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PubMed2004

Tube thoracostomy during allogeneic stem cell transplantation does not carry an increased risk for infections or bleeding.

BACKGROUND: Candidates for stem cell transplantation may occasionally suffer from massive pleural effusions related to their disease and require tube thoracostomy. The additional risk of this procedure during allogeneic transplantation procedure is not known. METHODS: Four high-risk patients transplanted in our institution during a 2-yr period had chest drainage by tube thoracostomy. The characteristics of the fluid, the clinical course, and the outcome were assessed. RESULTS: A total of nine chest drains were inserted (range 1-5). No bleeding complications related to the procedure were noted. None of the patients developed any clinical signs of local infection at the tube insertion site or within the pleural fluid. All cultures taken from the drained fluid or from the insertion wound were negative. CONCLUSIONS: Tube thoracostomy in itself does not seem to pose additional risks in the transplant procedure, despite all patients in this series being considered to be at high-risk for complications.

Adult↗
PubMed2006

Efficacy and safety of iodopovidone pleurodesis through tube thoracostomy.

OBJECTIVE: To evaluate the efficacy and safety of iodopovidone as an agent for pleurodesis through tube thoracostomy in patients with recurrent pleural effusions and pneumothorax. METHODS: This was a prospective study in which pleurodesis was performed with a solution of 20 mL 10% iodopovidone and 80 mL normal saline solution infused through a tube thoracostomy and left in the pleural cavity for 4 h. RESULTS: A total of 64 patients (34 men) with a mean (+/-SD) age of 47.1 +/- 15.4 years were included. There were 37 cases of pleural effusion and 27 of pneumothorax. A complete response (neither reaccumulation of fluid nor recurrence of pneumothorax) was obtained in 32 (86.5%) patients with pleural effusion and 25 (92.6%) patients with pneumothorax. A second procedure (i.e. repeated pleurodesis) was attempted successfully in four patients in the pleural effusion group. All patients experienced chest pain to a varying degree as recorded on a Visual Analogue Scale (median 50.5, range 10-95). Seven patients developed fever and one immunocompromised patient developed empyema following the procedure. There were no recurrences at a median follow up of 5 months (range 3-15 months) in the pleural effusion group, and 13 months (range 6-24 months) in the pneumothorax group. CONCLUSIONS: Iodopovidone can be used as an effective and safe agent for (chemical) pleurodesis (through tube thoracostomy), which is inexpensive and readily available.

Anti-Infective Agents, Local↗
PubMed2001

The value of small-bore catheter thoracostomy in the treatment of malignant pleural effusions.

BACKGROUND: Malignant pleural effusions can cause severe debilitating symptoms and impair the quality of life. Treatment is often palliative, usually consisting of sequential thoracenteses or tube thoracostomy with or without sclerotherapy. Large-bore thoracostomy tubes have traditionally been used for drainage and sclerotherapy. More recently, the use of small-bore catheters has been studied. OBJECTIVES: To assess the efficacy and safety of small-bore catheter (Pleuracan) thoracostomy combined with talc sclerotherapy for palliative treatment of malignant pleural effusions. METHODS: Between May 1998 and March 2000, 24 consecutive patients presenting at our inpatient clinic were studied. Follow-up radiography at the end of the 1st month (immediate response) and 3rd month (long-term follow-up) after talc pleurodesis was performed to assess the response rates. RESULTS: Of the 24 patients included, 2 patients did not show lung expansion after pleural drainage. Two patients died within 30 days after talc pleurodesis and 1 did not undergo 30-day postpleurodesis radiography. The remaining 19 patients made up the study group to assess the response rates (8 men, 11 women). Overall response rates of talc pleurodesis via small-bore catheter were found to be 84.2% [complete response (CR): 68.4%, partial response (PR): 15.8%] at 30-day and 78.6% (CR: 57.2%, PR:2 1.4%) at 90-day follow-up, respectively. One patient reported moderate pain during catheter placement. Four patients experienced mild to moderate pleuritic chest pain, shortness of breath, or both within 4 h after instillation. Seven of the 22 patients (31.8%) had a transient fever (< or =39.0 degrees C) 6-24 h after talc instillation that lasted less than 24 h and was successfully treated with acetaminophen. One patient had significant subcutaneous emphysema that resolved in 24 h. Four patients died because of tumor progress (2 patients in the 1st month and 2 patients between 30 and 90 days). CONCLUSION: Pleurodesis can successfully be performed via a small-bore catheter in patients with recurrent malignant pleural effusion. To validate the results of the study, a prospective randomized study, comparing this device (Pleuracan) and a 'standard' 16- to 24-french chest drain, should be performed.

