Academic literature on the topic 'Chest tube'

Objective Chest-tube clogging can lead to complications after heart and lung surgery. Surgeons often choose large-diameter chest tubes or place more than one chest tube when concerned about the potential for clogging. The purpose of this report is to describe the design and function of a proprietary active tube clearance system, a novel device that clears clots and debris from chest tubes. Device Description The active tube clearance system is a novel chest tube clearance apparatus developed to maintain chest tube patency. Chest tube clearance is achieved by advancing the specially designed clearance member back and forth within the chest tube under sterile conditions, breaking down and pulling clots back toward the drainage receptacle, thereby leaving the inner portion of the chest tube clear of any obstructing material. Conclusions By maintaining chest tube patency, chest tube drainage can be performed more safely, and this apparatus may possibly lead to the use of smaller chest tubes and less invasive insertion techniques.

Abstract Background The need for chest X-rays (CXR) following large-bore chest tube removal has been questioned; however, the utility of CXRs following removal of small-bore pigtail chest tubes is unknown. We hypothesized that CXRs obtained following removal of pigtail chest tubes would not change management. Methods Patients < 18 years old with pigtail chest tubes placed 2014–2019 at a tertiary children’s hospital were reviewed. Exclusion criteria were age < 1 month, death or transfer with a chest tube in place, or pigtail chest tube replacement by large-bore chest tube. The primary outcome was chest tube reinsertion. Results 111 patients underwent 123 pigtail chest tube insertions; 12 patients had bilateral chest tubes. The median age was 5.8 years old. Indications were pneumothorax (n = 53), pleural effusion (n = 54), chylothorax (n = 6), empyema (n = 5), and hemothorax (n = 3). Post-pull CXRs were obtained in 121/123 cases (98.4%). The two children without post-pull CXRs did not require chest tube reinsertion. Two patients required chest tube reinsertion (1.6%), both for re-accumulation of their chylothorax. Conclusions Post-pull chest X-rays are done nearly universally following pigtail chest tube removal but rarely change management. Providers should obtain post-pull imaging based on symptoms and underlying diagnosis, with higher suspicion for recurrence in children with chylothorax.

Background Malposition of percutaneously inserted chest tubes is considered as a rare complication in critically ill patients. Its incidence, however, remains uncertain. The aims of the study were to assess the true incidence of chest tube malposition in critically ill patients and to identify predicting factors. Methods The authors prospectively studied 122 chest tubes percutaneously inserted in 75 consecutive critically ill patients. For clinical reasons independent of the study, thoracic computed tomography scanning was performed in 63 patients, allowing direct visualization of 106 chest tubes. Based on these findings, chest tube position was classified as intrapleural, intrafissural, or intraparenchymal. Factors predicting chest tube malposition were analyzed by univariate and multivariate analysis. Results The mean delay between chest tube placement and thoracic scan was 3.5+/-2.9 days. Twenty-two chest tubes were diagnosed as being intrafissural (21%), and 10 were diagnosed as being intraparenchymal (9%). The only predicting factor associated with the risk of malposition was the use of a trocar for the percutaneous insertion of the chest tube (P=0.032). Conclusions Malposition was detected in 30% of percutaneously inserted chest tubes, a higher incidence than previously reported. Avoiding the use of a trocar may reduce significantly the incidence of chest tube malposition.

We reviewed the epidemiology, clinical manifestations, and outcomes of 3 cases of chest tube–related empyema due to methicillin-resistantStaphylococcus aureus(MRSA). Antiseptic-impregnated chest tubes were inserted in cultures containing MRSA isolates from these 3 patients, and zone of inhibition were measured. Chest tube–related MRSA empyema might complicate tube thoracostomy, and coating the chest tube with antiseptic agents could prevent this complication.

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.

