Role of streptokinase in management of retained hemothorax: a multicentric study

Background: Enzymatic debridement of the pleural cavity for retained haemothorax is a frequently overlooked option.Methods: A retrospective, multicentre study was carried out using intrapleural streptokinase was carried out in 15 patients with retained or clotted haemothorax.Results: Thirteen of fifteen patients (86%) with retained pleural collections underwent successful enzymatic debridement and tube drainage with streptokinase injections in our study. The average increase in chest tube output following streptokinase injections was 160%. No significant adverse reactions occurred. Two patients required thoracotomy when streptokinase therapy failed. No deaths were reported in the study.Conclusions: Intrapleural streptokinase is a safe, effective means of removing retained proteinaceous collections in the pleural space. It is a useful adjunct to chest tube drainage and may obviate the need for more invasive procedures.

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Repair of a traumatic subarachnoid-pleural fistula with the percutaneous injection of fibrin glue in a 2-year-old

Journal of Neurosurgery Pediatrics ◽

10.3171/2015.5.peds15194 ◽

2016 ◽

Vol 17 (1) ◽

pp. 13-18 ◽

Cited By ~ 4

Author(s):

Jason K. Chu ◽

Brandon A. Miller ◽

Michael P. Bazylewicz ◽

John F. Holbrook ◽

Joshua J. Chern

Keyword(s):

Fibrin Glue ◽

Chest Tube ◽

Epidural Injection ◽

Dural Defect ◽

Percutaneous Injection ◽

Ct Guided ◽

First Line Therapy ◽

Tube Output ◽

Chest Tube Output ◽

Dural Defects

Subarachnoid-pleural fistulas (SPFs) are rare clinical entities that occur after severe thoracic trauma or iatrogenic injury during anterolateral approaches to the spine. Treatment of these fistulas often entails open repair of the dural defect. The authors present the case of an SPF in a 2-year-old female after a penetrating injury to the chest. The diagnosis of an SPF was suspected given the high chest tube output and was confirmed with a positive β2-transferrin test of the chest tube fluid, as well as visualization of dural defects on MRI. The dural defects were successfully repaired with CT-guided percutaneous epidural injection of fibrin glue alone. This case represents the youngest pediatric patient with a traumatic SPF to be treated percutaneously. This technique can be safely used in pediatric patients, offers several advantages over open surgical repair, and could be considered as an alternative first-line therapy for the obliteration of SPFs.

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Factors Related to Pleural Effusions After Fontan Procedure in the Era of Fenestration

Circulation ◽

10.1161/circ.104.suppl_1.i-148 ◽

2001 ◽

Vol 104 (suppl_1) ◽

Author(s):

Raymond T. Fedderly ◽

Beth N. Whitstone ◽

Stephanie J. Frisbee ◽

James S. Tweddell ◽

S. Bert Litwin

Keyword(s):

Hospital Stay ◽

Chest Tube ◽

Single Ventricle ◽

Fontan Procedure ◽

Fontan Operation ◽

Univariate Analysis ◽

Ordinary Least Squares ◽

Pleural Effusions ◽

Tube Output ◽

Chest Tube Output

Background Significant pleural effusions after the Fontan operation prolong hospital stay, may increase the risk of infection, and may necessitate a pleurodesis procedure. Methods and Results From February 1991 to April 2000, 98 consecutive patients under the age of 18 years underwent the fenestrated Fontan procedure at Children’s Hospital of Wisconsin. Ninety-four patients who survived at least 30 days after surgery were retrospectively evaluated for the following factors: age, ventricular morphology (right single ventricle, left single ventricle [RV/LV]), fenestration open (FO) or closed (FC) at end of operation, intracardiac Fontan (IF) or extracardiac Fontan (EF), days with chest tube output per day >5, 10, and/or 20 mL · kg −1 · d −1 (CTO5, CTO10, and CTO20, respectively), need for pleurodesis, length of hospital stay (LOS), operation during winter respiratory viral season of November through March (ReVS+, ReVS−), and pre-Fontan mean pulmonary artery pressure (PAP) and pulmonary vascular resistance (PVR). In univariate analysis, the ReVS+ patients had prolonged LOS, greater chest tube output, and more pleurodesis ( P <0.05), and PAP was related to CTO5 and CTO10 but not to CTO20 or LOS. No significant differences were found in LOS, CTO5, CTO10, CTO20, and need for pleurodesis between patients in RV/LV, FO/FC, IF/EF, or PVR groups. Patients <4 years of age had more instances of CTO20 ( P <0.05). When we used ordinary least squares regression analysis with age, FO or FC, RV or LV, PAP, and ReVS+ or ReVS− to predict each of CTO5, CTO10, CTO20, and LOS, only ReVS+ or ReVS− and age were statistically significant in all models. Conclusions Use of the Fontan procedure during the respiratory viral season appeared to be related to significant, prolonged pleural effusions and longer hospitalizations.

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Role of chest tube drainage in physical function after thoracoscopic lung resection

Journal of Thoracic Disease ◽

10.21037/jtd.2019.08.26 ◽

2019 ◽

Vol 11 (S15) ◽

pp. S1947-S1950

Author(s):

Pengfei Li ◽

Shuangjiang Li ◽

Guowei Che

Keyword(s):

Physical Function ◽

Chest Tube ◽

Lung Resection ◽

Chest Tube Drainage ◽

Tube Drainage

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Risk of Renal Dysfunction after Less Invasive Multivessel Coronary Artery Bypass Grafting

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1097/imi.0b013e3182614f80 ◽

2012 ◽

Vol 7 (3) ◽

pp. 180-186 ◽

Cited By ~ 1

Author(s):

Soroosh Kiani ◽

Alex K. Brown ◽

Dinesh J. Kurian ◽

Stanislav Henkin ◽

Mary M. Flynn ◽

...

