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PubMedDate not supplied

Predicting nosocomial bloodstream infections using surrogate markers of injury severity: clinical and methodological perspectives.

BACKGROUND: Injury severity indices are numerical scores that are utilized to predict nosocomial bloodstream infections (BSI) in critically ill patients. However, surrogate markers of injury severity (SMIS) may be more clinically meaningful than these commonly used numerical injury severity indices with respect to the control and prevention of nosocomial BSI. OBJECTIVE: The purpose of this study was to demonstrate the clinical and research implications of using the SMIS in predicting nosocomial BSI. METHOD: A prospective nonexperimental cohort study was conducted on 361 critically ill trauma patients. Three logistic regression models were examined for their clinical relevance and statistical parsimony. The first model included the Injury Severity Score (ISS) and 5 other independent predictors, and excluded the SMIS. The second model included all study variables. The third model excluded the ISS. RESULTS: The analysis suggested that number of blood units transfused, number of central venous catheters inserted, and use of chest tube(s) were the SMIS. The ISS was found to be an independent predictor of nosocomial BSI only when the SMIS were not included in the model. The model that included the SMIS and excluded the ISS explained the highest variance in nosocomial BSI and had the best negative predictive value (93%). DISCUSSION: Clinicians can use knowledge of SMIS to develop interventions that minimize the risk of nosocomial BSI. Hence, the SMIS can serve not only as a prediction tool but also as a way to enhance control and prevention strategies for BSI.

Analysis of Variance↗
PubMed2006

Ventricular diastolic stiffness predicts perioperative morbidity and duration of pleural effusions after the Fontan operation.

BACKGROUND: We validated the clinical relevance of ventricular stiffness by examining surgical morbidity in children with univentricular hearts undergoing Fontan operation. We hypothesized that ventricular stiffness affects Fontan morbidity, particularly duration of pleural effusions. METHODS AND RESULTS: Sixteen children with right ventricular (RV) (n =11) or left ventricular (LV) (n =5) dominance were studied intraoperatively at a median age of 3.3 years (1.8 to 5.1). Transesophageal long-axis echocardiograms and ventricular pressure by micromanometer provided end-diastolic pressure (P) area (A) relations during initiation and conclusion of cardiopulmonary bypass. Curve fitting to the equation P=alphae(betaA) defined the ventricular stiffness constant, beta. Changes in beta and clinical correlations were examined. Ventricular stiffness increased after bypass in patients with complete pre-bypass and post-bypass data (n =11, P=0.023, mixed models methodology). Pre-bypass beta correlated well with duration of chest tube (CT) drainage (r=0.90, n =16), net perioperative fluid balance (r=0.71, n=14), and length of stay (LOS) (r=0.81, n =16). CT duration and LOS also correlated significantly with post-bypass beta (r=0.77 for both, n=11), but insignificantly with preoperative catheterization pressures. CONCLUSIONS: Intraoperative beta predicts duration of CT drainage, net perioperative fluid balance, and LOS after the Fontan operation. These observations could improve risk stratification and clinical management of children at high-risk undergoing the Fontan operation.

Chest Tubes↗
PubMed1999

Management of pleural effusions in children with malignant lymphoma.

PURPOSE: The aim of this study was to determine potential problems in the diagnosis and management of children with pleural effusions and malignant lymphoma as well as the efficacy of thoracentesis. METHODS: The case histories of six children with malignant lymphoma who presented with pleural effusions were reviewed. Thoracentesis was performed using the Seldinger technique. RESULTS: Four of the children presented with symptoms and chest radiograph findings similar to pneumonia. A large mediastinal mass was present in two children. Pleural fluid analysis resulted in a definitive diagnosis of lymphoma in five of the six children. Two of the children had symptoms of reexpansion pulmonary edema after removal of pleural fluid. An empyema developed in one child after thoracotomy and chest tube placement. Reaccumulation of pleural fluid was common before initiating chemotherapy. CONCLUSIONS: Malignant pleural effusions frequently are present in children with non-Hodgkin's lymphoma. They may present with respiratory distress because of the size of the effusion, the mediastinal mass, or both. Management of these pleural effusions is associated with potential complications, some of which are life threatening. Thoracentesis is the initial diagnostic and therapeutic procedure of choice. The use of a Seldinger technique for thoracentesis has proved useful and safe. In patients with large effusions, aggressive removal of the pleural fluid may be followed by reexpansion pulmonary edema.