Adenocarcinoma↗
PubMedDate not supplied

The effect of tube thoracostomy on oxygenation in ICU patients.

Previous research found that in noncritically ill patients, thoracocentesis has an unpredictable effect on oxygenation, possibly due to re-expansion pulmonary edema and systemic hypotension. The authors performed a retrospective analysis to study the effect of tube thoracostomy on oxygenation in ICU patients, and the complications associated with it. The authors reviewed the charts of 58 ICU patients in whom 74 procedures were performed. Demographic data, APACHE II score, and indication for thoracocentesis were retrieved from the patient's file. The P(a)O(2)/FiO(2) ratio was calculated before, 12, 24, and 48 hours after tube thoracostomy. P(a)O(2)/FiO(2) ratios at the mentioned time intervals were compared using 1-way analysis of variances (ANOVA) with repeated measures. Logistic regression analysis was used to identify factors associated with a good response to treatment. Age of the patients was 53 +/- 19.0 years (range, 17-88), APACHE II score was 21 +/- 8.3 (range, 6-38), and median length of stay was 13.5 days (interquartile range, 7-25). The volume drained during the first 24 hours was 1077 +/- 667 ml. P(a)O(2)/FiO(2) ratio was 185 +/- 79.3 before chest drainage, 197 +/- 79.1 at 12 hours, 217 +/- 88.9 at 24 hours, and 233 +/- 99.8 at 48 hours. In only 54% of the procedures, a response to therapy was present. Multivariate analysis identified a P(a)O(2)/FiO(2) below 180 to be independently associated with improvement in oxygenation. At 24 and 48 hours, the P(a)O(2)/FiO(2) ratio was significantly higher than before drainage (P <.001). There were 13 complications in 11 procedures (14.9%). The authors' results suggest that tube thoracostomy can be used as an adjunct in the treatment of selected patients with hypoxemic respiratory failure in the ICU. A low P(a)O(2)/FiO(2) seems to be a good predictor of response to therapy. However, the complication rate is considerable, especially in patients with a prolonged ICU stay.

APACHE↗
PubMed1999

[Pyothorax associated lymphoma treated by chemotherapy after thoracostomy].

A 62-year-old man with a medical history that included artificial pneumothorax therapy at the age of 18 was admitted to our hospital because of persistent cough. Chest computed tomographic scans disclosed atelectasis in the right lung and pyothorax surrounded by calcifications. Radiographic examination failed to disclose any tumors. After admission, high grade fever developed due to aggravated pyothorax infection. Because antibiotic therapy and drainage failed, open window thoracostomy was performed. Tumors were found along the wall of the pyothorax cavity, and examination of resected specimens yielded a diagnosis of non-Hodgkin's lymphoma, diffuse large cell type (B-cell lineage). It was difficult to close the pyothorax cavity due to infection and lymphoma. Therefore, with the thoracic window open, the patient was given combination chemotherapy including CHOP (6 courses) and DeVIC (7 courses). He died of disseminated intravascular coagulation 17 months after thoracostomy. In patients with pyothorax associated lymphoma, chemotherapy is sometimes difficult to perform because of persistent pyothorax infection. Although edema and ascites due to protein loss from the tumor complicated the treatment of our patient, we concluded that open window thoracostomy is effective in managing pyothorax prior to and during chemotherapy.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1992

Prophylactic antibiotics for the prevention of infectious complications including empyema following tube thoracostomy for trauma: results of meta-analysis.

