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Role of Intercostal Drainage Tube in Chest Trauma
Published in Kajal Jain, Nidhi Bhatia, Acute Trauma Care in Developing Countries, 2023
Tube thoracostomy is an important part in the management of traumatic chest injuries. Good planning and placement technique is essential to avoid complications. They are the primary management of haemothorax and pneumothorax, with good clinical judgement being essential for planning their timely removal.
Thoracic Trauma
Published in Ian Greaves, Keith Porter, Jeff Garner, Trauma Care Manual, 2021
Ian Greaves, Keith Porter, Jeff Garner
Possible complications of tube thoracostomy include: Misplacement of the tube, which is usually extra-pleural due to inadequate dissectionDamage to thoracic or abdominal organs by instruments (trocars should never be used)Damage to the intercostal neurovascular bundle under the ribsSubcutaneous emphysema due to air leakage around the tubeLater infection (local, or empyema)
Congenital diaphragmatic hernia
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
Erin E. Perrone, George B. Mychaliska
The muscle is approximated with 4/0 Vicryl, and the skin is closed with 5/0 Monocryl. Evacuation of the pneumothorax is accomplished by inserting a catheter into the chest before closure of the final port incision. A thoracostomy tube should only be used in cases with a concern for bleeding or an air leak.
Does the time to diagnosis and treatment influence outcome in adults with pleural infections
Published in European Clinical Respiratory Journal, 2023
Mads Brögger Klausen, Christian Laursen, Morten Bendixen, Babu Naidu, Eihab O Bedawi, Najib. M. Rahman, Thomas Decker Christensen
Overall, a correlation between DOS and outcome was found in six studies. Three studies [14,16,19] found DOS to be a significant predictive factor for intraoperative conversion to open surgery from VATS. These results suggest that earlier intervention may decrease the rate of conversions to open surgery and in turn potentially improve the prognosis of pleural infection patients, as intervention with VATS seems to have fewer complications [3]. Metin et al. [15] found DOS to be significantly longer in the group treated with tube thoracostomy compared to patients treated with more invasive methods, although selection-biased allocation of treatment based on patient characteristics cannot be excluded. Chung et al. [18] found patients with DOS<4 weeks had significantly shorter chest tube duration, shorter LOS, and reduced duration of surgical procedure, all indicating a benefit of early intervention. Since we believe that mortality is an important outcome to investigate, it was included as an outcome when we designed the study. Unfortunately, none of the included studies analyzed the effect of DOS on mortality. Thus, we were not able to draw conclusions on the mortality as an outcome, but in the future it will be a very important outcome nonetheless.
An occult iatrogenic pneumothorax as a cosmetic procedure complication
Published in Baylor University Medical Center Proceedings, 2023
Alejandro José Quiroz Alfaro, Cara East, Iván Javier Rodríguez Acosta, Roberto Eduardo Quiroz Simanca
The next day, the patient presented with sudden-onset dyspnea, tachycardia, and mild mesogastric tenderness without peritoneal irritation. A chest x-ray showed bibasal alveolar-reticular infiltrates and right basal atelectasis (Figure 1a). Her oxygen saturation was 91%, and an arterial blood gas showed respiratory alkalosis with moderate hypoxemia on a 32% fraction of inspired oxygen (partial pressure of oxygen in the arterial blood, 56 mm Hg; ratio of arterial oxygen partial pressure to fractional inspired oxygen, 175); the D-dimer was 1167 ng/mL. The patient was immediately transferred to the intensive care unit. Pulmonary embolism protocol CT angiography showed a left-sided 35% pneumothorax, with no evidence of pulmonary embolism or fat embolism (Figure 1b). An abdominal ultrasound was normal. A left-sided chest tube was inserted, and the marked hypoxemia and acute respiratory failure resolved. After 48 hours, chest CT showed small residual pneumothorax with complete left lung reexpansion. The thoracostomy tube was removed, and the patient was discharged.
Point-of-care ultrasound for diagnosis of pneumothorax in a pregnant COVID-19 patient in the emergency department
Published in Journal of Obstetrics and Gynaecology, 2022
Muge Gulen, Salim Satar, Nurdan Unlu, Cemre Ipek Esen, Mehmet Bozkurt, Sarper Sevdimbas, Selen Acehan
If the pneumothorax that occurs during pregnancy is small (<2 cm), the mother is not dyspneic, and there is no foetal distress, it can be managed with a simple observation. Otherwise, aspiration can be performed, or a chest drain can be applied to patients with persistent air leaks. In our case, tube thoracostomy was performed in the critical care unit of the ED because the pneumothorax was large enough to cause a mediastinal shift, and the patient had tachycardia, tachypnoea and hypoxia (MacDuff et al. 2010). Because of the risk of recurrence in subsequent pregnancies, a minimally invasive video-assisted thoracoscopic surgery (VATS) procedure should be considered after remission. Successful pregnancies and spontaneous deliveries without pneumothorax recurrence have been reported after the VATS procedure (Lal et al. 2007). Our patient is now at the 27th week of pregnancy, and her pregnancy continues without any problems. She is still under routine follow-up.