Mobile chest radiography remains the most appropriate test for critical care patients with cardiorespiratory changes and with patients who have chest tubes and lines as a monitoring tool, and to detect complications related to their use. However, one of the most frequent issues recognized radiographically with patients in critical care is chest tubes and lines malposition. This can be related to technical quality reasons which can affect their appearance in the chest radiography. This research considers how the technical quality of the ICU/CCU chest radiography can impact upon the appearance of chest tubes/lines and how that appearance can impact on the decision making. Results show that the methods used in the chest phantom experiment to estimate the degree of angulation have a large effect upon the appearance of anatomical structures, but it does not have a particularly large effect upon the apparent changes of tube/line position central venous catheter and endotracheal tube (CVC, ETT). The study also shows that there was a little difference between the two image processing algorithms, apart from the visualisation of sharp reproduction of the trachea and proximal bronchi, which was significantly better using the standard algorithm compared to the inverted algorithm. The two methods used to estimate the degree of angulation and the apparent position of the CVC/ETT on 17 mobile chest radiographs provide limited useful information to the image interpreter in estimating the degree of angulation and degree of malpositioning of the tube and line.

UVOD: Drenaža grudnog koša nakon resekcija pluća je osnovni grudno hirurški postupak, koji omogućuje proširenje (reekspanziju) pluća iz kolabiranog stanja, evakuaciju vazduha, krvi i izliva iz pleuralnog prostora i potpomognuta je primenom aspiracije na drenove (sukciona ili aspiraciona drenaža). Iako je drenaža  svakodnevna grudno hirurška procedura, postupak sa drenovima je zasnovan prvenstveno na iskustvu, a manje na osnovu naučnih studija. Pri mirnom disanju inspiratorni pritisak u pleuralnom prostoru je prosečno - 8 cm H2O, a ekspiratorni - 4 cm H2O. Pri forsiranom disanju pritisci mogu dostići - 50 cm H2O i +70 cm H2O. Na osnovu tih fizioloških podataka, većina hirurga primenjuje aspiraciju od - 10 do - 40 cm H2O. Koncepta pleuralnog deficita - disproporcije volumena preostalog plućnog tkiva i zapremine grudnog koša doveo je do razvoja tehničkih postupaka za postizanje nove fiziološke ravnoteže u pleuralnom prostoru i razmatranja rutinske primene podvodne (pasivne) drenaže nakon resekcija pluća. Pritisak na zdravstvenu službu za smanjenje troškova i skraćenje postoperativne hospitalizacije uz mogućnost rane mobilizacije pacijenta čine podvodnu drenažu zanimljivom alternativom tradicionalno prihvaćenoj aktivnoj aspiraciji na drenove.  CILJ: Da se utvrdi da li aplikacija aktivne aspiracije na drenove nakon lobektomije pluća u poređenju da podvodnom drenažom ima povoljno terapijsko dejstvo na postizanje i održavanje reekspanzije pluća; Da se kvantitativno uporede različiti modovi aktivne aspiracije preko drenova; Da se uporedi dužina hospitalizacije i pojava hirurških i nehirurških komplikacija između grupa ispitanika kod kojih se primenjuje podvodna (pasivna) drenaža i aspiracija preko drenova. METODOLOGIJA: Prospektivna studija bez randomizacije obuhvatila je 301 ispitanika kojima je načinjena lobektomija pluća zbog karcinoma pluća na Klinici za grudnu hirurgiju Instituta za plućne bolesti Vojvodine u Sremskoj Kamenici u periodu od 01.01.2008. - 28.02.2010. godine. Beleženi su i analizirani podaci o preoperativnom stanju: plućnoj funkciji, prethodno primljenoj neoadjuvantnoj hemioterapiji i pridruženim bolestima. Analizirani su hirurški operativni podaci o postojanju buloznog emfizema, adhezija u pleuralnom prostoru, anatomskoj vrsti lobektomije, dodatnim hirurškim procedurama i postojanju gubitka vazduha na kraju operacije. Analizirani su postoperativni podaci o secernaciji na drenove tokom prva 24 h i ukupno, trajanju gubitka vazduha na drenove u danima, ukupnom trajanju drenaže, ukupnom trajanju hospitalizacije, pojavi produženog gubitka vazduha na dren definisanog kao gubitak duže od 7 dana, potrebi za redrenažom grudnog koša (broj drenova upotrebljenih za redrenažu), kompletnost reekspanzije pluća pre vađenja drenova, pojavi drugih hirurških komplikacija, pojavi opštih medicinskih komplikacija i pojavi kasnih komplikacija – više od 30 dana nakon operacije ili nakon otpusta. Prvu grupu ispitanika sačinjavaju pacijenti kojima je načinjena lobektomija pluća, nakon čega je aplikovana aspiracija od -20 cm vodenog stuba do klemovanja i vađenja drenova. Drugu grupu ispitanika