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Nascimento IKDO, Morad HM, Perlingeiro JAG, Parreira JG, Assef JC. Predictors of pleural complications in trauma patients undergoing tube thoracostomy: A prospective observational study. Rev Col Bras Cir 2022; 49:e20223300. [PMID: 36000682 PMCID: PMC10578792 DOI: 10.1590/0100-6991e-20223300-en] [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: 02/11/2022] [Accepted: 05/14/2022] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE to identify variables related to pleural complications in patients undergoing tube thoracostomies due to traumatic injuries. METHOD we conducted a prospective observational study from May/2019 to January/2021 including adult trauma patients submitted to tube thoracostomies after hospital admission. Patients undergoing thoracotomies as the initial treatment were not included. We excluded patients with suspected and confirmed COVID-19 diagnosis during the hospitalization. Pleural complications were defined as clotted hemothorax, residual pneumothorax and empyema. Students t, Mann Whitneys, Chi square and Fishers exact test were used to compare variables between groups. We considered p<0.05 as significant. RESULTS we analyzed 68 patients. The mean age was 36.0 + 12.6 years and 91.2% were male. The mean RTS and ISS were, respectively, 7.0 ± 1.6 and 15.9 ± 7.6. The most frequent trauma mechanism was stab wounds in 50.0%, followed by blunt trauma in 38.2%. The severity of thoracic injuries was stratified (AIS) as 2 (4.4%), 3 (80.9%), 4 (13.2%), e 5 (1.5%). Pleural complications happened in 14 (20.5%) patients, being clotted / residual hemothorax (11.8%), residual pneumothorax (4.4%), empyema (2.9%) and miscellaneous (1.4%). These patients were treated by thoracoscopy (5), thoracotomy (3), chest re-drainage (3) and clinical measures alone (3). There was a significant association between pleural complications with the time of permanence (p<0,001) and the necessity of relocation (p<0,001) of the drain. CONCLUSION the predictors of pleural complications in this series were time of permanence and the necessity of relocation of the drain.
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Affiliation(s)
| | - Helena Machado Morad
- - Faculdade de Ciências Médicas da Santa Casa de São Paulo, Cirurgia - São Paulo - SP - Brasil
| | - Jacqueline Arantes Gianninni Perlingeiro
- - Faculdade de Ciências Médicas da Santa Casa de São Paulo, Cirurgia - São Paulo - SP - Brasil
- - Irmandade da Santa Casa de Misericórdia de São Paulo, Serviço de Emergência - São Paulo - SP - Brasil
| | - José Gustavo Parreira
- - Faculdade de Ciências Médicas da Santa Casa de São Paulo, Cirurgia - São Paulo - SP - Brasil
- - Irmandade da Santa Casa de Misericórdia de São Paulo, Serviço de Emergência - São Paulo - SP - Brasil
| | - Jose Cesar Assef
- - Faculdade de Ciências Médicas da Santa Casa de São Paulo, Cirurgia - São Paulo - SP - Brasil
- - Irmandade da Santa Casa de Misericórdia de São Paulo, Serviço de Emergência - São Paulo - SP - Brasil
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NASCIMENTO ISISKOBASHIGAWADO, MORAD HELENAMACHADO, PERLINGEIRO JACQUELINEARANTESGIANNINNI, PARREIRA JOSÉGUSTAVO, ASSEF JOSECESAR. Fatores preditivos de complicações pleurais em vítimas de trauma submetidas à drenagem pleural: Estudo prospectivo observacional. Rev Col Bras Cir 2022. [DOI: 10.1590/0100-6991e-20223300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO Objetivo: identificar as variáveis relacionadas às complicações pleurais em vítimas de trauma submetidas a drenagem torácica. Método: estudo observacional prospectivo entre maio/2019 e janeiro/2021, incluindo adultos submetidos a drenagem torácica após a admissão hospitalar para tratamento de lesões traumáticas. Pacientes que desenvolveram COVID19 foram excluídos. As complicações pleurais foram caracterizadas como: pneumotórax residual, hemotórax residual / coagulado e empiema pleural. Comparamos as variáveis coletadas entre os grupos de pacientes com e sem estas complicações. Os testes t de Student, Mann Whitney, Chi quadrado e Fisher foram utilizados para análise estatística. Foram considerados significativos