Since 1977, six clinical trials have been performed on the subject of routine antibiotic prophylaxis in patients requiring tube thoracostomy for trauma. No definitive conclusions have been reached regarding the efficacy of antibiotic use in this setting. The results of these clinical trials were pooled to generate an unbiased estimate of the efficacy of antibiotic prophylaxis for tube thoracostomy using the technique of meta-analysis. Meta-analysis is a statistical method for synthesizing results from separate but similar experiments, grouping them, and comparing each to the null hypothesis. Meta-analysis allows synthesis of all of the available data on antibiotic prophylaxis for tube thoracostomy to resolve the controversy surrounding this issue generated by different but similar clinical studies with conflicting results. Despite different conclusions of value when taken individually, the combined analysis does not support the null hypothesis (no effect of antibiotics). The statistical method is highly significant despite different mechanisms of injury, pathologic findings, and antibiotics employed.

Anti-Bacterial Agents↗
PubMed1988

Bronchopleural fistula. A novel type of window thoracostomy.

Bronchopleural fistula usually associated with chronic empyema after lung operations continues to occur in modern surgical practice. Successful treatment depends to a large extent on adequate dependent drainage of the empyema space. Tube thoracostomy, although useful initially, is unacceptable as long-term treatment. Window thoracostomy as currently performed is effective but unnecessarily extensive. We describe a simpler procedure, triangular window thoracostomy, for use as a permanent pleurocutaneous stoma or as an interim measure before definitive surgical treatment.

Bronchial Fistula↗
PubMed1996

[A case of right postpneumonectomy empyema treated by open window thoracostomy, thoracoplasty, pedicled omental flap and musculocutaneous flaps].

A case of right postpneumonectomy empyema treated by open window thoracostomy, thoracoplasty, pedicled omental flap and musculocutaneous flaps is reported. After open window thoracostomy, pedicled omental flap and musculocutaneous flaps transplantation utilizing techniques used in plastic surgery were performed, and right postneumonctomy empyema was successfully treated. In this study, open window thoracostomy was effective against depuration of the empyema cavity and omental and musculocutaneous flaps against the infection control and plombage of the cavity. Furthermore, to maximize the effect of musculocutaneous flaps and to use them effectively, it is thought that techniques utilized in plastic surgery are effective and necessary.

Adenocarcinoma↗
PubMed1998

Role of prophylactic antibiotics for tube thoracostomy in chest trauma.

The objective of this study was to evaluate the efficacy of antibiotic prophylaxis in association with tube thoracostomy for chest trauma patients with Injury Severity Scores of 9 or 10. A double-blind randomized clinical trial of patients requiring tube thoracostomy was performed at an urban Level 1 trauma center. All patients included in this series were patients with Injury Severity Scores of 9 or 10 (hemothorax/pneumothorax) who suffered isolated chest trauma secondary to blunt or penetrating trauma. Before chest tube placement, 139 patients (34 blunt trauma, 105 penetrating trauma) were blindly randomized to Group A (71 patients) for which they received 1 g cefazolin intravenously every 8 hours or Group B (68 patients) for which they received a placebo intravenously every 8 hours. Antibiotic or placebo was administered before chest tube insertion and continued until the time of chest tube removal. The majority of patients underwent chest tube placement in the emergency room with a small number of delayed pneumothoraces (4 patients) treated after admission. In the 71 patients receiving antibiotic, 7 complications (1 pleural effusion, 2 chest tube reinsertions, 4 additional chest tubes) occurred, none of which were infectious. In the 68 patients receiving placebo, 7 complications (2 empyemas, 2 pneumonias with effusions, 1 pleural effusion, 2 chest tube reinsertions) occurred, 4 of which were infectious and required antibiotic intervention (P = 0.05, Fisher's exact test). This study showed that patients receiving antibiotics have a significantly reduced incidence of infectious complications and suggests that patients who undergo tube thoracostomy for chest trauma would benefit from administration of prophylactic antibiotics.

Adult↗
PubMed1980

Complications of tube thoracostomy for acute trauma.

Closed tube thoracostomy is a common and very useful procedure in therapy of acute thoracic injury. However, it is not without risk. With aggressive use of this procedure in the emergency department, the incidence of technical complications was 1 percent. Our review suggests that complications can be further diminished by the routine use of large thoracostomy tubes that are placed well up on the chest after confirmation of an open pleural space, by avoiding the use of a trocar for tube placement, and by the use of a high volume, low pressure suction system. Empyema was the most common complication associated with tube thoracostomy after trauma. It occurred in 2.4 percent of the patients. Its exact causes is not known, and the role of prophylactic antibiotics needs to be established.

