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 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.

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.

scholarly journals Postoperative Air Leaks With Prompt Improvement of Low Suction on Digital Drainage Devices: a Retrospective Study

2020 ◽  
Author(s):  
Suguru Mitsui ◽  
Shunsuke Tauchi ◽  
Takahiro Uchida ◽  
Hisashi Ohnishi ◽  
Toshio Shimokawa ◽  
...  
Keyword(s):  
Chest Tube ◽  
Pulmonary Resection ◽  
Maximum Amount ◽  
Fluid Volume ◽  
Suction Pressure ◽  
Air Leak ◽  
Air Leaks ◽  
Tube Removal ◽  
Chest Tube Removal ◽  
Pressure Suction

Abstract Purpose: The aim was to investigate the most effective suction pressure for preventing or promptly improving postoperative air leaks.Methods: We retrospectively analyzed the postoperative data of 242 patients who were monitored with a digital drainage system after pulmonary resection between December 2017 and June 2020. We divided the patients into 3 of group by suction pressure, A (Low-pressure suction group: -5 cm H₂O), B (Intermediate-pressure group: -10 cm H₂O), C (High-pressure suction group: -20 cm H₂O). Duration of air leaks, duration of chest tube replacement, the amount of postoperative air leak, fluid volume drained before chest tube removal, and the maximum amount of air leaks during drainage were evaluated.Results: A total 217 patients were included. In the order of A, B, and C groups, duration of air leaks gradually decreased and significant trend was observed (p=0.019). Duration of chest tube replacement did not significantly differ among the three groups (p=0.126). The amount of postoperative air leak just after surgery did not significantly differ among the three groups (p=0.175), however, the amount of postoperative day 1 air leak gradually decreased with statistical significance in order of A, B, and C groups (p=0.033). The maximum amount of air leaks during drainage gradually decreased in order of A, B and C groups (p=0.036). Fluid volume drained before chest tube removal did not significantly differ among the three groups (p=0.986).Conclusion: Low-pressure suction after pulmonary resection would be useful for preventing or promptly improving postoperative air leaks.

scholarly journals Postoperative Air Leaks with Prompt Improvement of Low Suction on Digital Drainage Devices: A Retrospective Study

2020 ◽  
Author(s):  
Suguru Mitsui ◽  
Shunsuke Tauchi ◽  
Takahiro Uchida ◽  
Hisashi Ohnishi ◽  
Toshio Shimokawa ◽  
...  
Keyword(s):  
Chest Tube ◽  
Pulmonary Resection ◽  
Maximum Amount ◽  
Fluid Volume ◽  
Suction Pressure ◽  
Air Leak ◽  
Air Leaks ◽  
Tube Removal ◽  
Chest Tube Removal ◽  
Pressure Suction

Abstract Purpose: The aim was to investigate the most effective suction pressure for preventing or promptly improving postoperative air leaks.Methods: We retrospectively analyzed the postoperative data of 242 patients who were monitored with a digital drainage system after pulmonary resection between December 2017 and June 2020. We divided the patients into 3 of group by suction pressure, A (Low-pressure suction group: -5 cm H₂O), B (Intermediate-pressure group: -10 cm H₂O), C (High-pressure suction group: -20 cm H₂O). Duration of air leaks, duration of chest tube replacement, the amount of postoperative air leak, fluid volume drained before chest tube removal, and the maximum amount of air leaks during drainage were evaluated.Results: A total 217 patients were included. In the order of A, B, and C groups, duration of air leaks gradually decreased and significant trend was observed (p=0.019). Duration of chest tube replacement did not significantly differ among the three groups (p=0.126). The amount of postoperative air leak just after surgery did not significantly differ among the three groups (p=0.175), however, the amount of postoperative day 1 air leak gradually decreased with statistical significance in order of A, B, and C groups (p=0.033). The maximum amount of air leaks during drainage gradually decreased in order of A, B and C groups (p=0.036). Fluid volume drained before chest tube removal did not significantly differ among the three groups (p=0.986).Conclusion: Low-pressure suction after pulmonary resection would be useful for preventing or promptly improving postoperative air leaks.

Ultrasonography Versus Chest Radiography After Chest Tube Removal for the Detection of Pneumothorax

2010 ◽  
Vol 21 (1) ◽  
pp. 34-38 ◽  
Author(s):  
Sandra Saucier ◽  
Carrie Motyka ◽  
Keith Killu
Keyword(s):  
Chest Radiography ◽  
Chest Tube ◽  
Cost Effective ◽  
Bedside Ultrasound ◽  
Perfect Agreement ◽  
Tube Removal ◽  
Ultrasound Technology ◽  
Reproducible Method ◽  
Chest Tube Removal ◽  
Κ Statistic