valores de p<0,05. Resultados: analisamos 68 casos, com média etária de 36,0 + 12,6 anos, de RTS de 7,0 ± 1,6 e ISS de 15,9 ± 7,6, sendo 62 (91,2%) do sexo masculino. Trinta e quatro pacientes (50,0%) foram vítimas de ferimento por arma branca. O AIS das lesões torácicas foi classificado como 2 (4,4%), 3 (80,9%), 4 (13,2%), e 5 (1,5%). As complicações pleurais ocorreram em 14 casos (20,5%), sendo hemotórax residual / coagulado em 8 casos (11,8%), pneumotórax residual em 3 (4,4%), o empiema pleural em 2 (2,9%) e associações em 1 (1,4%). Estas complicações foram tratadas por videotoracoscopia (5 casos), toracotomia (3), redrenagem de tórax (3) e medidas clínicas apenas (3). A redrenagem de tórax (p<0,001) e o tempo de permanência do dreno (p<0,001) tiveram relação significativa com a presença de complicações pleurais. Conclusão: a redrenagem do tórax e o maior tempo de permanência do dreno foram associados às complicações pleurais.
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Affiliation(s)
| | | | | | - JOSÉ GUSTAVO PARREIRA
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, Brazil; Irmandade da Santa Casa de Misericórdia de São Paulo, Brazil
| | - JOSE CESAR ASSEF
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, Brazil; Irmandade da Santa Casa de Misericórdia de São Paulo, Brazil
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Shah A, Dave S, Galvagno S, George K, Menne AR, Haase DJ, McCormick B, Rector R, Dahi S, Madathil RJ, Deatrick KB, Ghoreishi M, Gammie JS, Kaczorowski DJ, Scalea TM, Menaker J, Herr D, Tabatabai A, Krause E. A Dedicated Veno-Venous Extracorporeal Membrane Oxygenation Unit during a Respiratory Pandemic: Lessons Learned from COVID-19 Part II: Clinical Management. MEMBRANES 2021; 11:306. [PMID: 33919390 PMCID: PMC8143287 DOI: 10.3390/membranes11050306] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 04/15/2021] [Accepted: 04/17/2021] [Indexed: 01/14/2023]
Abstract
(1) Background: COVID-19 acute respiratory distress syndrome (CARDS) has several distinctions from traditional acute respiratory distress syndrome (ARDS); however, patients with refractory respiratory failure may still benefit from veno-venous extracorporeal membrane oxygenation (VV-ECMO) support. We report our challenges caring for CARDS patients on VV-ECMO and alterations to traditional management strategies. (2) Methods: We conducted a retrospective review of our institutional strategies for managing patients with COVID-19 who required VV-ECMO in a dedicated airlock biocontainment unit (BCU), from March to June 2020. The data collected included the time course of admission, VV-ECMO run, ventilator length, hospital length of stay, and major events related to bleeding, such as pneumothorax and tracheostomy. The dispensation of sedation agents and trial therapies were obtained from institutional pharmacy tracking. A descriptive statistical analysis was performed. (3) Results: Forty COVID-19 patients on VV-ECMO were managed in the BCU during this period, from which 21 survived to discharge and 19 died. The criteria for ECMO initiation was altered for age, body mass index, and neurologic status/cardiac arrest. All cannulations were performed with a bedside ultrasound-guided percutaneous technique. Ventilator and ECMO management were routed in an ultra-lung protective approach, though varied based on clinical setting and provider experience. There was a high incidence of pneumothorax (n = 19). Thirty patients had bedside percutaneous tracheostomy, with more procedural-related bleeding complications than expected. A higher use of sedation was noted. The timing of decannulation was also altered, given the system constraints. A variety of trial therapies were utilized, and their effectiveness is yet to be determined. (4) Conclusions: Even in a high-volume ECMO center, there are challenges in caring for an expanded capacity of patients during a viral respiratory pandemic. Though institutional resources and expertise may vary, it is paramount to proceed with insightful planning, the recognition of challenges, and the dynamic application of lessons learned when facing a surge of critically ill patients.
