Toward a Next-Generation Digital Chest Tube

2021 ◽  
pp. 155335062110425
Author(s):  
Daniel T. DeArmond ◽  
Lucas M. Holt ◽  
Andrew P. Wang ◽  
Kristen N. Errico ◽  
Nitin A. Das
Keyword(s):  
Chest Tube ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Air Leak ◽  
Chest Tubes ◽  
Pump System ◽  
Suction Pump ◽  
Lung Expansion ◽  
Tube Removal ◽  
Prolonged Air Leak

Chest tubes in patients who have undergone pulmonary resection with pleural air leak are painful, impair ventilatory mechanics, and increase hospital length of stay and costs. Despite these well-documented concerns, current protocols for chest tube management in this setting are not well supported by evidence. Excessive suction applied to chest tubes has been associated with prolonged air leak due to alveolar over-distension, and most practitioners intuit that suction should be minimized to the lowest level needed to maintain desired pleural apposition. Unfortunately, there is no evidence-based protocol for the establishment of minimal adequate suction. Digital suction devices in current clinical use can identify air leak resolution preventing the delay of chest tube removal but cannot guide suction minimization while an air leak persists. We recently described a monitor of lung expansion in a porcine model of pleural air leak that could detect loss of pleural apposition continuously in real-time based on electrical impedance readings obtained directly from the surface of the lung via chest tube-embedded electrodes. The value of the impedance signal was “in-range” when pleural apposition was present but became abruptly “out-of-range” when pneumothorax due to inadequate suction developed. These findings suggested that a digitally controlled suction pump system could be programmed to recognize the development of pneumothorax and automatically identify and set the minimum level of suction required to maintain pleural apposition. We present here preliminary proof of concept for this system.

Initial Chest Tube Management after Pulmonary Resection

2005 ◽  
Vol 71 (5) ◽  
pp. 416-419 ◽  
Author(s):  
G. Antanavicius ◽  
J. Lamb ◽  
P. Papasavas ◽  
P. Caushaj
Keyword(s):  
Hospital Stay ◽  
Chest Tube ◽  
Pulmonary Resection ◽  
Length Of Hospital Stay ◽  
Hospital Length ◽  
Tube Thoracostomy ◽  
Hospital Length Of Stay ◽  
Air Leak ◽  
Chest Tubes ◽  
Water Seal

Tube thoracostomy management with suction or water seal after anatomical pulmonary resection remains somewhat controversial. Initial chest tube management may influence the duration of pleural fluid drainage, duration of tube thoracostomy, and/or hospital length of stay following pulmonary resection. We hypothesized that initial chest tube management with water seal decreases time for chest tube removal and decreases time of hospital stay. A retrospective chart review was performed on 109 consecutive patients who underwent lobectomy or segmentectomy in Western Pennsylvania Hospital between December 1999 and December 2003. Comparison was made between chest tube management of water seal or suction in patients with and without air leak. Of the 109 patients, 78 (72%) had no air leak at the completion of surgery, and 31 (28%) had air leak. In the group without air leak (n = 78), water seal was used in 32 (41%) patients and suction in 46 (59%). In patients placed to water seal initially after surgery (n = 32), removal of chest tubes was on postoperative day (POD) 3.19 ± 0.24 and hospital discharge was on POD 5.13 ± 0.61. In patients placed to suction initially (n = 46), chest tubes were removed on POD 4.52 ± 0.40. Hospital discharge was on POD 6.74 ± 0.5. Both duration of chest tube ( P < 0.007) and length of hospital stay ( P < 0.04) were significantly lower in the water seal group. In the air leak group (n = 31), 7 (23%) patients were managed with water seal and 24 (77%) patients with suction. Both duration of chest tube ( P = 0.001) and length of hospital stay ( P < 0.05) were significantly lower in the water seal group. In patients without air leak, chest tubes should be managed with water seal following anatomical pulmonary resection, resulting in significantly shorter chest tube duration and hospital length of stay.

Autologous Blood Pleurodesis: What Is the Optimal Time Interval and Amount of Blood?