Adolescent↗
PubMedDate not supplied

Horner's syndrome: a delayed complication after thoracostomy tube removal.

PURPOSE: Description of a complication from tube thoracostomy. METHODS: Case report from experience at an Air Force tertiary care hospital in a 50-year-old female smoker undergoing left upper lobectomy for lung cancer. RESULTS: Horner's syndrome resulted 18 hours after removal of an apical thoracostomy tube. CONCLUSIONS: Horner's syndrome caused by tube thoracostomy is a rare but real complication. One should avoid placing the tip of the tube in the medial thoracic apex with the intent of avoiding second-order sympathetic chain pathways. As evidenced by our patient with a delayed onset of presentation, malpositioned tubes should be repositioned before symptoms develop. Long-term prognosis is poor once Horner's syndrome develops.

Journal Article↗
PubMed1994

Efficacy of short term versus long term tube thoracostomy drainage before tetracycline pleurodesis in the treatment of malignant pleural effusions.

BACKGROUND: A study was undertaken to compare the efficacy of short term tube thoracostomy drainage with standard tube thoracostomy drainage before instillation of tetracycline for sclerotherapy of malignant pleural effusions. METHODS: The study consisted of a randomised clinical trial in a sequential sample of 25 patients with malignant pleural effusions documented cytopathologically. Fifteen patients were randomly assigned to group 1 (standard protocol) and 10 to group 2 (short term protocol). Patients in group 1 had tube thoracostomy suction drainage until radiological evidence of lung re-expansion was obtained and the amount of fluid drained was < 150 ml/day, before tetracycline (1.5 g) was instilled. The chest tube was removed when the amount of fluid drained after instillation was < 150 ml/day. Patients in group 2 also had suction drainage, but the tetracycline (1.5 g) was instilled when the chest radiograph showed the lung to be re-expanded and the effusion drained, which was usually within 24 hours. The chest tube was removed the next day. RESULTS: The response to tetracycline sclerotherapy in the two groups was the same (80%) but the duration of chest tube drainage was significantly shorter for patients in group 2 (median two days) than for those in group 1 (median seven days). CONCLUSIONS: The duration of chest tube drainage before sclerotherapy for malignant pleural effusions need not be influenced by the amount of fluid drained daily but by radiographic evidence of fluid evacuation and lung re-expansion. Shorter duration of drainage will reduce the length of hospital stay without sacrificing the efficacy of pleurodesis.

Adult↗
PubMed1985

Giant lung abscess treated by tube thoracostomy.

Pulmonary resection is the recommended treatment for large lung abscesses that do not respond to medical management. Tube thoracostomy, effective in the past, has been used less and less in recent years. Personal experience with three patients and a review of the literature led me to the following conclusions: In the treatment of a lung abscess 8 cm or larger, tube thoracostomy is an effective form of drainage, is probably safer than pulmonary resection, and may yield a superior result. Rather than being reserved as a desperation measure for poor risk patients, tube thoracostomy should be considered early in the hospital course.

Adolescent↗
PubMed1983

Open window thoracostomy in the management of postpneumonectomy empyema with or without bronchopleural fistula.

Postpneumonectomy empyema, with or without bronchopleural fistula, remains an infrequent but serious complication of pulmonary resection. We reviewed our experience with the Clagett procedure in 31 patients with postpneumonectomy empyema. Seven had empyema alone and 24 had empyema with bronchopleural fistula. Ten patients died of metastatic disease without attempted closure of the thoracostomy window. In eight patients the total Clagett procedure was completed; window closure was permanent in two patients, but the remaining six had recurrence of empyema (four of whom had persistent occult fistulas). In eight further patients, persistent infection prevented attempted closure of the window. Five patients refused further surgical procedures. In only two of 31 patients were we able to achieve permanent closure of the thoracostomy window. Based on this experience, we conclude that open window thoracostomy provides adequate drainage and an excellent interim or permanent treatment of the infected pneumonectomy space. However, the presence of persistent bronchopleural fistula prevents successful completion of the total Clagett procedure. In our series, there were no deaths related to empyema or the surgical procedures performed for it.

