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PubMed1990

Enhanced effective fibrinolysis following the neutralization of heparin in open heart surgery increases the risk of post-surgical bleeding.

The tissue-type plasminogen activator related fibrinolytic system was studied in 24 patients undergoing cardiopulmonary bypass surgery. The degradation of fibrinogen and fibrin was followed during and after surgery by means of new sensitive and specific assays and the changes were related to the blood loss measured in the chest tube drain during the first 24 postoperative hours. Although tissue-type plasminogen activator was significantly released into the circulation during the period of extracorporeal circulation (p less than 0.01), constantly low levels of fibrinogen degradation products indicated that a systemic generation of plasmin could be controlled by the naturally occurring inhibitors. Following extracorporeal circulation heparin was neutralized by protamine chloride, and in relation to the subsequent generation of fibrin, there was a short period with increased concentrations of fibrinogen degradation products (p less than 0.01) and a prolonged period of degradation of cross-linked fibrin, as detected by increased concentrations of D-Dimer until 24 h after surgery (p less than 0.01). Patients with a higher than the median blood loss (520 ml) in the chest tube drain had a significantly higher increase of D-Dimer than patients with a lower than the median blood loss (p less than 0.05). We conclude that the incorporation of tissue-type plasminogen activator into fibrin and the in situ activation of plasminogen enhance local fibrinolysis, thereby increasing the risk of bleeding in patients undergoing open heart surgery.

Adult↗
PubMed1997

[Pleurodesis in malignant pleural effusion: bleomycin vs. mitoxantrone].

In a controlled clinical trial we investigated 102 patients with malignant pleural effusion due to breast cancer, lung cancer, ovarian cancer and other tumors to compare the therapeutic effect and adverse events of pleurodesis with bleomycin (BMC) or mitoxantrone (MIT) via chest tube. Finally 96 patients had been treated according to the protocol. Age, gender, Broca index, performance score or distribution of primary tumors were not statistically different between the BMC (n = 49) or MIT group (n = 47). We found no differences between intention-to-treat and according-to-protocol groups as well. 30 days after BMC pleurodesis we found remissions of the effusion in 91% of patients (complete remission [CR] 51%, partial remission [PR] 40%), after 90 days in 83% (40% CR, 43% PR). 30 days after MIT instillation we found remission in 73% of patients (35% CR, 38% PR), after 90 days in 61% (29% CR, 32% PR) (30 and 90 days: p < 0.05). Adverse events were not different between BMC and MIT group. BMC is a safe and effective sclerosing agent for pleurodesis via chest tube.

Aged↗
PubMed2001

[Life threatening and fatal complications of radical neck dissection].

BACKGROUND: Between 1990 and 1999, 395 neck dissections were performed in 357 patients: 195 left-sided (105 of these radical) and 200 right-sided (107 of these radical). Life-threatening complications occurred in four cases and two patients died. CASE REPORTS: After left-sided radical neck dissection with chylous fistula, a chylothorax resulted, which could not be controlled in spite of chest tube drainage and thoracotomy so that the 75-year-old female patient died 30 days postoperatively. A 66-year-old man died 35 days after a functional neck dissection of the left side because of extreme chylous flow of up to 7 l/day in spite of parenteral nutrition, local surgical revision, and intrathoracic ligation of the thoracic duct. Undetected cirrhosis of the liver was regarded to be the reason for this extremely increased lymph flow. In a 63-year-old man, a jugular foramen hemorrhage during radical neck dissection could only be managed after 3 h and approximately 6 l of blood loss. In a 66-year-old man, a discrete injury of the pleura led to cardiovascular failure due to a tension pneumothorax with mediastinal shift about 45 min later, which required immediate chest tube placement. DISCUSSION: In none of these unusual cases, which accounted for 1% of all evaluated interventions, had the patients been informed about the observed complication. However, no legal consequences resulted. Nevertheless, dramatic courses of chylous fistulas and rare complications should be considered both forensically when seeking informed consent and clinically.

Aged↗
PubMed1995

[Residual postoperative pneumothorax: harmless radiological finding or complication-prone diagnosis?].