Adolescent↗
PubMedDate not supplied

Low-dose aprotinin in cardiac operations.

BACKGROUND: Patients with heart disease are frequently maintained on a regimen of aspirin. During cardiac surgery aspirin-induced platelet dysfunction increases the risk of bleeding. METHODS: The files of 82 patients who had undergone open-heart surgery were selected to study the efficacy of the low-dose (2 million KIU) aprotinin regimen in decreasing blood loss and transfusion requirements for patients receiving aspirin. Patients were divided into three groups: Group 1, includes those who received neither aspirin nor aprotinin (n = 41), Group 2, received both aspirin and aprotinin (n = 27) and Group 3, did not receive aprotinin despite aspirin intake (n = 14). Primary outcome measures in this study were total volume of blood loss (postoperative chest tube drainage) and volume of transfusions during hospitalization. RESULTS: Patients treated with aprotinin (Group 2) had significantly lower total blood loss (359 ml versus 527 ml and 628 ml in Group 1 and Group 3, p < 0.05), rates of bleeding (17.2 ml/hr versus 25.7 and 30.4 ml/hr in groups 1 and 3 respectively). A significant difference was also found when comparing the volume of blood transfusions (224.4 ml versus 262.4 and 537.5 ml) and prevalence of transfusion (33.3% versus 36.6% and 64.3%). CONCLUSION: Low-dose aprotinin significantly reduces blood loss and blood transfusions in patients receiving aspirin who undergo cardiac operations.

Aprotinin↗
PubMedDate not supplied

Pneumothorax after diagnostic laparoscopy.

Here we want to call laparoscopist's attention to pneumothorax after diagnostic laparoscopy. Diagnostic laparoscopy has less complications, compared with laparoscopic surgery. In our experience, only one case (0.04%) developed pneumothorax during routine diagnostic laparoscopic procedure. This complication is presented in a 50-year-old female. She complained of dyspnea just after the decrease of intraabdominal pressure and deflation of intraperitoneal gas. The chest roentgenogram showed a right pneumothorax, and a right chest tube was inserted with immediate relief of tension. Pneumothorax during diagnostic laparoscopy is relatively rare but a major complication; Medline literature research showed six reported cases of pneumothorax after diagnostic laparoscopy from 1983 to 1998 including our case. The etiology was idiopathy in 5 and diaphragmatic injury in 1. Hypotension, elevation of inspiratory pressure, dyspnea, a decrease in systemic oxygen saturation, and loss of breath sounds suggest tension pneumothorax. The clinical condition of the patients improved rapidly because of the easy diffusion of the gas used in laparoscopy. Diagnostic laparoscopists should be aware of this complication and treat ventilatory problems.

Biopsy↗
PubMed1998

Complications of dual chamber pacemaker implantation in the elderly. Pacemaker Selection in the Elderly (PASE) Investigators.

Pacemakers are frequently implanted, yet accurate prospective data on implant complications are limited. Elderly patients may be at increased risk of implant complications and are increasingly being referred for pacemaker implantation. The purpose of the present analysis was to define the incidence and possible predictors of serious complications of dual chamber permanent pacemaker implantation in the elderly. Therefore, we sought to prospectively identify the incidence and predictors of pacemaker implant complications in a large multicenter trial involving patients receiving a dual chamber pacemaker. The Pacemaker Selection in the Elderly (PASE) study was a prospective trial designed to evaluate quality of life in dual chamber pacemaker recipients age 65 years or older randomized to DDDR versus VVIR programming. In addition to being age 65 years or older, patients enrolled in this study were in normal sinus rhythm, and had standard indications for permanent pacemaker implantation. All patients received dual chamber pacemakers and were randomized to DDDR versus VVIR pacing. Pacemaker implant complications were collected on standardized forms which were completed at pacemaker implantation and during follow-up appointments. In this study of 407 patients, there were 26 complications occurring in 25 patients (6.1%). The most frequent complication was lead dislodgment which occurred in 9 patients. This was followed by pneumothorax (8 patients) and cardiac perforations (4 patients). In 18 patients (4.4%) repeat surgical procedures (including chest tubes) were required. Complications were noted prior to discharge in only 18 patients. There were no significant predictors of overall complications. Pneumothorax was more frequent in patients > or = 75 years old, and was observed only in patients with subclavian venous access. In conclusion, complications from pacemaker implantation in the elderly are seen in 6.1% of patients and 4.4% of patients require a repeat surgical procedure. Other than advanced age and lower weight predicting for pneumothorax, there are no significant clinical predictors of complications.