2021 ◽  
Author(s):  
Alessio Campisi ◽  
Andrea Dell'Amore ◽  
Yonghui Zhang ◽  
Zhitao Gu ◽  
Angelo Paolo Ciarrocchi ◽  
...  
Keyword(s):  
Chest Tube ◽  
Autologous Blood ◽  
Optimal Time ◽  
Time Interval ◽  
Air Leak ◽  
Increased Risk ◽  
Tube Removal ◽  
Blood Patch ◽  
Prolonged Air Leak ◽  
Chest Tube Removal

Abstract Background Air leak is the most common complication after lung resection and leads to increased length of hospital (LOH) stay or patient discharge with a chest tube. Management by autologous blood patch pleurodesis (ABPP) is controversial because few studies exist, and the technique has yet to be standardized. Methods We retrospectively reviewed patients undergoing ABPP for prolonged air leak (PAL) following lobectomy in three centers, between January 2014 and December 2019. They were divided into two groups: Group A, 120 mL of blood infused; Group B, 60 mL. Propensity score-matched (PSM) analysis was performed, and 23 patients were included in each group. Numbers and success rates of blood patch, time to cessation of air leak, time to chest tube removal, reoperation, LOH, and complications were examined. Univariate and multivariate analysis of variables associated with an increased risk of air leak was performed. Results After the PSM, 120 mL of blood is statistically significant in reducing the number of days before chest tube removal after ABPP (2.78 vs. 4.35), LOH after ABPP (3.78 vs. 10.00), and LOH (8.78 vs. 15.17). Complications (0 vs. 4) and hours until air leak cessation (6.83 vs. 3.91, range 1–13) after ABPP were also statistically different (p < 0.05). Air leaks that persisted for up to 13 hours required another ABPP. No patient had re-operation or long-term complications related to pleurodesis. Conclusion In our experience, 120 mL is the optimal amount of blood and the procedure can be repeated every 24 hours with the chest tube clamped.

scholarly journals Safety of early discharge with a chest tube after pulmonary segmentectomy

2020 ◽  
Vol 58 (3) ◽  
pp. 613-618
Author(s):  
Feichao Bao ◽  
Natasha Toleska Dimitrovska ◽  
Shoujun Hu ◽  
Xiao Chu ◽  
Wentao Li
Keyword(s):  
Chest Tube ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Early Discharge ◽  
Air Leak ◽  
Tube Removal ◽  
Prolonged Air Leak ◽  
Life Threatening ◽  
Chest Tube Removal ◽  
Hospital Days

Abstract OBJECTIVES Early removal of chest tube is an important step in enhanced recovery after surgery protocols. However, after pulmonary resection with a wide dissection plane, such as pulmonary segmentectomy, prolonged air leak, a large volume of pleural drainage and the risk of developing empyema in patients can delay chest tube removal and result in a low rate of completion of the enhanced recovery after surgery protocol. In this study, we aimed to assess the safety of discharging patients with a chest tube after pulmonary segmentectomy. METHODS We retrospectively reviewed a single surgeon’s experience of pulmonary segmentectomy from May 2019 to September 2019. Patients who fulfilled the criteria for discharging with a chest tube were discharged and provided written instructions. They returned for chest tube removal after satisfactory resolution of air leak or fluid drainage. RESULTS In total, 126 patients underwent pulmonary segmentectomy. Ninety-five (75%) patients were discharged with a chest tube postoperatively. The mean time to chest tube removal after discharge was 5.6 (range 2–32) days, potentially saving 532 inpatient hospital days. Overall, 90 (95%) patients experienced uneventful and successful outpatient chest tube management. No life-threatening complications were observed. No patient experienced complications resulting from chest tube malfunction. Five (5%) patients experienced minor complications. Overall, all patients reported good-to-excellent mobility with a chest tube. CONCLUSIONS Successful postoperative outpatient chest tube management after pulmonary segmentectomy can be accomplished in selected patients without a major increase in morbidity or mortality.

