A Medical Strategy to Reduce Persistent Chest Tube Drainage After the Fontan Operation

2005 ◽  
Vol 96 (1) ◽  
pp. 130-133 ◽  
Author(s):  
Joseph R. Cava ◽  
Sarah M. Bevandic ◽  
Michelle M. Steltzer ◽  
James S. Tweddell
Perfusion ◽  
2011 ◽  
Vol 26 (6) ◽  
pp. 529-535 ◽  
Author(s):  
D Klugman ◽  
MT Donofrio ◽  
D Zurakowski ◽  
RA Jonas

Objective: To determine how the anti-inflammatory properties of aprotinin impact on postoperative complications in children undergoing the Fontan procedure. Methods: We included all patients between 14 months and 18 years (n=56) undergoing a Fontan operation at our institution between January 2005 and June 2009. The study group (n=29) included patients from January 2005 through December 2007 all of whom received aprotinin. The control group (n=27) included all patients from January 2008 through June 2009 who did not receive aprotinin. We reviewed all medical records and collected preoperative, intraoperative and postoperative data. Duration and volume of chest tube drainage were the primary outcome measures. Results: Of the 20% of patients who had postoperative arrhythmias, multivariate logistic regression analysis demonstrated only aprotinin was associated with significantly decreased postoperative arrhythmias ( P=0.01). Renal function and fenestration or Fontan thrombosis did not differ significantly; there was no statistically significant difference in volume or duration of chest tube drainage. Median duration of chest tube drainage was 7 days in the aprotinin group and 8 days for patients who did not receive aprotinin ( P=0.36). Conclusion: The anti-inflammatory properties of aprotinin may be protective against postoperative arrhythmias. Aprotinin does not confer increased risks of prolonged chest tube drainage, renal dysfunction or thrombosis in patients undergoing the Fontan procedure.


2002 ◽  
Vol 39 ◽  
pp. 399-400
Author(s):  
Joseph R. Cava ◽  
Raymond T. Fedderly ◽  
Sarah M. Bevandic ◽  
Michelle Steltzer ◽  
Patrick J. Phelan ◽  
...  

2020 ◽  
Vol 16 (3) ◽  
Author(s):  
Atanu Pan ◽  
Debarshi Jana

Background: Empyema thoracis (ET) is a serious infection of the pleural space. Despite the availability of broad spectrum antibacterial, improved vaccination coverage and better diagnostic tools, Empyema Thoracis remains associated with high morbidity worldwide. Delay   in   early   diagnosis,   failure   to institute   appropriate   antimicrobial   therapy,   multidrug resistant   organisms,   malnutrition,   comorbidities,   poor health  seeking  behaviour  and  high treatment  cost  burden contribute  to  increased  morbidity  in  children. The available  treatment  options  include  intravenous broad-spectrum antibiotics  either  alone  or  in  combination  with surgical  procedure  (thoracocentesis,  chest  tube  drainage, fibrinolytic  therapy,  decortications  with  video  assistedthoracoscopic surgery (VATS) and open drainage. Methods: Fifty Children between 1 month to 16 years admitted in the Pediatrics Ward, PICU of College of Medical Sciences, Bharatpur,Nepal. Data analysis was done by SPSS 24.0. Results: Present study found that according to blood culture, 3(6.0%) patients had enterococcus, 40(80.0%) patients had no growth, 2(4.0%) patients had pseudomonas, 4(8.0%) patients had staphylococcus and 1(2.0%) patients had streptococcus. We found that 20(40.0%) patients had done CT scan thorax, 30(60.0%) patients had not done CT scan thorax and 32(64.0%) patients had Amoxiclav first line antibiotic and 18(36.0%) patients had Ceftriaxone first line antibiotic. Conclusions: Suitable antibiotics and prompt chest tube drainage is an effective method of treatment of childhood empyema, especially in resource-poor settings. Majority of the patients progress on this conservative management and have good recovery on follow up.  


CHEST Journal ◽  
2011 ◽  
Vol 139 (3) ◽  
pp. 519-523 ◽  
Author(s):  
Yizhak Kupfer ◽  
Chanaka Seneviratne ◽  
Kabu Chawla ◽  
Kavan Ramachandran ◽  
Sidney Tessler

PEDIATRICS ◽  
1984 ◽  
Vol 73 (5) ◽  
pp. 587-593 ◽  
Author(s):  
F. John McLaughlin ◽  
D. A. Goldmann ◽  
D. M. Rosenbaum ◽  
G. B. C. Harris ◽  
S. R. Schuster ◽  
...  

Sixteen patients, aged 1 month to 15 years, were studied to determine the clinical course and longterm outcome of empyema in previously healthy children. The pathogens responsible were Haemophilus influenzae type b (seven patients), Staphylococcus aureus (five patients), Streptococcus pneumoniae (three patients), and viridans group Streptococcus (one patient). All patients had loculated fluid showing on chest roentgenographs. Chest tube drainage yielded 20 to 1,495 mL (mean 293 mL) during the first three days, accounting for 83% of total drainage. Chest tubes were removed after three to 17 days (mean ten days). Only slight roentgenographic improvement showed during chest tube drainage. Three patients required an open thoracotomy because of an unsatisfactory clinical response. Hospitalization ranged from eight to 77 days (mean 25 days). All patients had residual pleural thickening shown on chest roentgenographs taken at discharge. Thirteen patients were seen 5 to 140 months (mean 66 months) after discharge. Findings from physical examination were normal in 12 of the 13 patients. Pulmonary function tests in ten of the 13 patients revealed (mean percent predicted ± 1 SD): vital capacity 92 ± 12, residual volume 85 ± 31, total lung capacity 92 ± 13, peak flow rate 96 ± 17, forced expiratory volume in 1 second 90 ± 13, and maximal mid-expiratory flow rate 93 ± 25. In all but one patient, findings on chest roentgenograms were normal or showed slight pleural thickening. Children with loculated empyema can be treated successfully with antibiotics and chest tube drainage. Few patients require open drainage, and further surgery is rarely required. The long-term outcome is excellent.


2012 ◽  
pp. 19-19
Author(s):  
Jaydeep Choudhury ◽  
Jayanta Bandyopadhyay

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