sačinjavaju pacijenti kojima je aplikovana aspiracija od -20 cm vodenog stuba na dan operacije i zatim -10 cm vodenog stuba do klemovanja i vađenja drenova. Treću grupu ispitanika sačinjavaju pacijenti kojima je načinjena lobektomija pluća, nakon čega je aplikovana aspiracija od -20 cm vodenog stuba na dan operacije i zatim podvodna drenaža do klemovanja i vađenja drenova. Četvrtu grupu ispitanika sačinjavaju pacijenti kojima je načinjena lobektomija pluća, nakon čega je aplikovana aspiracija od -20 cm vodenog stuba na dan operacije i zatim dnevna procena i modifikacija na sledeći način: aspiracija od -20 cm vodenog stuba do postizanja reekspanzije pluća, zatim postepeno smanjenje aspiracije po nahođenju operatera do klemovanja i vađenja drenova. REZULTATI: Između grupa ispitanika ne postoji statistički značajna razlika po starosti (p=0,77),  parametrima plućne funkcije: vrednost FEV1 (p=0,6316), vrednost ITGV (p=0,6202), vrednost TLC (p=0,6922) i za vrednost RV ne postoji razlika (p=0,6552). Razlika ne postoji između grupa ni u učestalosti pridruženih bolesti (p=0,4522). Grupe su međusobno homogene po preoperativnim parametrima. Snižen FEV1 u ukupnoj populaciji pacijenata nije uticao na pojavu produženog gubitka vazduha (P=0,571), kao ni povišenje ITGV (P=0,22), RV (p=0,912), niti vrednost TLC (0,521). Upoređene su međusobno osnovne vrste lobektomija: desna gornja, leva gornja, desna donja, leva donja, srednja lobektomija, kao i donja i gornja bilobektomija desno. Kako je učestalost svake pojedinačne lobektomije u 4 grupe ispitanika mali da bi se uporedile iste lobektomije između grupa, poređenje je moguće samo između anatomski različitih lobektomija kumulativno u svim grupama. Razlika u pojavi produženog gubitka vazduha između različitih lobektomija postoji, ali nije dostigla statističku značajnost (p=0,061). Međutim, kada se analizira svaka lobektomija pojedinačno, uočava se da desna donja bilobektomija ima značajno veću učestalost produženog gubitka vazduha u odnosu na sve ostale lobektomije zajedno (P=0,009). Razlika u dužini drenaže kod  različitih lobektomija je dostigla statistički značaj (p=0,0356), kao i u ukupnoj dužini hospitalizacije (p=0,0007). Dodatak resekcije perikarda, grudnog zida ili dijafragme, klinasta resekcija susednog režnja ili sleeve resekcija bronha kao dodatne procedure nisu uticali na pojavu produženog gubitka vazduha (p=0,58). Podaci o učestalosti adhezija u ispitivanoj populaciji pacijenata i njihovom uticaju na pojavu produženog gubitka vazduha daju granične vrednosti. I ovde je broj pacijenata u svakoj pojedinačnoj kategoriji adhezija (postojanje adhezija na skali od 0-3) mali da bi testiranje povezanosti sa produženim gubitkom vazduha moglo dostići statističku značajnost - razlika postoji, ali nije značajna (p=0,065). Radi povećanja statističke snage je izvedeno testiranje za podelu ima ili nema adhezija. Razlika postoji, ali ni ovim testiranjem nije dostignuta statistički značajna razlika (p=0,057). Postojanje buloznog emfizema takođe dovodi do povećanja učestalosti produženog gubitka vazduha, ali ni ovde razlika nije značajna (p=0,063).  Primena hemoterapije pre operacije nije dovela do statistički značajne razlike u pojavi produženog gubitka vazduha (p=0,0623) i ukupnoj stopi komplikacija (p=0,088), kao ni dužine hospitalizacije (p=0,2), iako razlika postoji i paradoksalno rezultat je bolji kod pacijenata koji su primili hemioterapiju, što može ukazivati na uticaj selekcije pacijenata za operaciju. Između 4 grupe ispitanika nije uočena razlika u potrebi za redrenažom grudnog koša (p=0,101), potrebi za povećanjem nivoa aktivne aspiracije (p=0,326), ukupnoj pojavi komplikacija (p=0,087) i pojavi produženog gubitka vazduha (P=0,323). Razlika postoji i visoko je značajna u dužini trajanja drenaže (p=0,001) i dužini hospitalizacije (P=0,000). Broj drenova (1 ili 2 drena postavljena intraoperativno) nije uticao na pojavu produženog gubitka vazduha (p=0,279), ali je značajno kraća hospitalizacija kod pacijenata sa jednim drenom (p=0,0001). Logistička regresiona analiza je pokazala da je samo donja bilobektomija značajno uticala na pojavu produženog gubitka vazduha na dren, dok nije nađen uticaj aktivne aspiracije na drenove, prisustva adhezija, buloznog emfizema, sniženih vrednosti FEV1, primene redukcije pleuralnog prostora (space reducing), broja drenova i dodatne operacije (resekcije). ZAKLJUČAK: Sprovedenim istraživanjem utvrđeno je da primena aktivne aspiracije na drenove ne pokazuje razliku u odnosu na podvodnu drenažu u postizanju i održavanju reekspanzije pluća nakon lobektomije. Aktivna aspiracija ne utiče na pojavu produženog gubitka vazduha na drenove definisanog kao gubitak vazduha duže od 7 dana, ali utiče na produženje ukupnog trajanja drenaže i hospitalizacije. Nivo aktivne aspiracije ili primena dnevnih modifikacija nivoa aspiracije ne utiče na rezultate lečenja.  