Keyword(s):

Cardiopulmonary Bypass ◽

Coronary Artery ◽

Coronary Artery Bypass Grafting ◽

Chest Tube ◽

Artery Bypass ◽

Bypass Grafting ◽

Off Pump ◽

Transfusion Requirements ◽

Tube Output ◽

Chest Tube Output

Objective Several centers have established that off-pump, multivessel coronary artery bypass grafting performed via a small thoracotomy (MVST) is feasible. However, this procedure can be challenging when posterolateral coronary targets need to be grafted. We hypothesized that use of cardiopulmonary bypass via peripheral access (MVST-PA) would improve outcomes compared with a completely off-pump approach (OP-MVST). Methods This was a prospective observational study of patients undergoing OP-MVST (n = 46) versus MVST-PA (n = 45) using bilateral internal mammary artery grafts onto the left anterior descending coronary artery and circumflex/right coronary artery distribution. Hemostasis was quantified by measuring platelet function (aggregometry), chest tube output, thrombolysis in myocardial infarction bleeding score (%hematocrit change at 24 hours), and transfusion requirements. The rate of mortality and major morbidity at 30 days was defined according to The Society of Thoracic Surgeons criteria. Estimated glomerular filtration rate (normalized to baseline levels) was determined daily until discharge. Results The OP-MVST versus MVST-PA groups had similar risk factors at baseline and risks of composite morbidity/mortality at 30 days. However, renal failure was significantly increased after OP-MVST (10.87 vs 0%, P = 0.05), and MVST-PA affected hemostasis as evidenced by inhibition of platelet function (latency to response on aggregometry, 29.9 vs 17.9 seconds; P = 0.04) and higher transfusion requirement (2.31 vs 0.85 units of red blood cells/patient, P = 0.04; 55.6% vs 34.8% transfused; P = 0.059). However, 24-hour chest tube output was similar (645 vs 750 mL; P = 0.53). Conclusions In comparison with a completely off-pump strategy, use of cardiopulmonary bypass to assist MVST reduced the risk of renal dysfunction with only modest tradeoffs in other morbidities, for example, altered coagulation and higher transfusion requirements. These data justify further study of the effect of MVST-PA on renal complications.

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Treatment of hepatic hydrothorax and reduction of chest tube output with octreotide

European Journal of Gastroenterology & Hepatology ◽

10.1097/00042737-200108000-00019 ◽

2001 ◽

Vol 13 (8) ◽

pp. 977-980 ◽

Cited By ~ 16

Author(s):

Rahel Pfammatter ◽

Christiana Quattropani ◽

Jürg Reichen ◽

Burkhard Göke ◽

Andreas C. C. Wagner

Keyword(s):

Chest Tube ◽

Hepatic Hydrothorax ◽

Tube Output ◽

Chest Tube Output

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Thoracotomy for blunt chest trauma: is chest tube output a useful criterion?

Acute Medicine & Surgery ◽

10.1002/ams2.148 ◽

2015 ◽

Vol 3 (2) ◽

pp. 81-85

Author(s):

Yasuaki Mizushima ◽

Shota Nakao ◽

Hiroaki Watanabe ◽

Tetsuya Matsuoka

Keyword(s):

Chest Tube ◽

Blunt Chest Trauma ◽

Chest Trauma ◽

Tube Output ◽

Chest Tube Output

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Aortic Valve Replacement via Right Minithoracotomy versus Median Sternotomy

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1097/imi.0000000000000062 ◽

2014 ◽

Vol 9 (2) ◽

pp. 75-81 ◽

Cited By ~ 11

Author(s):

Donald D. Glower ◽

Bhargavi S. Desai ◽

G. Chad Hughes ◽

Carmelo A. Milano ◽

Jeffrey G. Gaca

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Median Sternotomy ◽

Relative Role ◽

Safe Alternative ◽

Delayed Wound Healing ◽

Tube Output ◽

Chest Tube Output

Objective The aim of this study was to define the relative role of a right minithoracotomy (RT) versus standard median sternotomy (ST) for open aortic valve replacement (AVR). Methods A retrospective analysis was performed of all 1348 patients undergoing isolated, open AVR at a single institution during a 14-year period. Because relatively few patients were technically suitable for redo AVR with the RT approach (n = 20), all redo patients (n = 209) were excluded, leaving 1139 patients available for analysis. Patients converting from RT to ST approach (n = 15) were analyzed separately. Results Relative to ST (n = 672), the RT patients (n = 452) were older with more stenosis but with more recent operation year, lower rate of congestive heart failure, higher ejection fraction, lower rate of endocarditis, and lower rate of renal disease than the ST AVR patients (all P < 0.0001). Right minithoracotomy AVR was associated with longer cardiopulmonary bypass times [157 (25) vs 131 (38), P = 0.0004] and clamp times [103 (20) vs 85 (27), P < 0.0001] but less transfusion (1.4 vs 3.4 U, P = 0.0003), less chest tube output (405 vs 950 mL, P < 0.0001), fewer reoperations for bleeding (0.4% vs 4%, P < 0.0001), shorter length of stay (6 vs 8 days, P = 0.03), and lower rate of atrial fibrillation (15% vs 20%, P = 0.03). Stroke, operative mortality, and survival were not significantly different between the groups. Conclusions Given the biases of retrospective propensity-adjusted analysis, these data suggest that RT AVR is a safe alternative to ST AVR in selected patients, with advantages of avoiding sternotomy with associated bleeding, transfusion, and delayed wound healing, at the expense of longer pump and clamp times.

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