Background Bedside ultrasound technology is an innovative, cost-effective, safe, and reproducible method used to make efficient decisions that directly affect the care of critical care patients. Purpose To validate the use of ultrasound technology when compared with the use of standard chest radiography for the detection of pneumothorax following chest tube removal. Methods A prospective observational comparison study of 50 cardiothoracic patients with surgically placed pleural chest tubes was conducted. The accuracy of bedside ultrasound technology was compared with standard chest radiography to detect pneumothorax. Results The sample κ statistic was 1.000, indicating a perfect agreement between bedside ultrasonography and chest radiography in the detection of pneumothorax. Completion of the bedside ultrasound procedure took significantly less time than chest radiography. Conclusions Bedside ultrasound technology is as accurate as chest radiography in detecting pneumothorax following chest tube removal and can save institutions’ time and money.

scholarly journals Multicenter randomized study on comparison between electronic and traditional chest drainage systems

2019 ◽  
Author(s):  
Giuseppe Marulli ◽  
Giovanni Maria Comacchio ◽  
Mario Nosotti ◽  
Lorenzo Rosso ◽  
Paolo Mendogni ◽  
...  
Keyword(s):  
Interobserver Variability ◽  
Chest Drain ◽  
Chest Drainage ◽  
Drainage Systems ◽  
Traditional System ◽  
Air Leaks ◽  
Tube Removal ◽  
Space Effect ◽  
Digital Chest ◽  
Chest Tube Removal

Abstract Background In patients submitted to major pulmonary resection, post-operative length of stay is mainly influenced by duration of air leaks and chest tube removal. The measurement of air leaks largely relies on traditional chest drainage systems which are prone to subjective interpretation. Difficulty to differentiate between active air leaks and bubbles due to a pleural space effect may also lead to tentative drain clamping and prolonged time for chest drain removal. New digital systems allow continuous monitoring of air leaks, identifying subtle leakage that may be not visible during daily patient evaluation. Moreover, an objective assessment of air leaks may lead to a reduced interobserver variability and to an optimized timing of chest tube removal. Methods This study is a prospective randomized, interventional, multicenter trial designed to compare the electronic chest drainage system (Drentech™ Palm Evo) with the traditional system (Drentech™ Compact) in a cohort of patients undergoing pulmonary lobectomy through a standard 3-ports VATS approach for benign or malignant disease. It will enroll 382 patients in 3 Italian centers. Duration of chest drainage and length of hospital stay will be evaluated in the two groups. Moreover, it will be evaluated if the use of a digital chest system compared with a traditional system reduces the interobserver variability. Finally, it will be evaluated the possible advantages of the digital drain system to distinguish an active air leak from a pleural space effect, by the evaluation of intrapleural differential pressure, and to identify potential predictors of prolonged air leaks. Discussion To date few studies have been performed to evaluate clinical impact of digital drainage systems. The proposed prospective randomized trial will provide new knowledge to this research area by investigating and comparing the difference between digital and traditional chest drain systems. In particular, the objectives of this project are to evaluate the feasibility and usefulness of utilizing the digital chest drain and to provide new tools to identify patients at higher risk of developing prolonged air leaks. Trial registration number NCT03536130, Registered 24 May 2018 - Retrospectively registered, https://clinicaltrials.gov/ct2/results?cond=&term=NCT03536130&cntry=&state=&city=&dist=

scholarly journals Complications after Chest Tube Removal and Reinterventions in Patients with Digital Drainage Systems

2019 ◽  
Vol 8 (12) ◽  
pp. 2092
Author(s):  
Yi-Ying Lee ◽  
Po-Kuei Hsu ◽  
Chien-Sheng Huang ◽  
Yu-Chung Wu ◽  
Han-Shui Hsu
Keyword(s):  
Predictive Factors ◽  
Lung Resection ◽  
Drainage System ◽  
Drainage Tube ◽  
Air Leak ◽  
Chest Drainage ◽  
Drainage Systems ◽  
Air Leaks ◽  
Thoracic Drainage ◽  
Tube Removal

Introduction: Digital thoracic drainage systems are a new technology in minimally invasive thoracic surgery. However, the criteria for chest tube removal in digital thoracic drainage systems have never been evaluated. We aim to investigate the incidence and predictive factors of complications and reinterventions after drainage tube removal in patients with a digital drainage system. Method: Patients who received lung resection surgery and had their chest drainage tubes connected with a digital drainage system were retrospectively reviewed. Results: A total of 497 patients were monitored with digital drainage systems after lung resection surgery. A total of 175 (35.2%) patients had air leak-related complications after drainage tube removals, whereas 25 patients (5.0%) required reintervention. We identified that chest drainage duration of five days was an optimal cut-off value in predicting air leak-related complications and reinterventions. In multiple logistic regression analysis, previous chest surgery history; small size (16 Fr.) drainage tubes; the presence of initial air leaks, defined as air leaks recorded by the digital drainage system immediately after operation; and duration of chest drainage ≥5 days were independent factors of air leak-related complications, whereas the presence of initial air leaks and duration of chest drainage ≥5 days were independent predictive factors of reintervention after drainage tube removal. Conclusion: Air leak-related complications and reinterventions after drainage tube removals happened in 35.2% and 5.0% of patients with digital thoracic drainage systems. The management of chest drainage tubes in patients with predictive factors, i.e., the presence of initial air leaks and duration of chest drainage of more than five days, should be treated with caution.

