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Almusally RM, Elbawab H, Alswiket H, Alamry R, Aldar H, Alismail M, Albahrani Z, Alghamdi Z, AlReshaid F, Sabri M. Chest tube size selection for pleural effusion: from the perspective of thoracic surgeons and pulmonologists. Hosp Pract (1995) 2024:1-8. [PMID: 39264214 DOI: 10.1080/21548331.2024.2401315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2024] [Accepted: 09/03/2024] [Indexed: 09/13/2024]
Abstract
BACKGROUND The current discourse within the thoracic surgical and pulmonological communities pertains to a contentious debate over the optimal selection criteria for thoracostomy tube diameters utilized in the management of pleural effusions. A comprehensive examination of the variables that inform the clinical decision-making paradigm for the determination of appropriate chest tube calibers is imperative to enhance patient management and elevate the prognostic results. OBJECTIVES The objective of this inquiry is to elucidate the determinants that influence thoracic surgeons and pulmonologists in their selection of chest tube size for the management of pleural effusions. METHODS This cross-sectional study was based on an electronic questionnaire that was sent to the targeted populations through e-mail or a professional WhatsApp. The survey assessed the considerations of chest tube size selection as well as the respective advantages, disadvantages, and potential complications related to each size. RESULTS The conducted study encompassed participants, with a nearly even distribution between thoracic surgeons (49.1%) and pulmonologists (50.9%). Most of these practitioners are within tertiary-level medical institutions (82.1%). A preference for small-bore chest tubes (SBCT), defined as < 14 French (Fr), was indicated by 54.8% of participants. The drawbacks associated with SBCT, such as kinking (60%) and blockage (70%), influenced the decision-making process negatively, while pain was a significant factor in the selection against LBCT (64%). Ultrasound guidance was a positive influence for the selection of SBCT (55%). Complications associated with LBCT included visceral and vascular injuries (55.7%), wound infection (45.3%), re-expansion pulmonary edema (43.3%), and subcutaneous emphysema (57.5%). In contrast, malposition was a complication more commonly associated with SBCT (49.1%). CONCLUSION The decision regarding chest tube size was influenced by several critical factors which included the nature of pleural effusion, the volume of pleural fluid, and potential complications specific to the size of the chest tube used.
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Affiliation(s)
- Rayyan M Almusally
- College of Medicine, Imam Abdulrahman Bin Faisal University, King Fahad Hospital of the University, Al Khobar, Saudi Arabia
| | - Hatem Elbawab
- College of Medicine, Imam Abdulrahman Bin Faisal University, King Fahad Hospital of the University, Al Khobar, Saudi Arabia
| | - Hasan Alswiket
- College of Medicine, Imam Abdulrahman Bin Faisal University, King Fahad Hospital of the University, Al Khobar, Saudi Arabia
| | - Ryad Alamry
- College of Medicine, Imam Abdulrahman Bin Faisal University, King Fahad Hospital of the University, Al Khobar, Saudi Arabia
| | - Hawra Aldar
- College of Medicine, Imam Abdulrahman Bin Faisal University, King Fahad Hospital of the University, Al Khobar, Saudi Arabia
| | - Maram Alismail
- College of Medicine, Imam Abdulrahman Bin Faisal University, King Fahad Hospital of the University, Al Khobar, Saudi Arabia
| | - Zahra Albahrani
- College of Medicine, Imam Abdulrahman Bin Faisal University, King Fahad Hospital of the University, Al Khobar, Saudi Arabia
| | - Zeead Alghamdi
- College of Medicine, Imam Abdulrahman Bin Faisal University, King Fahad Hospital of the University, Al Khobar, Saudi Arabia
| | - Farouk AlReshaid
- College of Medicine, Imam Abdulrahman Bin Faisal University, King Fahad Hospital of the University, Al Khobar, Saudi Arabia
| | - Mohammed Sabri
- College of Medicine, Imam Abdulrahman Bin Faisal University, King Fahad Hospital of the University, Al Khobar, Saudi Arabia
- Surgery Faculty of Medicine, College of Medicine, Menoufia University, Al Minufiyah, Egypt