U ovom istraživanju preoperativna plućna funkcija, kao ni preoperativna hemoterapija ne utiču na pojavu produženog gubitka vazduha na drenove. Desna donja bilobektomija u odnosu na sve druge lobektomije dovodi do češće pojave produženog gubitka vazduha, produžene drenaže i hospitalizacije. Dodatne resekcije okolnih tkiva u sklopu lobektomije ili primena redukcije pleuralnog prostora ne utiču na pojavu produženog gubitka vazduha. Intraoperativni nalaz adhezija u pleuri i buloznog emfizema pluća povećavaju rizik produženog gubitka vazduha, ali je taj uticaj na granici statističke značajnosti. Primena jednog drena nakon lobektomije umesto dva ne utiče na pojavu produženog gubitka vazduha, ali utiče na skraćenje drenaže i hospitalizacije. U multivarijatnoj analizi samo je donja bilobektomija značajno uticala na pojavu produženog gubitka vazduha na dren, dok nije nađen uticaj aktivne aspiracije na drenove, prisustva adhezija, buloznog emfizema, sniženih vrednosti FEV1, primene redukcije pleuralnog, broja drenova i dodatne resekcije okolnih tkiva.
INTRODUCTION: The drainage of the thorax after pulmonary resection is a basic thoracic surgery procedure which enables reexpansion after lung collapse and the evacuation of air, blood and effusion from the pleural cavity. It is supported by the use of drainage aspiration (suction or aspiration drainage). Although drainage is an everyday procedure in thoracic surgery, the use of drains is based mainly on specialist experience and less on scientific research. During calm breathing the inspiratory pressure in the pleural cavity is – 8cm H2O on average, while the expiratory pressure is – 4cm H2O. During forced breathing the pressures can reach up to – 50 cm H2O and + 70 cm H2O. Based on this physiological data, most surgeons apply the aspiration from – 10 to – 40 cm H2O. The concept of pleural deficit (the disproportion of the volume of the remaining pulmonary tissue and the volume of the thorax) has attributed to development of new technical procedures in order to achieve a new physiological balance in the pleural cavity. It has also brought upon the consideration of routine underwater seal drainage after pulmonary resection. Underwater seal drainage represents an interesting alternative to the traditional active drainage aspiration, especially considering the need to reduce medical expenses and shorten the postoperative hospitalization period. AIM: To determine whether active drainage aspiration after pulmonary lobectomy has a favorable therapeutic effect on achieving and maintaining pulmonary reexpansion in comparison with underwater seal drainage; to quantitatively compare the different modes of active drainage aspiration; to compare hospitalization duration and surgical and non-surgical complication with groups of patients on whom either underwater seal drainage or aspiration drainage was applied. METHODOLOGY: The prospective study without randomization has covered 301 patients on whom pulmonary lobectomy was performed due to lung carcinoma at the Thoracic Surgery Clinic of the Institute of Pulmonary Diseases of Vojvodina from 1st January 2008 to 28th February 2010. The data collected in the pre-operative state included: pulmonary function, previous neoadjuvant chemotherapy and comorbidities. In the research, surgical operative data and postoperative data were analyzed. Surgical operative data included information about the bullous emphysema, adhesion in the pleural cavity, anatomic type of lobectomy, additional surgical procedures and air leak after surgery. Postoperative data involved information about amount of fluid on drainage during the first 24 hours and in total, air leak duration in days, total drainage period, overall hospitalization period, prolonged air leak defined as leak longer than 7 days, the need for redrainage of thorax (number of tubes used for redrainage), completeness of pulmonary reexpansion before the end of drainage, other surgical complications, comorbidities and late complications (after more than 30 days following the surgery or release). The first group consists of patients on whom pulmonary lobectomy was performed, after which an aspiration of – 20 cm H2O was applied before clamping and tube extraction. The second group consists of patients on whom pulmonary lobectomy was performed, after which an aspiration of – 20 cm H2O was applied on surgery day and again – 10 cm H2O before clamping and tube extraction. The third group consists of patients on whom pulmonary lobectomy was