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Complications of open thoracoabdominal aortic aneurysm repair
Published in Sachinder Singh Hans, Mark F. Conrad, Vascular and Endovascular Complications, 2021
Two chest tubes (apical and angled) are placed at the conclusion of the open TAAA repair. The angled chest tube should be left in place for 5–7 days or until the patient has been adequately diuresed. Gentle diuresis typically occurs on the second postoperative day when the intense inflammatory response to the operation begins to subside. We encourage early cessation of bed rest (when able) and frequent incentive spirometry use.
Principles of lung surgery
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
Saleem Islam, James D. Geiger, Steven S. Rothenberg, M. Kunisaki Shaun
After closure, warm saline is poured into the chest and the stump is tested for a leak by applying a pressure of 30–40 cmH2O with the ventilator. Surrounding pleura may be used to reinforce the stump and possibly promote healing. A chest tube is placed and secured as described previously.
Thoracic trauma
Published in Brice Antao, S Irish Michael, Anthony Lander, S Rothenberg MD Steven, Succeeding in Paediatric Surgery Examinations, 2017
Marianne Beaudin, Rebeccah L Brown
In the trauma bay, orotracheal intubation needs to be performed if oxygenation does not improve with supplemental oxygen, if the patient cannot adequately protect the airway (classically for GCS score <8) or if the patient is in shock. Once an airway is established, one must address immediately-life-threatening conditions such as tension pneumothorax and cardiac tamponade. Tension pneumothorax is a clinical rather than a radiological diagnosis, and needle decompression followed by chest tube insertion should be done rapidly. A chest tube should be inserted for simple and open pneumothorax. It is important to remember that a simple pneumothorax can be quickly converted into a tension pneumothorax with initiation of positive-pressure ventilation.
The impact of dissection of station 9 on survival and the necessity of pulmonary ligament division during upper lobectomy for lung cancer
Published in Acta Chirurgica Belgica, 2023
Serkan Yazgan, Ahmet Üçvet, Yunus Türk, Soner Gürsoy
The operation was completed by inserting single chest tube in patients who underwent VATS upper lobectomy and double chest tube in patients undergoing thoracotomy. A daily chest roentgenogram was performed in all patients. In VATS resections, the chest tube was removed when air leak had ceased and the drainage volume had dropped below 100–200 cc. In thoracotomy patients, of the two chest tubes, one apical and one basal, the latter was removed first when the drainage volume was below 100–200 cc. The approach to the apical drain was the same as that described for VATS. The patients whose chest tube was removed were discharged on the same day or the next day after having checked with a chest X-ray at the end of a reasonable period of time. When prolonged air leak (PAL) occurred in both surgical methods, the chest tube was replaced with the Heimlich valve system instead of the closed underwater drainage, enabling the patient to be discharged.
Indwelling tunneled pleural catheters in patients with hepatic hydrothorax: A single-center analysis for outcomes and complications
Published in Canadian Journal of Respiratory, Critical Care, and Sleep Medicine, 2023
Fatmah F. Alhabeeb, Katia Carle-Talbot, Natalie Rakocevic, Tinghua Zhang, Michael Mitchell, Kayvan Amjadi, Chanel Kwok
The management of HH is challenging as patients are often resistant to first-line medical therapies including diuretics, sodium restriction and alcohol abstinence.4 Upon accumulation of a large pleural effusion, these patients require serial thoracentesis for symptomatic relief. However, this is not a sustainable, long-term solution for the vast majority of patients. Frequent hospital visits have a significant financial and psychosocial impact on patients, diminishing their quality of life. In addition, the rapid re-accumulation of the effusion creates a frequent and unpredictable need for clinical intervention, making it logistically challenging to manage refractory patients in an outpatient setting. As a result, patients will often require hospitalization with chest tube insertion and drainage. Transjugular intrahepatic portosystemic shunt (TIPS) procedure and liver transplantation are alternative methods for the management of HH; however, these methods are not a feasible option for many patients.5
Increasing trends of colistin resistance in patients at high-risk of carbapenem-resistant Enterobacteriaceae
Published in Annals of Medicine, 2022
Hadir A. El-Mahallawy, Marwa El Swify, Asmaa Abdul Hak, Mai M. Zafer
This study was conducted in the microbiology laboratory at the National Cancer Institute (NCI), Cairo University, between January and December 2019. NCI is a tertiary referral hospital receiving cancer patients from all over Egypt. In total, 196 multidrug-resistant enterobacterial isolates were collected during the study period. These were recovered from 196 different hospitalized cancer adult patients with either haematology malignancy or solid tumours with age ranging between 18 and 55 years old. Of these, 55.6% (n = 109) were males and 44.4% (n = 87) were females. The collected isolates included 100 (51%) K. pneumoniae, 89 (45.4%) E. coli and seven (3.6%) E. cloacae. The recovered infectious isolates were obtained from different clinical sources. Most of the isolates were recovered from blood cultures 62.6% (n = 124), surgical site infections specimens (pus, wound) 24% (n = 47), sputum and chest tube 5.1% (n = 10), and specimens from other sites 7.7% (n = 15) (Figure 1). The chest tubes were inserted in cases of clinically suspected lower respiratory tract infections, i.e. they had infections prior to chest tube insertion. Besides, the sample was obtained in the first two to three days of insertion and the organism isolated was a known pathogen with detected antibiotic resistance.