Comparison of pain and efficacy between large-bore and small-bore chest tube drainage for malignant pleural effusion in Songklanagarind Hospital: A randomized controlled trial.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e19608-e19608
Author(s):  
Apirudee Porntepkasemson ◽  
Sarayut Lucien Geater
Keyword(s):  
Randomized Controlled Trial ◽  
Pleural Effusion ◽  
Chest Tube ◽  
Malignant Pleural Effusion ◽  
Controlled Trial ◽  
Chest Tubes ◽  
Tube Insertion ◽  
Randomized Controlled ◽  
Lung Expansion ◽  
Tube Removal

e19608 Background: Malignant pleural effusion is one of the most common presenting symptoms in lung cancer. There has been no large RCT comparing large-bore and small-bore chest tubes in terms of pain and efficacy of management. Methods: A randomized controlled trial was conducted in 2011. Patients with malignant pleural effusion were randomly allocated to receive either a large-bore or small-bore chest tube. The primary objective was to compare pain using the Numeric Rating Scale. Other objectives included the efficacy of the drainage and pleurodesis and any complications were recorded. Results: Each arm comprised 21 patients. Median age was 61.2 years. Thirty-eight patients (90.5%) had adenocarcinoma; 14(33.3%) had received systemic chemotherapy. Pain score did not differ significantly between the groups from the time of tube insertion to removal. However, pain rose from day 4 until day 9 in the small-bore group. The proportion of patients requiring a second chest tube was higher in the small-bore group (small-bore = 7, 33.3 %; large-bore = 1, 4.8%; p 0.052). Complications were higher in the small-bore group. Five patients were complicated by tube occlusion which occurred only in the small-bore group (23.8 %, p 0.048). Times from tube insertion to lung expansion, to pleurodesis and to chest tube removal did not differ significantly between groups. Pleurodesis was effective in 70-80 % in both groups at the 28-day follow-up. Conclusions: No differences between large-bore and small-bore chest tubes were seen in pain, efficacy of drainage or success of pleurodesis. However, small-bore chest tubes had a higher rate of occlusion and more frequently required additional tube insertion.

Management of pneumothorax and bronchial fistulae

2016 ◽  
Author(s):  
Wissam Abouzgheib ◽  
Raquel Nahra
Keyword(s):  
Chest Tube ◽  
Chest Tube Drainage ◽  
Conservative Approach ◽  
Lung Collapse ◽  
Air Leak ◽  
Chest Tubes ◽  
Tube Drainage ◽  
Tube Removal ◽  
Associated Symptoms ◽  
Chest Tube Removal

The management of pneumothorax is dependent on size and associated symptoms. A conservative approach is preferred in small and asymptomatic ones. While a large pneumothorax warrants chest tube drainage, small bore could be as effective as large chest tubes and should be used first. The use of bedside ultrasound plays a major role in the acute management of pneumothorax and has an excellent negative predictive value. In some instances, there may be an associated air leak, caused by a broncho- or alveolopleural fistula, which can be managed by chest tube drainage, with or without suction, depending on the severity and extent of lung collapse. With a large air leak, wall suction is needed to keep the lung inflated. In small, intermittent air leaks, suction should be avoided to promote healing of the fistula. With the availability of one-way valves, management of these fistulae became easier, allowing blockage of the airway causing the air leak, and promoting healing and early chest tube removal.

scholarly journals What Keeps Postpulmonary Resection Patients in Hospital?

2003 ◽  
Vol 10 (2) ◽  
pp. 86-89 ◽  
Author(s):  
T Bardell ◽  
D Petsikas
Keyword(s):  
Regression Analysis ◽  
Linear Regression ◽  
Chest Tube ◽  
Pulmonary Resection ◽  
Linear Regression Analysis ◽  
Air Leak ◽  
Air Leaks ◽  
Tube Removal ◽  
Prolonged Air Leak ◽  
Chest Tube Removal