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Abdulelah M, Abu Hishmeh M. Infective Pleural Effusions-A Comprehensive Narrative Review Article. Clin Pract 2024; 14:870-881. [PMID: 38804400 PMCID: PMC11130797 DOI: 10.3390/clinpract14030068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Revised: 05/08/2024] [Accepted: 05/14/2024] [Indexed: 05/29/2024] Open
Abstract
Infective pleural effusions are mainly represented by parapneumonic effusions and empyema. These conditions are a spectrum of pleural diseases that are commonly encountered and carry significant mortality and morbidity rates reaching upwards of 50%. The causative etiology is usually an underlying bacterial pneumonia with the subsequent seeding of the infectious culprit and inflammatory agents to the pleural space leading to an inflammatory response and fibrin deposition. Radiographical evaluation through a CT scan or ultrasound yields high specificity and sensitivity, with features such as septations or pleural thickening indicating worse outcomes. Although microbiological yields from pleural studies are around 56% only, fluid analysis assists in both diagnosis and prognosis by evaluating pH, glucose, and other biomarkers such as lactate dehydrogenase. Management centers around antibiotic therapy for 2-6 weeks and the drainage of the infected pleural space when the effusion is complicated through tube thoracostomies or surgical intervention. Intrapleural enzymatic therapy, used to increase drainage, significantly decreases treatment failure rates, length of hospital stay, and surgical referrals but carries a risk of pleural hemorrhage. This comprehensive review article aims to define and delineate the progression of parapneumonic effusions and empyema as well as discuss pathophysiology, diagnostic, and treatment modalities with aims of broadening the generalist's understanding of such complex disease by reviewing the most recent and relevant high-quality evidence.
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Affiliation(s)
- Mohammad Abdulelah
- Department of Internal Medicine, University of Massachusetts Chan Medical School—Baystate Campus, Springfield, MA 01199, USA
| | - Mohammad Abu Hishmeh
- Department of Internal Medicine, University of Massachusetts Chan Medical School—Baystate Campus, Springfield, MA 01199, USA
- Department of Pulmonary and Critical Care Medicine, University of Massachusetts Chan Medical School—Baystate Campus, Springfield, MA 01199, USA
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Mortman KD, Tanenbaum MT, Cavallo KM, Kelley D, Bonitto SS, Sadur A, Amdur R, Sarin S, Napolitano MA. Reintervention Rate After Pigtail Catheter Insertion Compared to Surgical Chest Tubes. Am Surg 2023; 89:5487-5491. [PMID: 36786011 DOI: 10.1177/00031348231157419] [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] [Indexed: 02/15/2023]
Abstract
BACKGROUND Prior studies suggest similar efficacy between large-bore chest tube (CT) placement and small-bore pigtail catheter (PC) placement for the treatment of pleural space processes. This study examined reintervention rates of CT and PC in patients with pneumothorax, hemothorax, and pleural effusion. METHODS This retrospective study examined patients from September 2015 through December 2020. Patients were identified using ICD codes for pneumothorax, hemothorax, or pleural effusion. Use of a pigtail catheter (≤14Fr) or surgical chest tube (≥20Fr) was noted. The primary outcome was overall reintervention rate within 30 days of tube insertion. Patients who died with a pleural drainage catheter in place, unrelated to complications from chest tube placement, were excluded. RESULTS There were 1032 total patients in the study: 706 CT patients and 326 PC patients. The PC group was older with more comorbidities and more likely to have effusion as the indication for pleural drainage. Patients with PC were 2.35 times more likely to have the tube replaced or repositioned (P < .0001), 1.77 times more likely to require any reintervention (P = .001) and 2.09 times more likely to remain in the hospital >14 days (P < .0001) compared to patients with CT. CONCLUSION PCs have a significantly higher reintervention rate compared to CT for the treatment of pneumothorax, hemothorax, and pleural effusion. Although PC are believed to cause less pain and tissue trauma, they do not necessarily drain the pleural space as well as CT. Decisions on which method of draining the chest should be made on a case-by-case basis.