Age Factors↗
PubMed2001

Blood product use during routine open heart surgery: the impact of the centrifugal pump.

A prospective randomized study was done including 1,000 patients undergoing routine open heart surgery. Patients were randomly assigned to either a roller pump or a BioMedicus centrifugal pump with identical extracorporeal circuits. There were no significant differences between study groups. Actual blood products transfused and predicted transfusion requirements (using Cardiac RiskMaster) were examined as was chest tube drainage (CTD). The predicted transfusion requirement was 885 of 1,000 patients. Transfusions were required by 472 of 1,000. Risk factors as significant predictors of increased CTD and use of blood products were emergency surgery status, increased cross-clamp time, and higher predicted risk of mortality. The only significant predictor of decreased CTD was the use of a centrifugal pump. Predictors of increased length of stay were myocardial infarction, preoperative urea, age, and massive transfusion. Data provide evidence that use of the centrifugal pump improves patient outcomes by decreasing CTD and decreasing the requirements for transfusion, which results in a shorter hospital stay.

Blood Transfusion↗
PubMed2003

Primary thoracoscopic treatment of empyema in children.

OBJECTIVE: The optimal treatment of pediatric empyema remains controversial. The objective of this study is to compare the use of conventional management versus primary thoracoscopic drainage and decortication in children with empyema. METHODS: Conventional management has consisted of chest drain insertion under general anesthesia plus intravenous antibiotics. Thoracoscopic drainage and decortication has consisted of primary thoracoscopic drainage and decortication plus antibiotics. The clinical course of 54 patients treated conventionally between 1989 and 1997 was compared with that of 21 patients treated by means of thoracoscopic drainage and decortication between September 2000 and September 2001. RESULTS: Results of the study demonstrated that patients in the drainage-decortication group had fewer invasive interventions per patient than those in the conventional management group (1.0 vs 1.26). Patients undergoing thoracoscopic drainage and decortication also had significantly shorter durations of intravenous antibiotic therapy (7.6 +/- 1.2 vs 18.2 +/- 7.5 days), chest tube drainage (4.0 +/- 0.5 vs 10.2 +/- 6.1 days), and hospital stays (7.4 +/- 0.8 vs 15.4 +/- 7.4). Moreover, there were no open thoracotomies and decortications in the thoracoscopic drainage and decortication group, whereas in the conventional management group 39% (21/54) of patients underwent an open procedure. CONCLUSION: Although the 2 groups were not prospectively randomized and they were treated in different time periods, the results of this study support the use of thoracoscopic surgery as the primary therapeutic modality in children presenting with pleural empyema. This strategy appears to offer significant benefits over conventional treatment in terms of duration of treatment and the need for more invasive surgery.

Chest Tubes↗
PubMed1997

Lung volume reduction surgery as an emergency and life-saving procedure.

Lung volume reduction surgery (LVRS) is emerging as a promising and unique therapeutic option for rigorously selected patients with severe debilitating emphysema. A 51 yr old man with generalized emphysema developed bilateral pneumothoraces during his first holiday abroad. Due to respiratory insufficiency, intubation and mechanical ventilation were necessary. In total, six chest tubes were inserted but massive air leak persisted and his respiratory condition deteriorated due to bronchopneumonia and sepsis. The patient was transferred to Belgium. As a last resort, bilateral LVRS was performed through a median sternotomy. The most diseased areas of the upper lobes containing the air leak were resected bilaterally and a pleurectomy was associated. Three months after operation, there was a remarkable improvement in spirometric values with an increase in forced expiratory volume in one second of almost 100%. The results were sustained after a follow-up of 18 months. In this dramatic case, lung volume reduction surgery proved to be effective, and was even a life saving procedure.

Chest Tubes↗
PubMed1997

Prehospital care, importance of early intervention on outcome.