performed, after which an aspiration of – 20 cm H2O was applied on surgery day and underwater seal drainage was applied before clamping and tube extraction. The fourth group consists of patients on whom pulmonary lobectomy was performed, after which an aspiration of – 20 cm H2O was applied on surgery day, and then daily monitored and modified in such a way that an aspiration of – 20 cm H2O was applied until pulmonary reexpansion and then gradually lowered according to individual surgery experience before clamping and tube extraction. RESULTS: There is no significant statistical difference between groups of patients in: age (p=0.77), FEV1 (p=0.6316), ITGV (p=0.6202), TLC (p=0.6922) and RV (p=0.6552) and comorbidities (p=0.4522). The groups are homogenous in pre-operative parameters. Lowered FEV1 among all patients did not affect prolonged air leak (p=0.571), nor the increase in values of ITGV (p=0.22), RV (p=0.912) and TLC (p=0.5211). The lobectomies that were compared were: upper right, upper left, lower right, lower left, middle, as well as upper and lower right bilobectomy. The comparison was implemented only on anatomically different lobectomies cumulatively among groups, due to the low occurrence of each type of lobectomy in groups. The difference in prolonged air leak does exist, but is not statistically significant (p=0.061). Prolonged air leak has a significantly higher occurrence in lower right bilobectomies (p=0.009). Drainage duration and hospitalization period variations in different kinds of lobectomy are statistically significant (p=0.0356 and p=0.0007, respectively). Additional pericardial, thoracic or diaphragm resection, wedge resection of the neighboring lobe, or sleeve bronchial resection did not affect prolonged air leak (p=0.58). The research has established that the occurrence of adhesion (on a scale 0-3) in patients and bulous emphysema attribute to prolonged air leak (p=0.065 and p=0.063, respectively).  Comparison between patients with and without adhesions revealed similar result. Difference exists, but it is not statistically significant (p=0,057).  Pre-operative chemotherapy had no statistical significance on prolonged air leak (p=0.0623), total rate of complications (p=0.088), nor hospitalization period (p=0.2). Paradoxically, the treatment was in favor of those patients who had taken pre-operative chemotherapy, which could be due to the selection of patients for surgery.  Among the four groups, there was no difference in need for thoracic redrainage (p=0.101), need for increase in level of active aspiration (p=0.326), overall complication occurrence (p=0.087) and prolonged air leak occurrence (p=0.323). There is a statistically significant difference in drainage duration (p=0.001) and hospitalization period (p=0.000). The number of tubes (1 or 2 tubes set intraoperatively) did not affect prolonged air leak occurrence (p=0.279). The hospitalization period in patients with one tube set intraoperatively is significantly shorter (p=0.0001). Logistic regression analysis has shown that only lower bilobectomy had a significant impact on prolonged air leak, unlike active drainage aspiration, the presence of adhesions, bullous emphysema or lowered FEV1 values, pleural cavity space reducing, number of tubes and resection. CONCLUSION: The research has shown: Active drainage aspiration has no difference in effect in achieving and maintaining pulmonary reexpansion after lobectomy when compared to underwater seal drainage; Active drainage aspiration does not affect prolonged air leak, defined as air leak longer than 7 days; Active drainage aspiration has an impact on the overall drainage duration and hospitalization period; The level of active drainage aspiration and daily modification of the mentioned do not affect treatment results; Preoperative pulmonary function does not affect prolonged air leak occurrence; Preoperative chemotherapy does not affect prolonged air leak occurrence; Prolonged air leak and drainage and hospitalization period occur most often in lower right bilobectomies; Nor additional resections nor pleural cavity reduction affect prolonged air leak occurrence; The presence of pleural adhesions and bullous emphysema rarely attribute to the increase of prolonged air leak occurrence; The number of tubes implemented intraoperatively does not affect prolonged air leak occurrence, but it shortens drainage and hospitalization periods; By multivariate analysis, that only lower bilobectomy has a significant impact on prolonged air leak, unlike active drainage aspiration, the presence of adhesions, bulous emphysema or lowered FEV1 values, pleural cavity space reducing, number of tubes and resection.