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Affiliation(s)
- Keith D Mortman
- Department of Surgery, Division of Thoracic Surgery, The George Washington University Hospital, Washington, DC, USA
| | - Mira T Tanenbaum
- Department of Surgery, Division of Thoracic Surgery, The George Washington University Hospital, Washington, DC, USA
| | | | - Devon Kelley
- The George Washington School of Medicine and Health Sciences, Washington, DC, USA
| | - Stephano S Bonitto
- The George Washington School of Medicine and Health Sciences, Washington, DC, USA
| | - Alana Sadur
- The George Washington School of Medicine and Health Sciences, Washington, DC, USA
| | - Richard Amdur
- Department of Surgery, Division of Thoracic Surgery, The George Washington University Hospital, Washington, DC, USA
| | | | - Michael A Napolitano
- Department of Surgery, Division of Thoracic Surgery, The George Washington University Hospital, Washington, DC, USA
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Cho Y, Lee HN, Shin JH, Park SJ, Lee S, Song JS. Double-Pigtail Drainage Catheter: A New Design for Efficient Pleural Drainage. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1089. [PMID: 37374293 DOI: 10.3390/medicina59061089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 05/13/2023] [Accepted: 05/30/2023] [Indexed: 06/29/2023]
Abstract
Background and Objectives: The novel double-pigtail catheter (DPC) has an additional pigtail coiling at the mid-shaft with multiple centripetal side holes. The present study aimed to investigate the advantages and efficacy of DPC in overcoming the complications of conventional single-pigtail catheters (SPC) used to drain pleural effusion. Materials and Methods: Between July 2018 and December 2019, 382 pleural effusion drainage procedures were reviewed retrospectively (DPC, n = 156; SPC without multiple side holes, n = 110; SPC with multiple side holes (SPC + M), n = 116). All patients showed shifting pleural effusions in the decubitus view of the chest radiography. All catheters were 10.2 Fr in diameter. One interventional radiologist performed all procedures and used the same anchoring technique. Complications (dysfunctional retraction, complete dislodgement, blockage, and atraumatic pneumothorax) were compared among the catheters using chi-square and Fisher's exact tests. Clinical success was defined as an improvement in pleural effusion within three days without additional procedures. Survival analysis was performed to calculate the indwelling time. Results: The dysfunctional retraction rate of DPC was significantly lower than that of the other catheters (p < 0.001). Complete dislodgement did not occur in any of the DPC cases. The clinical success rate of DPC (90.1%) was the highest. The estimated indwelling times were nine (95% confidence interval (CI): 7.3-10.7), eight (95% CI: 6.6-9.4), and seven (95% CI: 6.3-7.7) days for SPC, SPC + M, and DPC, respectively, with DPC showing a significant difference (p < 0.05). Conclusions: DPC had a lower dysfunctional retraction rate compared to conventional drainage catheters. Furthermore, DPC was efficient for pleural effusion drainage with a shorter indwelling time.
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Affiliation(s)
- Youngjong Cho
- Department of Radiology, University of Ulsan College of Medicine, Gangneung Asan Hospital, 38 Bangdong-gil, Gangneung 25440, Republic of Korea
| | - Hyoung Nam Lee
- Department of Radiology, Soonchunhyang University College of Medicine, Cheonan Hospital, Cheonan 31151, Republic of Korea
| | - Ji Hoon Shin
- Department of Radiology, University of Ulsan College of Medicine, Asan Medical Centre, 88 Olympic-ro 43-gil, Seoul 05505, Republic of Korea
| | - Sung-Joon Park
- Department of Radiology, Korea University College of Medicine, Korea University Ansan Hospital, Ansan 15355, Republic of Korea
| | - Sangjoon Lee
- Vascular Center, The Eutteum Orthopedic Surgery Hospital, Paju 10905, Republic of Korea
| | - Jae-Seok Song
- Department of Preventive Medicine & Public Health, Catholic Kwandong University College of Medicine, 24 Beomil-ro 579beon-gil, Gangneung 25601, Republic of Korea
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The Application of Pigtail Catheters in Postoperative Drainage of Lung Cancer. Clin Lung Cancer 2021; 23:e196-e202. [PMID: 34426075 DOI: 10.1016/j.cllc.2021.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 06/12/2021] [Accepted: 07/08/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Although minimally invasive surgery has been widely carried out at present, the postoperative pain of patients with lung cancer is still one of the difficult problems to solve in clinical practice. OBJECTIVE This study explored whether indwelling pigtail catheters after lung cancer surgery can help to reduce postoperative pain and promote the recovery of patients as soon as possible. MATERIALS AND METHODS From June 2018 to June 2020, patients who underwent thoracoscopic radical resection of lung cancer in our hospital were randomly divided into 2 groups: the pigtail catheter group and the control group. We compared the postoperative time of thoracic catheter removal, postoperative pain score, proportion of postoperative pleural effusion, postoperative hospitalization time, and postoperative complications of the 2 groups. RESULTS A total of 1375 patients were enrolled, including 677 patients in the pigtail catheter group and 698 patients in the control group. Compared with the control group, the pigtail catheter group had an earlier time of thoracic catheter removal, lower postoperative pain score, lower proportion of pleural effusion diagnosed by postoperative chest radiograph, and shorter postoperative average hospital stay, but there was no significant difference in postoperative complications. CONCLUSION The application of pigtail catheters after radical resection of lung cancer can reduce postoperative pain, accelerate the recovery of patients and shorten the postoperative hospital stay and is safe and reliable in clinical application.