BACKGROUND: Prolonged air leak (longer than three days) was hypothesized to be the primary cause of extended hospital stays following pulmonary resection. Its effect on length of stay (LOS) was compared with that of suboptimal pain control, nausea and vomiting, and other causes. Predictors of prolonged LOS and of prolonged air leaks were investigated.DESIGN: Retrospective review of 91 patients. Primary reasons for prolonged hospitalization were determined. Patient characteristics (demographic information, pulmonary function test results, body habitus measurements, smoking history), operative factors (procedure performed, duration of operation, complications) and postoperative factors (time of chest tube removal) were considered. Student'sttest andX2analysis were used to compare continuous and ratio data, respectively, and linear regression analysis was used to define the equation relating two variables.RESULTS: The mean postoperative LOS was 6.4 days. Only prolonged air leak was predictive of increased LOS (9.4 days versus 5.4 days, P<0.001). Forced expiratory volume in 1 s less than 1.5 L/min, carbon monoxide diffusing capacity less than 80% predicted and the detection of a pneumothorax were all predictive of prolonged air leak. A strong correlation between the time of chest tube removal and LOS was found (r=0.937, P<0.001). Linear regression analysis showed postoperative LOS and duration of thoracostomy tube insertion to be related by the equation y = 0.88x + 2.49 days.CONCLUSIONS: These results suggest that increased LOS following pulmonary resection is due primarily to prolonged air leaks. Furthermore, patients who have their chest tubes removed sooner are discharged sooner.

scholarly journals Intrabronchial Valve Treatment for Prolonged Air Leak: Can We Justify the Cost?

2016 ◽  
Vol 2016 ◽  
pp. 1-6 ◽  
Author(s):  
Eitan Podgaetz ◽  
Felix Zamora ◽  
Heidi Gibson ◽  
Rafael S. Andrade ◽  
Eric Hall ◽  
...  
Keyword(s):  
Individual Patient Data ◽  
Cost Effective ◽  
Air Leak ◽  
Levels Of Care ◽  
Air Leaks ◽  
Limited Experience ◽  
Tube Removal ◽  
Prolonged Air Leak ◽  
Chest Tube Removal ◽  
The Cost

Background.Prolonged air leak is defined as an ongoing air leak for more than 5 days. Intrabronchial valve (IBV) treatment is approved for the treatment of air leaks.Objective.To analyze our experience with IBV and valuate its cost-effectiveness.Methods.Retrospective analysis of IBV from June 2013 to October 2014. We analyzed direct costs based on hospital and operating room charges. We used average costs in US dollars for the analysis not individual patient data.Results.We treated 13 patients (9 M/4 F), median age of 60 years (38 to 90). Median time from diagnosis to IBV placement was 9.8 days, time from IBV placement to chest tube removal was 3 days, and time from IBV placement to hospital discharge was 4 days. Average room and board costs were $14,605 including all levels of care. IBV cost is $2750 per valve. The average number of valves used was 4. Total cost of procedure, valves, and hospital stay until discharge was $13,900.Conclusion.In our limited experience, the use of IBV to treat prolonged air leaks is safe and appears cost-effective. In pure financial terms, the cost seems justified for any air leak predicted to last greater than 8 days.

scholarly journals Ambulant treatment with a digital chest tube for prolonged air leak is safe and effective

2021 ◽  
Vol 0 (0) ◽  
pp. 0-0
Author(s):  
Lars Dinjens ◽  
Wytze S. de Boer ◽  
Jos A. Stigt
Keyword(s):  
Chest Tube ◽  
Air Leak ◽  
Prolonged Air Leak ◽  
Digital Chest

Chest tube removal after cardiac surgery

1997 ◽  
Vol 17 (1) ◽  
pp. 34-38 ◽  
Author(s):  
SC Thomson ◽  
S Wells ◽  
M Maxwell
Keyword(s):  
Cardiac Surgery ◽  
Quality Of Care ◽  
Length Of Stay ◽  
Chest Tube ◽  
Chest Tubes ◽  
Tube Removal ◽  
Chest Tube Removal

Prompt remove of chest tubes by RNs has allowed earlier and more aggressive ambulation of our patients and, along with other interventions, has decreased length of stay by 1.5 days while improving quality of care. Proper education, both didactic and clinical, is the key component in preparing RNs to safely and effectively perform this procedure.

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