Percutaneous chest tube insertion is routinely performed on surgical wards, in the intensive care unit, in the emergency department, and in pulmonary medicine. While it has been shown that trained physicians can safely perform chest tube insertion, severe complications have been described, associated with a lack of proper training and/or an incorrect insertion or management of chest tubes. The proper technique of thoracic drainage is key for safety and effectiveness. Chest tube insertion has been well described, step by step, in the British Thoracic Society guidelines. The level of scientific proof of these recommendations ranges from a high level of evidence (A) to an expert opinion (C) (see Table 28.1).

This chapter reviews the main problems in obtaining portable X-rays in intensive cardiac care unit patients and describes specific features of radiographs taken in the supine anteroposterior position. It also includes a brief review of a systematic, multistep approach of evaluating the quality of radiographic images and describing the chest wall, pulmonary vasculature, the heart and its chambers, the great vessels, and the position of tubes, lines, and devices. This chapter covers the most common conditions for which chest radiographs are useful and provides intensive cardiac care unit physicians, cardiologists, cardiology fellows, and medical students with basic information on water retention, air collection, and lung-related problems. It also focuses on the monitoring of line and device placements (e.g. central venous catheters, tube malposition) and procedure-related abnormalities, which may be apparent on chest X-rays and are helpful for timely diagnoses.