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Heraganahally SS, Silva SAMS, Howarth TP, Kangaharan N, Majoni SW. Comparison of clinical manifestation among Australian Indigenous and non- Indigenous patients presenting with pleural effusion. Intern Med J 2021; 52:1232-1241. [PMID: 33817935 DOI: 10.1111/imj.15310] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 03/24/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND There is sparse evidence in the literature in relation to the nature and causes of pleural effusion among Australian Indigenous population. METHODS In this retrospective study, Indigenous and non-Indigenous adults diagnosed to have pleural effusion over a two-year study period were included for comparative analysis. RESULTS Of the 314 patients, 205 (65%) were non-Indigenous and 52% were males. In comparison to non-Indigenous, the Indigenous patients were younger (50 years (IQR 39,60) vs 63 years (IQR 52,72), p<0.001), females (61% vs 41%, p=0.001), have higher prevalence of renal and cardiovascular disease and tend to have exudative effusion (93% vs 76%, p=0.032). Infections was judged to be the most common cause for effusion in both groups, more so among the Indigenous cohort. Effusion secondary to renal disease was higher (13% vs 1%, p<0.001) among Indigenous Australians, in contrast malignant effusions were higher (13% vs 4%, p=0.004) among non-Indigenous. Length of hospital stay was longer for Indigenous patients (p=0.001), and a greater proportion received renal dialysis (13% vs 1%, p<0.001). Intensive care unit (ICU) admissions rates were higher with infective etiology of pleural effusion (82% vs. 53% Indigenous & 44% vs. 39% non-Indigenous respectively). Re-presentations to hospital were higher among Indigenous patients (46% vs 33%, p=0.046) and were associated with renal and cardiac disease and malignancy in non-Indigenous. CONCLUSION There are significant differences in the way pleural effusion manifests among Australian Indigenous patients. Understanding these differences may facilitate approaches to the management and to implement strategies to reduce morbidity and mortality in this population. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Subash Shanthakumar Heraganahally
- Department of Respiratory and Sleep Medicine, Royal Darwin Hospital, Tiwi, Darwin, Northern Territory, Australia.,College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia.,Northern Territory Medical Program, Flinders University, Darwin, Northern Territory, Australia.,Darwin Respiratory and Sleep Health, Darwin Private Hospital, Tiwi, Darwin, Northern Territory, Australia
| | - Sampathawaduge Anton Mario Shemil Silva
- Department of Respiratory and Sleep Medicine, Royal Darwin Hospital, Tiwi, Darwin, Northern Territory, Australia.,College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia.,Northern Territory Medical Program, Flinders University, Darwin, Northern Territory, Australia
| | - Timothy Paul Howarth
- Darwin Respiratory and Sleep Health, Darwin Private Hospital, Tiwi, Darwin, Northern Territory, Australia.,College of Health and Human Sciences, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Nadarajah Kangaharan
- Department of General Medicine, Royal Darwin Hospital, Tiwi, Darwin, Northern Territory, Australia.,NT Cardiac service, Darwin Private Hospital, Tiwi, Darwin, Northern Territory, Australia
| | - Sandawana William Majoni
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia.,Northern Territory Medical Program, Flinders University, Darwin, Northern Territory, Australia.,Department of Nephrology, Royal Darwin Hospital, Tiwi, Darwin, Northern Territory, Australia.,Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
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