470 patients underwent either lobectomy, bilobectomy or decortication at our institution between 1980 and 1991. A residual postoperative pneumothorax was observed in 20.7% of the patients at discharge after removal of the chest tubes. There was no significant correlation between the development of a residual postoperative pneumothorax and the patient's age and gender, the type of operation (lobectomy vs bilobectomy vs decortication) and the date of operation (as related to the introduction of stapling devices). This residual postoperative pneumothorax at discharge resolved without any further treatment in 95% of the patients during follow-up. Complete regression was observed in 91% of the patients within one year after the operation and the duration of regression did not correlate with the size of the pneumothorax at discharge. No empyema was observed in any patient with residual pneumothorax during follow-up, which also holds true for patients who underwent resection or decortication for inflammatory disease. We conclude that there is no need for treatment of residual postoperative pneumothorax, either with space-filling maneuvers at the initial operation or repeat chest tube insertions during follow-up, provided there is no evidence of lung collapse.

Female↗
PubMed2002

Management of late-stage parapneumonic empyema.

PURPOSE: Despite the reported value of early video-assisted thoracoscopic surgery (VATS) for empyema, many children are still referred to the surgeon late in the disease process. The authors wished to determine the optimal management strategy for this group of children. METHODS: Medical records of all children (n = 70) from 1990 to 2000 with late-presenting empyema (stage II or III) were reviewed. Patients were grouped as (G1) successful management with chest tube (CT), (G2) surgery after initial CT, (G3) thoracentesis followed by surgery, and (G4) surgery alone. RESULTS: There were no significant differences with respect to age, gender, pleural cultures or fluid analysis. Fifty-one (73%) patients required surgical intervention. Treatment using CT (G1, G2) or thoracentesis (G3) was associated with prolonged length of stay (LOS) when compared with surgery alone (G4; 12 v 8 days). For G2, G3, and G4, rapid clinical improvement and early discharge (6 days) was seen after surgery. For all surgery groups (G2, G3, G4), video-assisted thoracoscopic surgery (n = 19) was associated with a longer postoperative fever (4 v 2 days; P <.05), but a shorter total LOS (12 v 15 days; P <.05) when compared with open decortication (n = 32). CONCLUSIONS: Over 70% of children with late presenting empyema required surgery, including more than half of the children who received initial chest tube drainage. Delay in surgery was associated with more procedures, more radiographs, and an increased LOS. Despite later intervention, patients undergoing surgery as an initial approach had the shortest length of stay. Early surgical intervention is indicated for most children referred with established empyema.

Adolescent↗
PubMed2006

Correlation of perioperative platelet function and coagulation tests with bleeding after cardiopulmonary bypass surgery.

The authors evaluated the correlation of post-cardiopulmonary bypass surgery bleeding, measured as 24-hour chest tube output/kilogram body weight, with platelet function tests using glass bead adhesion and Thrombelastograph Platelet Mapping (Haemoscope Corporation, Niles, Ill); coagulation tests; patient characteristics; surgery parameters; and visual assessment of surgical field bleeding before closure as not bleeding (code 1), oozing (code 2), and excessive bleeding (code 3). All platelet function and coagulation tests indicated significant dysfunction 15 minutes after protamine neutralization of heparin. With the exception of glass bead adherence, these assays indicated poor recovery of function 1 hour postoperatively. By multiple regression, the most significant predictors of postoperative bleeding were a low body mass index (BMI) (P < 0.0001), lowest core body temperature (P = 0.0006), and cross clamp time (P < 0.0001). Low core temperature was significantly (P < 0.0001) correlated with cross clamp time, which the authors believe is the most likely cause of coagulation and platelet dysfunction. None of the platelet function tests significantly correlated with bleeding. Looking at the highest quartile of chest tube output patients (n = 19) versus the upper and lower 50th percentile of coagulation and platelet function, bleeding could be explained for 11 patients by BMI plus surgery parameters along with coagulation and/or platelet dysfunction. In three cases without negative surgery parameters, coagulation dysfunction was observed. The remaining five cases did not give a clear indication of which parameters were primarily responsible for the bleeding.

Adult↗
PubMed2006

Lessons learned from initial experience with peritonectomy and intra-peritoneal chemotherapy infusion.