This chapter reviews the main problems in obtaining portable X-rays in intensive cardiac care unit patients and describes specific features of radiographs taken in the supine anteroposterior position. It also includes a brief review of a systematic, multistep approach of evaluating the quality of radiographic images and describing the chest wall, pulmonary vasculature, the heart and its chambers, the great vessels, and the position of tubes, lines, and devices. This chapter covers the most common conditions for which chest radiographs are useful and provides intensive cardiac care unit physicians, cardiologists, cardiology fellows, and medical students with basic information on water retention, air collection, and lung-related problems. It also focuses on the monitoring of line and device placements (e.g. central venous catheters, tube malposition) and procedure-related abnormalities, which may be apparent on chest X-rays and are helpful for timely diagnoses.

This chapter reviews the main problems in obtaining portable X-rays in intensive cardiac care unit patients and describes specific features of radiographs taken in the supine anteroposterior position. It also includes a brief review of a systematic, multistep approach of evaluating the quality of radiographic images and describing the chest wall, pulmonary vasculature, the heart and its chambers, the great vessels, and the position of tubes, lines, and devices. This chapter covers the most common conditions for which chest radiographs are useful and provides intensive cardiac care unit physicians, cardiologists, cardiology fellows, and medical students with basic information on water retention, air collection, and lung-related problems. It also focuses on the monitoring of line and device placements (e.g. central venous catheters, tube malposition) and procedure-related abnormalities, which may be apparent on chest X-rays and are helpful for timely diagnoses.

This chapter reviews the main problems in obtaining portable X-rays in intensive cardiac care unit patients and describes specific features of radiographs taken in the supine anteroposterior position. It also includes a brief review of a systematic, multistep approach of evaluating the quality of radiographic images and describing the chest wall, pulmonary vasculature, the heart and its chambers, the great vessels, and the position of tubes, lines, and devices. This chapter covers the most common conditions for which chest radiographs are useful and provides intensive cardiac care unit physicians, cardiologists, cardiology fellows, and medical students with basic information on water retention, air collection, and lung-related problems. It also focuses on the monitoring of line and device placements (e.g. central venous catheters, tube malposition) and procedure-related abnormalities, which may be apparent on chest X-rays and are helpful for timely diagnoses.

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.

Transfers and retrievalsRapid sequence intubationLaryngeal mask airway insertionNeedle cricothyroidotomyNeedle thoracocentesisIntercostal chest drain insertionArterial line insertionCentral venous accessIntravenous cutdownIntraosseous accessExternal pacingPericardiocentesisFibreoptic bronchoscopyIntra-abdominal pressure measurementLumbar punctureSengstaken–Blakemore tube insertionProne positioning• Intrahospital transfer (e.g. to ICU or to CT scan)....

Both increased fibrinolysis and reduced platelet number and function have been reported postoperatively in cardiopulmonary (CP) bypass patients, but correlations with postoperative bleeding often have not been found. We simultaneously evaluated platelet and fibrinolytic parameters to assess their individual and combined contributions to postoperative blood loss. Plasminogen (pig) concentration, alpha-2-antiplasmin (AP) concentration, free protease activity (fPA), platelet count, and platelet aggregability were measured in nine patients undergoing cardiopulmonary bypass surgery. Hematocrit was also measured in order to determine the degree of blood dilution during CP bypass. Chest tube drainage was used as the measure of postoperative blood loss. Pig and AP concentrations decreased With hemodilution during bypass. fPA did not decrease with dilution but remained at pre-bypass levels. Platelet count decreased during bypass but aggregability to ADP and arachidonic acid (AA) did not change significantly. Following protamine administration there was a large increase (83$) in fPA, the platelet count showed a further drop (from 61% to 50% of pre-bypass levels), and platelet aggregability decreased significantly (from 95% to 34% of pre-bypass levels). Early chest tube drainage (1st 4 hrs postoperatively) correlated positively (p[0.05) with the combination of increase in free protease activity and decrease in platelet count. Total chest tube drainage correlated positively (p[ 0.05) with the combination of increase in free protease activity and decrease in platelet aggregability to ADP. None of the measured parameters individually showed significant correlation with chest tube drainage. In this patient sampling, however, the combination of changes in fibrinolytic activity and changes in platelet function did correlate significantly with chest tube drainage. These data indicate that the increased fibrinolytic activity and the decreased platelet number and function have a synergistic effect on postoperative blood loss in CP bypass patients.

Tube Thoracostomy (TT) is a surgical procedure involving the insertion of a plastic tube into the patient’s pleural cavity with the purpose of evacuating the air or fluid contents that have abnormally accumulated in this space [1]. Chest tube insertion has been identified as part of a core set of skills needed in a physician’s repertoire when caring for an injured patient [2]. Iatrogenic injuries, traumatic injuries, as well as malignancy, are the likely clinical scenarios were tube thoracotomy may be required. The presentation of these clinical events can be classified into three broad categories: pneumothorax, hemothorax, and pleural effusion, all of which lead to the abnormal accumulation of air, blood, or lymphatic fluid within the pleural space, respectively.