Anti-Bacterial Agents↗
PubMed1995

Tube thoracostomy. Factors related to complications.

OBJECTIVE: To determine the complication rate and risk factors associated with tube thoracostomy (TT) in the trauma patient. DESIGN: Retrospective hospital chart review. SETTING: Level I trauma center. PATIENTS: Four hundred twenty-six consecutive patients who underwent TT were initially reviewed; 47 deaths occurred unrelated to TT placement. The remaining 379 patients required 599 tubes and composed the study population. MAIN OUTCOME MEASURES: The determination of adverse outcomes related to TT, including thoracic empyema, undrained hemothorax or pneumothorax, improper tube positioning, post-tube removal complications, and direct injuries to the lung. RESULTS: The overall complication rate was 21% per patient. Although complications were not related to the Injury Severity Score, the presence of shock, admission to the intensive care unit, and the need for mechanical ventilation were associated with the increased incidence of complications. There were fewer complications (6%) when the TT was performed by a surgeon compared with TT performed by an emergency physician (13%, P < .0001) or TT performed prior to transfer to our hospital (38%, P < .0001). CONCLUSIONS: Tube thoracostomy is associated with significant morbidity. The striking difference in the complication rate between surgeons and other physicians who perform this procedure suggests that additional training may be indicated.

Adult↗
PubMedDate not supplied

Over-the-wire placement of large bore thoracostomy tubes.

A simple method is described for placement of large caliber thoracostomy tubes utilizing an over-the-wire (Seldinger) technique. The method employs an angioplasty balloon catheter on which a renal fascial dilator and sheath are mounted. Through the sheath a large caliber thoracostomy tube is placed into the pleural space.

Humans↗
PubMed2001

Are chest radiographs routinely necessary following thoracostomy tube removal?

OBJECTIVE: Chest radiographs (CXRs) are routinely obtained at many institutions in all pediatric patients following thoracostomy tube removal to search for pneumothorax (PTX). To aid in evaluating the necessity of this practice, this study investigates whether clinical signs and symptoms may be a sensitive predictor of PTX in such patients. MATERIALS AND METHODS: Reports from CXRs obtained following chest tube removal in all pediatric patients (374 patients) who underwent cardiac surgery with chest tube placement over 1 year were reviewed. For cases with reported PTX, the PTX was quantified and chart review was performed to assess whether signs and symptoms of PTX preceded the CXR result. RESULTS: Fifty-one of 374 children (13.6%) had a radiographically defined PTX within 6 h after thoracostomy tube removal. The PTX was large (>40%) in 2 children, moderate (20-40%) in 5 children, and small (<20%) in 44 children. Symptoms (dyspnea, tachypnea, respiratory distress) or signs (increased oxygen requirement, worsening arterial blood gas and/or hypotension) of respiratory distress were present at the time of the initial CXR in six of seven patients, who later underwent a major clinical intervention, and in one patient who did not. Major clinical interventions were performed in all patients with a large PTX, four of five patients with a moderate PTX, and one patient with a small PTX that later enlarged. CONCLUSIONS: Clinical signs and symptoms identified nearly all patients with significant pneumothoraces. Future prospective investigations may examine reserving chest radiography following chest tube removal for select groups, such as symptomatic patients or those with tenuous cardiovascular status.

Adolescent↗
PubMed2006

Management of multiple tension pneumatoceles refractory to tube thoracostomy decompression.

A 10-month-old boy had multiple tension pneumatoceles develop 4 weeks after pneumonia with parapneumonic empyema caused by methicillin-resistant Staphylococcus aureus. The pneumatoceles failed to completely respond to tube thoracostomy drainage, and sudden onset of cardiopulmonary collapse occurred after induction of anesthesia. He was rescued by multiple percutaneous venous catheter decompressions, followed by lobectomy. Our experience showed that surgery remains the definitive treatment for pediatric patients with multiple tension pneumatoceles. However, extra caution should be taken in the preoperative management of these patients, even in the presence of tube thoracostomy.

Air↗