INTRODUCTION: Patients diagnosed with peritoneal carcinomatous usually survive for less than 6 months. Cytoreductive surgery allows relief of the obstruction and improvement in functional status, while intraperitoneal chemotherapy infusion provides high local concentrations of chemotherapeutic agents. Our institutional experience is reviewed to assess the selection criteria, peri-operative complications, and outcomes. MATERIALS AND METHODS: We carried out a retrospective review of nine patients who had undergone aggressive cytoreductive surgery and hyperthermic intra- and early post-operative chemotherapy by a single surgeon between April 2000 and October 2004. The inclusion criteria were: (1) a demonstrated absence of extra-peritoneal and hepatic spread, (2) fitness of the patient and ability to tolerate cytoreductive surgery and intra-operative chemotherapy, and (3) the presence of a primary tumor originating form the gastro-intestinal tract (colonic, appendiceal, and gastric primaries). RESULTS: Seven women and two men, with a median age of 55 years, were treated. The median duration of the operation was 12 hours and 55 minutes. Seven of the nine patients required the insertion of at least one chest tube. All patients were monitored in the surgical intensive care unit (SICU) for a median of 1 day, started on feeds after a median of 6 days, and were hospitalized for a median of 16 days (range:11-18 days). There was no peri-operative mortality and only one major peri-operative complication (11.1%). At the time of analysis, the median follow-up was 16 months (range: 2-40 months), and the median disease-free survival was 8 months, with four of the nine patients showing no evidence of recurrence. To date, all of the patients are still alive. A 1-year survival rate of 100% is also documented. CONCLUSIONS: This article describes our initial experience with peritonectomy and intra-operative, intra-peritoneal chemotherapy infusion. Our initial problems included difficulty with leakage of the chemotherapeutic agents into the thoracic cavity that had to be overcome by the early insertion of chest-tubes. With appropriate patient selection, cytoreductive surgery with the infusion of intra-operative chemotherapy can be considered to be a therapeutic option for some patients with diffuse peritoneal metastases, and good disease-free and overall survival can be achieved with minimal morbidity.

Adult↗
PubMedDate not supplied

A novel synthetic sealant to treat air leaks at cardiac reoperation.

PURPOSE: Pulmonary injury with resultant air leak is common at cardiac reoperation. Sequelae of this complication include prolonged chest tube drainage and time to ambulation, extended hospitalization and increased costs, and mediastinitis. The purpose of this study was to test the efficacy of a new synthetic absorbable sealant at treatment air leaks occurring at cardiac reoperation. PATIENTS AND METHODS: Fifteen patients having cardiac reoperation had lung injuries repaired with FocalSeal-L Sealant (Focal, Inc., Lexington, MA). Mean age was 61+/-15 years, and mean interval from the previous to the current operation was 44+/-38 months. RESULTS: In all patients, FocalSeal-L Sealant was successful at sealing intraoperative air leaks. Postoperatively, 73% of patients had no air leak. Four patients (27%) developed a recurrent air leak, three on postoperative day 1 and one on postoperative day 2. In three of these patients, the air leak sealed within 3 days. In the fourth patient, an immunosuppressed heart transplant recipient with mediastinitis, the air leak never sealed; that patient died of sepsis after an omental flap failed to control the air leak. In patients without air leak, chest tubes were removed on postoperative day 1 (9 patients) or 2 (1 patient). CONCLUSION: This novel synthetic sealant prevents postoperative air leaks in the majority of patients suffering lung injury at cardiac reoperation.

Biocompatible Materials↗
PubMed1998

Treatment of malignant pleural effusion: pleurodesis using a small percutaneous catheter. A prospective randomized study.

The aim of this prospective, randomized study was to investigate the possibility of performing pleurodesis using a small percutaneous catheter (Cystofix catheter, CH10, 65 cm) inserted at bedside in patients with recurrent malignant pleural effusion and to compare this catheter with a conventional large bore chest tube (CH24) placed in connection with diagnostic thoracoscopy. After drainage pleurodesis was performed with tetracycline as sclerosing agent. Of 18 evaluable consecutive patients (mean age 67.8 years) nine were randomized for pleurodesis with the small and nine for the large catheter. In the former group, the majority (seven of nine) did not find insertion of the catheter more unpleasant than thoracentesis. In the latter group only a few (two of nine) found insertion comparable with thoracentesis (P < 0.05). All patients found the presence of the large catheter very or somewhat unpleasant (two and seven patients), whereas this was only the case for a few (no and two patients) treated with the small catheter (P < 0.05). In the former group three patients required new thoracentesis, whereas this was only the case for two patients in the latter group (P > 0.05). No complications were seen. We conclude that pleurodesis in patients with recurrent malignant pleural effusion can be performed with a small percutaneous catheter (Cystofix) with an effect similar to that obtained with a large-bore chest tube and with less discomfort for the patient.

Aged↗
PubMed1983

Noninvasive treatment of pneumothorax with oxygen inhalation.