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Affiliation(s)
- Aakash Shah
- Department of Surgery, Division of Cardiac Surgery, School of Medicine, University of Maryland, Baltimore, MD 21201, USA; (S.D.); (R.J.M.); (K.B.D.); (M.G.); (J.S.G.)
| | - Sagar Dave
- Program in Trauma, Department of Surgery, School of Medicine, University of Maryland, Baltimore, MD 21201, USA; (S.D.); (K.G.); (T.M.S.); (D.H.)
| | - Samuel Galvagno
- Program in Trauma, Department of Anesthesiology, School of Medicine, University of Maryland, Baltimore, MD 21201, USA;
| | - Kristen George
- Program in Trauma, Department of Surgery, School of Medicine, University of Maryland, Baltimore, MD 21201, USA; (S.D.); (K.G.); (T.M.S.); (D.H.)
| | - Ashley R. Menne
- Program in Trauma, Department of Emergency Medicine, School of Medicine, University of Maryland, Baltimore, MD 21201, USA; (A.R.M.); (D.J.H.)
| | - Daniel J. Haase
- Program in Trauma, Department of Emergency Medicine, School of Medicine, University of Maryland, Baltimore, MD 21201, USA; (A.R.M.); (D.J.H.)
| | - Brian McCormick
- Perfusion Services, University of Maryland Medical Center, Baltimore, MD 21201, USA; (B.M.); (R.R.)
| | - Raymond Rector
- Perfusion Services, University of Maryland Medical Center, Baltimore, MD 21201, USA; (B.M.); (R.R.)
| | - Siamak Dahi
- Department of Surgery, Division of Cardiac Surgery, School of Medicine, University of Maryland, Baltimore, MD 21201, USA; (S.D.); (R.J.M.); (K.B.D.); (M.G.); (J.S.G.)
| | - Ronson J. Madathil
- Department of Surgery, Division of Cardiac Surgery, School of Medicine, University of Maryland, Baltimore, MD 21201, USA; (S.D.); (R.J.M.); (K.B.D.); (M.G.); (J.S.G.)
| | - Kristopher B. Deatrick
- Department of Surgery, Division of Cardiac Surgery, School of Medicine, University of Maryland, Baltimore, MD 21201, USA; (S.D.); (R.J.M.); (K.B.D.); (M.G.); (J.S.G.)
| | - Mehrdad Ghoreishi
- Department of Surgery, Division of Cardiac Surgery, School of Medicine, University of Maryland, Baltimore, MD 21201, USA; (S.D.); (R.J.M.); (K.B.D.); (M.G.); (J.S.G.)
| | - James S. Gammie
- Department of Surgery, Division of Cardiac Surgery, School of Medicine, University of Maryland, Baltimore, MD 21201, USA; (S.D.); (R.J.M.); (K.B.D.); (M.G.); (J.S.G.)
| | - David J. Kaczorowski
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA;
| | - Thomas M. Scalea
- Program in Trauma, Department of Surgery, School of Medicine, University of Maryland, Baltimore, MD 21201, USA; (S.D.); (K.G.); (T.M.S.); (D.H.)
| | - Jay Menaker
- Department of Surgery, University of California San Francisco Medical Center, San Francisco, CA 94143, USA;
| | - Daniel Herr
- Program in Trauma, Department of Surgery, School of Medicine, University of Maryland, Baltimore, MD 21201, USA; (S.D.); (K.G.); (T.M.S.); (D.H.)
| | - Ali Tabatabai
- Program in Trauma, Department of Medicine, Division of Pulmonary and Critical Care, School of Medicine, University of Maryland, Baltimore, MD 21201, USA;
| | - Eric Krause
- Department of Surgery, Division of Thoracic Surgery, School of Medicine, University of Maryland, Baltimore, MD 21201, USA;
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