scholarly journals Multicenter randomized study on the comparison between electronic and traditional chest drainage systems

Trials ◽  
2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Giuseppe Marulli ◽  
Giovanni M. Comacchio ◽  
Mario Nosotti ◽  
Lorenzo Rosso ◽  
Paolo Mendogni ◽  
...  
Keyword(s):  
Interobserver Variability ◽  
Chest Drain ◽  
Chest Drainage ◽  
Drainage Systems ◽  
Traditional System ◽  
Air Leaks ◽  
Tube Removal ◽  
Space Effect ◽  
Digital Chest ◽  
Chest Tube Removal

Abstract Background In patients submitted to major pulmonary resection, the postoperative length of stay is mainly influenced by the duration of air leaks and chest tube removal. The measurement of air leaks largely relies on traditional chest drainage systems which are prone to subjective interpretation. Difficulty in differentiating between active air leaks and bubbles due to a pleural space effect may also lead to tentative drain clamping and prolonged time for chest drain removal. New digital systems allow continuous monitoring of air leaks, identifying subtle leakage that may be not visible during daily patient evaluation. Moreover, an objective assessment of air leaks may lead to a reduced interobserver variability and to an optimized timing for chest tube removal. Methods This study is a prospective randomized, interventional, multicenter trial designed to compare an electronic chest drainage system (Drentech™ Palm Evo) with a traditional system (Drentech™ Compact) in a cohort of patients undergoing pulmonary lobectomy through a standard three-port video-assisted thoracic surgery approach for both benign and malignant disease. The study will enroll 382 patients in three Italian centers. The duration of chest drainage and the length of hospital stay will be evaluated in the two groups. Moreover, the study will evaluate whether the use of a digital chest system compared with a traditional system reduces the interobserver variability. Finally, it will evaluate whether the digital drain system may help in distinguishing an active air leak from a pleural space effect, by the digital assessment of intrapleural differential pressure, and in identifying potential predictors of prolonged air leaks. Discussion To date, few studies have been performed to evaluate the clinical impact of digital drainage systems. The proposed prospective randomized trial will provide new knowledge to this research area by investigating and comparing the difference between digital and traditional chest drain systems. In particular, the objectives of this project are to evaluate the feasibility and usefulness of digital chest drainages and to provide new tools to identify patients at higher risk of developing prolonged air leaks. Trial registration ClinicalTrials.gov, NCT03536130. Retrospectively registered on 24 May 2018.

Therapeutic Pneumoperitoneum: Relevant or Obsolete in 2015?

2016 ◽  
Vol 65 (05) ◽  
pp. 375-381 ◽  
Author(s):  
Jonathan Berger ◽  
Joe Small ◽  
Rafael Garza ◽  
Rafael Andrade ◽  
Eitan Podgaetz
Keyword(s):  
Chest Tube ◽  
Pulmonary Function Tests ◽  
Vital Signs ◽  
Pleural Space ◽  
Abdominal Incision ◽  
Intraperitoneal Pressure ◽  
Proper Patient Selection ◽  
Tube Removal ◽  
Prolonged Air Leak ◽  
Chest Tube Removal

Background Therapeutic pneumoperitoneum (TP) is one alternative to manage pleural space problems. We describe our technique and experience. Materials and Methods Medical records of all patients who underwent TP from January 1, 2007, to January 1, 2015, were reviewed after Institutional Review Board approval. We report indication, preprocedure pulmonary function tests, volume of insufflated air, time to chest tube removal, and complications. We place a red rubber catheter into the peritoneal space through the diaphragm or a small abdominal incision, insufflate with room air, record volume (liters), intraperitoneal pressure (goal 9–10 mm Hg), and monitor vital signs, airway pressures, and urine output. Results We performed TP in 32 patients. Follow-up was available for 31 patients. Indications were prevention of pleural space problems in bilobectomy patients (n = 11), following decortication for empyema (n = 11), prevention of prolonged air leak (n = 3), prevention of postresection space (n = 4), and spontaneous chylothorax (n = 2). TP was done postoperatively in three patients. Median air volume used was 3.5 L (3–6 L). Time to chest tube removal overall was 7.8 days (3–20 days) and to discharge 10.2 days (4–32 days). No patient developed respiratory failure, renal failure, or required evacuation of TP. Conclusion TP is a simple, safe, and effective technique to manage pleural space problems. Proper patient selection and meticulous technique are imperative for the successful clinical application of TP. We believe that TP is an underutilized tool for the management of pleural space problems and merits wider application in thoracic surgical practice.

Sign in / Sign up

Export Citation Format

Share Document