The treatment for pneumothorax varies from invasive chest tube drainage to conservative management with bed rest. Based on the behavior of gases in closed body cavities, the inhalation of supplemental oxygen hastens absorption of the pneumothorax. To evaluate oxygen as a therapeutic agent, we treated 8 patients with pneumothoraces of various degrees with a high concentration of inspired oxygen delivered by a partial rebreathing mask. Periodic roentgenograms were used to measure the change in size of pneumothorax in order to assess the rate of resolution. 6 patients with pneumothoraces of less than 30% showed a mean resolution rate of 4.2% per day with reduction to one-third original size in the first 72 h. This was more than three times the rate of resolution (1.25% per day) previously reported with breathing room air alone. In 2 patients who initially received a lower concentration of inspired oxygen via nasal cannula, the rate of absorption increased after placing them on a partial rebreathing mask. 2 patients with four episodes of pneumothoraces greater than 30% did not benefit from this form of therapy and eventually needed chest tube drainage. We conclude that the administration of high concentrations of inspired oxygen is an effective method to enhance the rate of resolution of pneumothoraces, particularly when smaller than 30%, thereby reducing morbidity and duration of hospitalization and avoiding invasive drainage procedures.

Absorption↗
PubMed2004

Pulmonary sequestration children: is the thoracoscopic approach a good option?

BACKGROUND: The thoracoscopic approach for pulmonary sequestration in children seems to be feasible and reproducible. To date, there have been no studies comparing the thoracoscopic approach with the conventional technique in this indication. Therefore, the aim of this study was to compare these two approachs. METHODS: We performed a retrospective study in patients treated surgically for a prenatal diagnosis of pulmonary sequestration between 2000 and 2003. Three or five ports were used, and single-lung ventilation was required. The clinical, operative, and postoperative data were compared with those for patients operated on during the same period via thoracotomy. For statistical purposes, the children who required conversion to the open proecedure were grouped with those who underwent thoracotomy. The following data were compared: age, and weight, operating time, duration of postoperative drainage via chest tube, duration of postoperative narcotic use, pain scores on the 1(st) and 2(nd) days after the procedure, and length of hospital stay. The Mann-Whitney test was used for statistical analysis. RESULTS: Five infants were operated on via a thoracoscopic approach. Two required conversion to an open procedure. There were four intralobar sequestrations (ILS) and one extralobar sequestration (ELS). The mean age at surgery was 6.2 months (range, 4-9). The mean operating time, excluding the patients who were converted to open, was 155 min (range, 120-190). In the thoracotomy group, there were one ELS and one ILS. Two groups were defined: the exclusively laparoscopy group (EL) (n = 3) and the thoracotomy and conversion group (TC) (n = 4). The duration of postoperative drainage, duration of postoperative narcotic use, and hospital stay seemed to be shorter in the group EL. These times, respectively, were 3.4 vs 2.75 days, 4.1 vs 3.3 days, and 7.5 vs 4.3 days = (p = 0.03). There were two complications in the TC group (one wound abcess and one pleural leak that required a chest tube). CONCLUSION: The thoracoscopic approach for pulmonary sequestration is feasible. It seems to reduce the duration of postoperative drainage, postoperative narcotic use, hospital and stay. These results need to be confirmed by a prospective and more detailed study.

Bronchopulmonary Sequestration↗
PubMed2005

Morbidity, survival, and site of recurrence after mediastinal lymph-node dissection versus systematic sampling after complete resection for non-small cell lung cancer.

BACKGROUND: Mediastinal lymph-node dissection was compared to systematic mediastinal lymph-node sampling in patients undergoing complete resection for non-small cell lung cancer with respect to morbidity, duration of chest tube drainage and hospitalization, survival, disease-free survival, and site of recurrence. METHODS: A consecutive series of one hundred patients with non-small-cell lung cancer, clinical stage T1-3 N0-1 after standardized staging, was divided into two groups of 50 patients each, according to the technique of intraoperative mediastinal lymph-node assessment (dissection versus sampling). Mediastinal lymph-node dissection consisted of removal of all lymphatic tissues within defined anatomic landmarks of stations 2-4 and 7-9 on the right side, and stations 4-9 on the left side according to the classification of the American Thoracic Society. Systematic mediastinal lymph-node sampling consisted of harvesting of one or more representative lymph nodes from stations 2-4 and 7-9 on the right side, and stations 4-9 on the left side. RESULTS: All patients had complete resection. A mean follow-up time of 89 months was achieved in 92 patients. The two groups of patients were comparable with respect to age, gender, performance status, tumor stage, histology, extent of lung resection, and follow-up time. No significant difference was found between both groups regarding the duration of chest tube drainage, hospitalization, and morbidity. However, dissection required a longer operation time than sampling (179 +/- 38 min versus 149 +/- 37 min, p < 0.001). There was no significant difference in overall survival between the two groups; however, patients with stage I disease had a significantly longer disease-free survival after dissection than after sampling (60.2 +/- 7 versus 44.8 +/- 8 months, p < 0.03). Local recurrence was significantly higher after sampling than after dissection in patients with stage I tumor (12.5% versus 45%, p = 0.02) and in patients with nodal tumor negative mediastinum (N0/N1 disease) (46% versus 13%, p = 0.004). CONCLUSION: Our results suggest that mediastinal lymph-node dissection may provide a longer disease-free survival in stage I non-small cell lung cancer and, most importantly, a better local tumor control than mediastinal lymph-node sampling after complete resection for N0/N1 disease without leading to increased morbidity.