The improvement of rescue systems and on-scene therapy has lead to a significant reduction of early posttraumatic death. It was the goal of this study to critically analyse the value of prehospital care in respect to early but also to delayed complications (single = SOF or multiple organ failure = MOF) In a retrospective analysis 1223 polytraumatized patients treated during 1984 and 1994, with an injury severity of more than 20 points according to the Injury Severity Score = ISS, on-scene therapy ("field stabilization") was evaluated. We could show that a sufficient preclinical airway management has major influence on late prognosis (MOF). We therefore definitely recommend early intubation at the scene in these patients. The intravenous access at the emergency place is always necessary independent whether the patient is in hemorrhagic shock or not. Loss of time can increase shock mechanisms making intravenous access even more difficult. If there is already a peripheral vasoconstriction and the localisation of an peripheral vein renders more difficult, one possibility is a venae section to get safe access. Concerning the amount of preclinical infusion controverse opinions exist. Our evaluation could not give an satisfactory statement because of a differing high incidence of mass bleeding in the groups with low (< 1000 ml) and high (> 2000 ml) preclinical infusion. The improvement of rescue systems and on-scene therapy has lead to a significant reduction of early posttraumatic death. Especially in those injuries, that are directly associated with the development of early death, i.e. intracranial bleeding, massive hemorrhage from thoracic and intraabdominal lesions these regimens on scene improved survival significantly (Fig 1) (Trunkey 1983). Nevertheless it is still discussed whether a longer rescue time is then justified to intensify on scene therapy. Recent publications demonstrate for instance that infusion therapy beginning on scene is not always necessary and sometimes especially in severe hemorrhagic shock can even aggrevate bleeding (Bickell 1989, Bickell 1991, Bickell 1993, Crawford 1991, Gross 1988, Stern 1993). On the other hand the value of on scene intubation and ventilation and chest tubing in these patients is critically discussed (Mattox 1989). Most of these studies however have their origin in the USA and are related exclusively to penetrating trauma (knife and gunshot wounds), which is completely different from underlying pathomechanisms (pure hemorrhagic shock). Only one reports of the same experience with blunt trauma (Barone 1986). Thus for severe blunt trauma the question is still open: "field stabilization" or "load and go" (Krausz 1992). A decision that always has to be related to the definite rescue time (Smith 1985). It was the goal of this study to critically analyse the value of prehospital care in respect to early but also to delayed complications (single = SOF or multiple organ failure = MOF).

Abdominal Injuries↗
PubMed1994

Clinical efficacy of doxycycline for pleurodesis.

To determine the efficacy of doxycycline as a pleural sclerosing agent, we examined the outcomes in 31 patients (aged 31 to 87 years) receiving doxycycline (500 to 1,000 mg) through a chest tube for malignant pleural effusions or persistent bronchopleural fistulae. Of the 27 patients with malignant pleural effusions, 21 patients had a complete short-term response (no fluid reaccumulation during the initial hospitalization); 5 of the 6 short-term nonresponders had partial control of effusions, with improvement in respiratory symptoms. Of the 23 patients who survived longer than 1 month, 15 patients did not have reaccumulation of fluid during follow-up. All four patients with persistent bronchopleural fistulae had resolution of their air leaks; one patient had recurrence with a partial pneumothorax. Pleural pain controllable with narcotic therapy was the only important complication. Thus, doxycycline is a suitable substitute for tetracycline as a pleural sclerosing agent.

Aged↗
PubMed1995

Video-assisted thoracoscopic surgery of bullous and bleb disorders of the lung using endoscopic stapling device.

The video-assisted thoracic surgical (VATS) approach appears to be a viable alternative to thoracotomy when surgical management of bullous and bleb disorders of the lung is required. Fifty patients with giant bullae (n = 6) and spontaneous pneumothoraces (n = 44) were recently treated by our group using the VATS approach and endoscopic stapling devices. Of the 50 patients, 47 were managed completely by the VATS approach, including six giant bullae that were asymptomatic in five and infectious in one and 41 pneumothoraces, of which 16 were first episode and 25 with recurrent pneumothorax. Median operating times for the bullous and bleb excisions were 147.8 and 45.9 min, respectively (p < 0.01), and median chest tube durations were 5.2 and 1.2 days, respectively (p < 0.05). There was no mortality, and significant morbidity was limited to prolonged air leak in more than 5 days in three patients and postoperative atelectasis in two patients. Median hospital stays of patients with bullous excision was 11.3 days compared with 4.7 days of those with bleb excision. We conclude that the VATS treatment is a safe, effective procedure in patients with bullous and bleb disorders of the lung even in asymptomatic giant bullae or spontaneous pneumothoraces with the first episode. The advantages of the VATS approach for these diseases are ease of operation, less pain, early mobility, and superior cosmetic results.

Adolescent↗
PubMed1996

Adenosine reduces postbypass transfusion requirements in humans after heart surgery.

