were able to maintain the set suction at high airflow rates (>20 L/min). Conclusions: Different chest drainage unit designs lead to different performances, some of which may negatively impact patient outcomes. This sounds the call to tailor our clinical practice for the individual patient. A paradigm shift to better understand all components of pleural physiology post-surgical intervention on this relatively neglected topic is needed to improve our daily practice.

Management of cardiorespiratory function of rabbits by a customized chest drain: An experimental study

Objective:

This study aimed to salvage the study population from the fatality that occurs due to iatrogenic injury to the thoracic cavity’s pleural membrane.

Materials and Methods:

An experimental study of temporomandibular joint arthroplasty with costochondral graft was carried out on 72 healthy ‘Oryctolagus cuniculus’ species of male rabbits. The rabbits were distributed into two age groups: growing (3–4 months) and adult (12–18 months). All the procedures were carried out under general anesthesia with xylazine hydrochloride and ketamine hydrochloride after calculating the doses, maintained by halothane and O₂ inhalations. Out of 72 rabbits, 33 rabbits had accidental perforation of the pleural membrane observed that required a chest drain.

Results:

In this study, 21 (63.64%) rabbits received chest drain and salvaged. The rest of the rabbits (n = 12; 36.36%) that did not receive any chest drain and died. Most of the rabbits (n = 17; 81%) were under the growing group, weighing less than 2 kg and four (19%) were adult rabbits.

Conclusion:

This manual chest drain is life-saving for rabbits. It is a new addition to the advancement of thoracic surgery on animals. It is cost-effective and safe. The developed customized drainage system may make it easier to harvest the costochondral graft-related experiments.

Acute pneumothorax due to immunotherapy administration in non-small cell lung cancer

Nowadays we have novel therapies for advanced stage non-small cell lung cancer. Immunotherapy has been introduced in the market for several years and until now its administration is mostly based on the programmed death-ligand 1. First line treatment with immunotherapy can be administered alone if programmed death-ligand 1 expression is ≥ 50%. All therapies for advanced stage disease have advantages and disadvantages, immunotherapy until now has presented mild adverse effects when compared to chemotherapy. However; it is known to induce inflammatory response to different tissues within the body. In our case acute pneumothorax was induced after immunotherapy administration.

Management of air leaks post-surgical lung resection

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.

A New Conveyable Device for Electro-drainage of Thorax

Chest tube is a flexible plastic tube used to discharge secretion in the cavity between the lungs and chest named pleural cavity. Normally, there is a small amount of fluid in the cavity between the lungs and chest; This fluid helps the movement of lungs during breathing without abrasion. Entrance of bit of air, blood or pus because injury in the pleural cavity can prevent the lungs from fully opening. Full or partial collapse of the lungs makes breathing difficult and can lead to respiratory arrest; putting chest tube in the pleural cavity causes the discharge of secretion and helps patients comfort. Chest Electro-Drainage mobile system is designed to drain air, blood, water and pus accumulated in the space between the visceral and parietal pleural cavity. Based on low volume and weight, this system can be used to treat Pneumothorax, Hemothorax and Hydrothorax and so forth, both in the emergency state and treatment centers. Obviously, this system will be an action to reduce deaths especially in the case of Pneumothorax.

Pathophysiological mechanism of post-lobectomy air leaks

Background

Air leak post-lobectomy continues to remain a significant clinical problem, with upper lobectomy associated with higher air leak rates. This paper investigated the pathophysiological role of pleural stress in the development of post-lobectomy air leak.

Methods

Preoperative characteristics and postoperative data from 367 consecutive video assisted thoracic surgery (VATS) lobectomy resections from one centre were collected prospectively between January 2014 and March 2017. Computer modelling of a lung model using finite element analysis (FEA) was used to calculate pleural stress in differing areas of the lung.

Results

Air leak following upper lobectomy was significantly higher than after middle or lower lobectomy (6.3% versus 2.5%, P=0.044), resulting in a significant six-day increase in mean hospital stay, P=0.004. The computer simulation model of the lung showed that an apical bullet shape was subject to eightyfold higher stress than the base of the lung model.

Conclusions

After upper lobectomy, the bullet shape of the apex of the exposed lower lobe was associated with high pleural stress, and a reduction in mechanical support by the chest wall to the visceral pleura due to initial post-op lack of chest wall confluence. It is suggested that such higher stress in the lower lobe apex explains the higher parenchymal air leak post-upper lobectomy. The pleural stress model also accounts for the higher incidence of right-sided prolonged air leak post-resection.

Dysfunctional Closed Chest Drainage - Common Causative Factors and Recommendations for Prevention

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.

Pleural gas analysis for the identification of alveolopleural fistulae

PURPOSE OF REVIEW

The method for identification of alveolopleural fistulae (APF) by visual inspection of air bubbles in the chest drainage system has several limitations and suffers from poor accuracy. Here we discuss the use of a novel technique of pleural gas analysis in the identification and management of APF.

RECENT FINDINGS

We found that pleural gas analysis has higher sensitivity and specificity than visual inspection in identifying APF. Additionally, we demonstrated that intrapleural gas milieu impacts lung healing and reduction of intrapleural carbon dioxide can promote resolution of APF.

SUMMARY

Pleural gas analysis is a novel technique to identify and manage APF. Integration of gas analysis in chest drainage systems would provide a more objective method for managing chest tubes and providing a favorable pleural gas environment for lung healing.