Aged↗
PubMed1999

Streptokinase and urokinase for the treatment of pleural effusions and empyemas.

It is evident from these studies that thrombolytics significantly increase the amount of drainage from pleural effusions or empyemas. The effect on other outcome measures, such as length of hospital stay, days before defervescence, days with chest tube, surgical procedures, and mortality is questionable. The lack of randomized, controlled trials comparing streptokinase and urokinase makes a true comparison rather difficult. Both agents are equally effective in increasing pleural drainage. Only one comparative trial demonstrated an increased incidence of fever with streptokinase, which was reversible on discontinuation. This reaction does not occur frequently based on the results of the published literature. Overall, the low incidence of adverse reactions associated with either agent may not justify the added expense of urokinase for this indication. A majority of the clinical trials can be criticized for their low numbers of patients along with lack of control groups. It is unknown whether statistical significance would have been obtained if adequate sample sizes were used. Inclusion criteria were not uniform, as characteristics of pleural fluid and presence of loculations may influence success. Volume of drainage is also less impressive when the amount used to instill the thrombolytic is subtracted from the amount of drainage. If this were considered, statistical significance could have been altered. Finally, therapeutic end points varied throughout the literature. Most studies used volume of drainage and X-ray findings as end points. However, such surrogate markers do not necessarily correlate with clinical improvement. The optimal dose of streptokinase is 250,000 units instilled through a chest tube (which is clamped for 2-4 h) on a daily basis until decreased drainage is obtained. The optimal dose of urokinase is not known and the administration methods vary throughout the literature, ranging from 50,000 to 250,000 units. The AWP of streptokinase is $122 for 250,000 units compared with $433 for 250,000 units of urokinase. In the only comparative trial, the average number of instillations was the same, so the cost of therapy with urokinase is significantly higher. The study by Bouros et al. poses an interesting observation. They successfully treated patients with 50,000 units of urokinase, which would be approximately the same cost as streptokinase. Further studies are needed to truly evaluate the efficacy of low-dose urokinase as well as comparative trials with these two agents. In conclusion, urokinase offers no significant benefits over streptokinase. The incidence of fever was greater in one comparative trial with streptokinase than with urokinase. Based on cost considerations and lack of comparative studies, urokinase infusions should be reserved for patients who develop fever when receiving continued therapy with streptokinase.

Clinical Trials as Topic↗
PubMedDate not supplied

Acute pleuropulmonary complications detected by computed tomography following myocardial revascularization.

INTRODUCTION: Pleuropulmonary changes are common following coronary artery bypass grafting surgery performed with a saphenous vein graft, with or without an internal mammary artery. The presence of atelectasis or pleural effusions reflects the thoracic trauma. PURPOSE: To define the postoperative incidence of changes in the lung and in the pleural space and to evaluate the influence of the trauma. METHODS: Thirty patients underwent elective coronary artery bypass grafting surgery (8 saphenous vein grafts and 22 saphenous vein grafts and internal mammary artery grafts with pleurotomy). Chest tubes in the left pleural space were used in all internal mammary artery patients. On the second (day 2) and seventh (day 7) postoperative day, patients underwent a computed tomography, and pleural effusions were rated as follows: grade 0 = no fluid to grade 4 = fluid in more than 75% of the hemithorax. Atelectasis was rated as follows: laminar = 1, segmental = 3, and lobar = 10 points. RESULTS: All patients had pleural effusion or atelectasis. Between day 2 and day 7, the number of patients with effusions or atelectasis on the right side decreased (P < 0.05). The incidence of effusions on day 2 in the saphenous vein graft group (87.5%) was higher (P < 0.05) than in the internal mammary artery group (52.3%). The incidence of atelectasis in the lower right lobe decreased (P < 0.05) from 86.7% (day 2) to 26.7% (day 7). The degree of atelectasis in both sides did not differ on day 2 (P = 0.42) but did on day 7 (P < 0.0001). There was a decrease in the atelectasis from day 2 to day 7 on the right side (P < 0.001), but not on the left (P = 0.21). On day 2 there was a relationship between atelectasis and effusion on the right (P = 0.04), but not on the left (P = 0.113). CONCLUSION: The present series demonstrates that there is a high incidence of both minimal pleural effusion and atelectasis after coronary artery bypass grafting surgery, which drops on the right side from day 2 to day 7 post surgery. Factors that contribute to the persistence of changes on the left side include the thoracic trauma and the presence of chest tubes and pericardial effusion.