OBJECTIVE: The objective of this study was to determine the effect, if any, of adenosine blood cardioplegia on blood component usage after heart surgery. SUMMARY BACKGROUND DATA: The most common cause of nonsurgical postcardiopulmonary bypass bleeding is platelet dysfunction. For this reason, pharmacologic agents are under investigation in an effort to reduce the need for transfusion in this setting. METHODS: A posthoc analysis of blood product usage was performed in data obtained from a Phase I, single center, open label, randomized study performed in 63 patients. The trial was designed to test the safety and tolerance of adenosine when added to blood cardioplegia in increasing doses to enhance myocardial protection. The database provided information regarding the effect of adenosine cardioplegia on venous plasma adenosine concentrations, the amount of platelets, fresh frozen plasma and packed erythrocytes used, and the association between the adenosine dose and postoperative thoracic drainage. RESULTS: The postoperative thoracic drainage at 6 hours, 24 hours, and at the time of chest tube removal in the high-dose adenosine cardioplegia group was 68%, 76%, and 75% of the placebo and low-dose adenosine cardioplegia group (p < 0.05). The highest dose of adenosine studied increased baseline adenosine venous plasma levels 360-fold, from 0.17 +/- 0.09 mumol/L to 42.30 +/- 11.20 mumol/L (p < 0.05). This marked increase was associated with a 68%, 56%, and 58% reduction in platelet, fresh frozen plasma, and packed erythrocyte usage, respectively (p < 0.05). CONCLUSIONS: In addition to enhancing the heart's tolerance to ischemia, adenosine-supplemented cardioplegic solution also may reduce bleeding after cardiopulmonary bypass.

Adenosine↗
PubMedDate not supplied

Enhanced blood conservation in primary coronary artery bypass surgery using heparin-bonded circuits with lower anticoagulation.

BACKGROUND: Despite many advances in blood conservation techniques, a significant proportion of patients undergoing primary coronary revascularization still require homologous transfusions. A comprehensive strategy to diminish perioperative blood loss was developed by integrating many individual components to create an improved blood conservation environment and was prospectively applied to 557 patients undergoing primary coronary artery bypass grafting (CABG) procedures performed in our medical center over a 14-month period. METHODS: The first 455 patients were treated with conventional, nonheparinbonded circuits (NHBCs) and full anticoagulation (activated clotting time [ACT] > 480 sec). We wanted to test the hypothesis of whether "tip-to-tip" heparin-bonded circuits (HBCs) used in conjunction with lower anticoagulation (ACT > 280 sec) when added to our current blood conservation environment can further enhance clinical outcomes. We prospectively applied this technique to a consecutive group of patients (n = 102). RESULTS: Compared to patients treated with NHBCs, patients treated with HBCs had a significantly lower mediastinal and pleural chest tube output in the first 24 hours (683 +/- 561 mL vs 984 +/- 616 mL, p < 0.00001) were less likely to be transfused (52% vs 68.1%, p < 0.01) and had a lower exposure to different blood donor units (4.1 +/- 8.4 vs 9.3 +/- 10.3, p < 0.000003). There were no complications directly related to HBCs used in conjunction with lower anticoagulation. Morbidity and mortality rates were similar in both treatment groups. CONCLUSION: In summary, HBCs in conjunction with lower anticoagulation were safely applied in patients undergoing primary CABG with marked improvement in blood conservation, and should be considered for broader clinical use.

Aged↗
PubMed1998

Emergency care in Namibia.

Namibia is a sparsely populated nation in southwest Africa. A state-run health service provides care to most of the population. The geography and population distribution dictate the delivery systems for prehospital and emergency care. A state-run ambulance service provides basic patient transportation to the state-run hospitals. There is no 911 system. Two private aeromedical companies in Namibia provide the full range of ground and aeromedical treatment, diver rescue, and helicopter and fixed-wing transport services. The scope of care includes cricothyrotomies, chest tubes, and rapid-sequence intubation. Equipment is modern and virtually identical to what is used in the United States. There are no emergency physicians in Namibia. General medical officers are the backbone of the state-run health service. General medical officers assigned to cover the ED are called casualty officers. No specialized training beyond internship is required, and assignments to casualty are viewed as temporary until better positions become available. Only the largest state hospital in the capital has a dedicated, 24-hour emergency staff. The private prehospital care/transport systems are well organized and sophisticated. Formal efforts should be undertaken to develop ties with our colleagues in Namibia. Potential areas for collaboration include injury surveillance and prevention, field trauma resuscitation, and prehospital care.