Acute Disease↗
PubMed2006

Simplified stepwise management of primary spontaneous pneumothorax: a pilot study.

In primary spontaneous pneumothorax (PSP) requiring intervention, removal of air from the pleural space can be achieved by manual needle aspiration or by pleural drainage after insertion of a chest tube. This study aimed to evaluate the efficacy and safety of a serial-steps approach with a single system (small-calibre catheter/Heimlich valve) in a homogeneous population of patients with a first episode of PSP. All patients had an 8.5 F distally multiperforated polyurethane pigtail catheter inserted via the anterior route, at the bedside without any guidance, using the Seldinger technique. A one-way Heimlich valve was connected to the catheter, allowing the air to flow spontaneously outwards for 24-48 h. Thereafter, if the lung failed to re-expand wall suction was applied. Patients with an air leak persisting for >4 days were referred for surgery. Primary end-points were success rates at 24 h and 1 week, and 1 yr recurrence-free survival. In total, 41 consecutive patients entered the study. They were typically thin, young, smoking males. No procedure-related complications were observed. The need for pain relief medication was minimal. Within the first 24 h, most of the patients were able to walk around and half of them were able to take a shower with their catheter in place. The 24-h and 1-week success rates were 61 and 85%, respectively, and the actuarial 1-yr recurrence rate was 24%. Four patients underwent surgical pleurodesis because of a persistent air leak. The length of stay when excluding the four surgical cases was 2.3+/-1.3 days. When 24-h and 1-week success rates and recurrence at 12 months were taken as end-points, the method described here is as effective as simple manual needle aspiration or a conventional chest tube thoracotomy. These results support further studies assessing this "one system, serial-steps approach" in an outpatient management algorithm.

Adolescent↗
PubMed1991

Image-guided catheter drainage of the infected pleural space.

Thoracic empyema occurs at all ages and has reported mortality rates of 10% to 75%. Most authors agree that complete drainage of complicated effusions or organized empyemas and reexpansion of atelectatic lung are important in obtaining a satisfactory clinical outcome. For initial tube drainage, a 26-F to 36-F chest tube traditionally has been inserted at the bedside. The results of this method of empyema evacuation have varied widely, with an overall cure rate reported to be 47%. Image-guided placement of smaller 8-F to 14-F catheters has been offered as an alternative therapy with an overall reported cure rate of 81% in 104 patients.

Catheterization↗
PubMed1989

Chest drainage tubes.

In general, appropriate use of tube thoracostomy results in complete drainage of the collected air and fluid in the pleural space and allows full expansion and occupation of the entire pleural space by the lung, thus protecting the lung and pleural space from subsequent complications. In addition, the drainage of the pleural space with a tube thoracostomy allows more accurate monitoring of the rate of accumulation of air and blood in the pleural space. Thus, it provides valuable information for the subsequent management of some patients, such as those with traumatic hemothorax.

Hemothorax↗
PubMed2001

[Complete transection of the left main bronchus due to a blunt chest trauma: report of a case].

A 62-year-old man was injured in a traffic accident. A chest roentgenogram showed pneumothorax, hemothorax, subcutaneous and mediastinal emphysema, multiple rib fractures, and a shift of the trachea to the right. Bilateral thorax drainage was performed, and air leakage from a left chest tube was observed. A chest computed tomogram demonstrated stenosis and deformation of the left main bronchus. Bronchofiberscopy revealed complete obstruction of the left main bronchus by the left main pulmonary artery. An emergency thoracotomy revealed complete transection of the left main bronchus and laceration. End-to-end anastomosis of the left main bronchus was performed with interrupted 4-0 PDS II suture. The patient was discharged at the 33rd hospital day.

Accidents, Traffic↗