Air Ambulances↗
PubMed2000

Questionnaire survey on management of spontaneous pneumothorax.

INTRODUCTION: Management of spontaneous pneumothorax (SP) is variable and the initial management of SP is often undertaken by frontline junior medical staff. OBJECTIVES: To assess if medical education in the principles of SP management is adequate and to determine if practice variability exists among different disciplines. METHODS: A validated questionnaire survey on the knowledge and practice of the junior medical staff posted to a general hospital from May to December 1998 was performed. 138 doctors posted to the various departments: medical (n = S9), surgical (n = 46) and emergency (n = 33) were surveyed. RESULTS: The response rate was 95%. 73% surveyed had experience inserting chest tubes (CT). Of the 27% (n = 37) who had never inserted CT, 41% were medical officers. Our results showed adequate knowledge pertaining to initial management of primary SP (PSP). The preferred site and method for CT insertion was the 5th intercostal space, anterior axillary line and open method. There was significant practice variability in the CT size, method of insertion and CT removal sequence among the disciplines (p < 0.05). However a significant proportion of staff (49%) chose to observe or aspirate an acutely breathless patient with a 10% secondary SP (SSP) instead of CT insertion. CONCLUSION: While knowledge in PSP appears adequate, management of SSP and practical training in CT insertion must be emphasized as it is a simple procedure that is potentially life-saving.

Attitude of Health Personnel↗
PubMedDate not supplied

Surgical repair of a liver injury in a patient: accompanied with tricuspid regurgitation.

A 42-year-old man with acute myocarditis developed a right lung abscess and tricuspid regurgitation with valvular vegetations. A chest tube was inserted from the 8th intercostal space on the anterior axillary line to drain acute thoracic empyema caused by rupture of the lung abscess. Six hours after the insertion, the patient went into shock. Since abdominal ultrasonography showed intraabdominal bleeding, an urgent laparotomy was performed. A large amount of blood was present in the peritoneal cavity. Pulsatile bleeding from the hepatic laceration and penetration of diaphragm were observed. Mattress sutures were used to close the hepatic laceration and the rent in the right hemi-diaphragm. Because the patient was hemodynamically stable postoperatively tricuspid valvular replacement was performed 5 days after the laparotomy. Four months after valve replacement, the patient is in good condition without any complaints.

Adult↗
PubMed2006

Patient perspectives on management of pneumothorax in lymphangioleiomyomatosis.

STUDY OBJECTIVES: The American College of Chest Physicians Delphi Consensus Statement on management of spontaneous pneumothorax recommended pleurodesis after the first secondary spontaneous pneumothorax to prevent recurrence, and evaluation of patients' perspectives regarding pneumothorax treatment was identified as a future research priority. Patients with lymphangioleiomyomatosis (LAM) are an ideal population for performing these studies, since pneumothorax occurs and recurs more commonly in LAM than in any other chronic pulmonary disorder. STUDY DESIGN AND PARTICIPANTS: A 23-item questionnaire evaluating opinions of pneumothorax treatment was distributed to 615 patients in the LAM Foundation patient database, with a response rate of 52%. RESULTS: Of respondents, 69% (216 of 314 patients) reported a history of radiographically documented pneumothorax, and 181 patients (84%) reported at least one pleurodesis procedure. Neither a history of pneumothorax nor surgical management of pneumothorax affected reported oxygen use or perception of overall lung function, yet 41% thought that their pneumothorax had contributed to a decline in lung function. Few patients (12%) worried frequently about a pneumothorax developing, but one third made lifestyle modifications due to fear of pneumothorax. Extensive pain associated with chest tube placement and inadequate pain management throughout treatment for pneumothorax were frequent concerns. Only 25% of respondents thought that pleurodesis was appropriate for a first pneumothorax, while 60% favored pleurodesis for a second pneumothorax. Despite the apparent reluctance to undergo pleurodesis, most patients agreed that pleurodesis helps prevent pneumothorax recurrence. One third of patients believed that their physicians did not consider their preferences regarding pneumothorax management. CONCLUSIONS: LAM patients and physicians may have different views about the significance of pneumothorax, in that most patients appear to favor a conservative initial approach to pneumothorax management. In conjunction with appropriate pain management, a better understanding of patients' perspectives will facilitate cooperative decision making and may ultimately improve clinical outcomes in LAM related to pneumothorax.

Chest Tubes↗