RESUMO
Introducción: La colocación de sondas pleurales es un procedimiento quirúrgico frecuente que puede tener graves complicaciones, las cuales dependen en la mayoría de los casos de la experiencia del operador, el tamaño del tubo y el uso de imágenes para guiar la inserción. Objetivo: Describir las principales lesiones esplácnicas provocadas durante la inserción de sondas pleurales y presentar algoritmos para el diagnóstico precoz y el tratamiento oportuno de estas iatrogenias. Métodos: Se realizó una revisión descriptiva narrativa durante el primer trimestre del año 2023. Se utilizaron las bases de datos electrónicas PubMed, LILACS, EBSCO y Cochrane. Se revisaron artículos publicados desde 1984 hasta el 2022. Se procuró que la mayoría de la información se enmarcara en un período no mayor de 10 años de antigüedad. Desarrollo: De las lesiones esplácnicas de la cavidad torácica, la de pulmón es la más frecuente y puede conducir a sangrado o fuga aérea persistente. Las lesiones vasculares son graves y pueden provocar la muerte si no se toman las medidas pertinentes. Se han descrito lesiones de órganos huecos de la cavidad abdominal que suelen ser parte de una hernia diafragmática. Dentro de las lesiones esplácnicas en el abdomen más frecuentes están la hepática y la esplénica. Conclusiones: Estas lesiones son prevenibles y se debe tener en cuenta su mecanismo de producción para evitarlas. Para este fin recomendamos una selección cuidadosa del sitio de inserción, realizar una confirmación adecuada de la posición de la sonda, manipularla cuidadosamente y monitorear constantemente al paciente(AU)
Introduction: Chest tube insertion is a frequent surgical procedure that can have serious complications, which depend mostly on the practitioner's experience, the tube's size and the use of imaging to guide the insertion. Objective: To describe the main splanchnic injuries caused during chest tube insertion, as well as to present algorithms for early diagnosis and timely treatment of these types of iatrogeny. Methods: A descriptive narrative review was performed during the first quarter of the year 2023. The electronic databases PubMed, LILACS, EBSCO and Cochrane were used. Articles published from 1984 to 2022 were reviewed. Most of the information was secured to be framed within a period of no more than 10 years. Development: Among the splanchnic injuries within the thoracic cavity, lung injury is the most frequent and may lead to bleeding or persistent air leak. Vascular injuries are severe and can lead to death if appropriate measures are not taken. Injuries to hollow organs of the abdominal cavity have been described to be usually part of a diaphragmatic hernia. Among the most frequent splanchnic lesions within the abdomen are the hepatic and splenic injuries. Conclusions: These lesions are preventable and their mechanism of production should be taken into account in order to avoid them. To achieve this, we recommend that the insertion site be carefully selected and that the tube's position be adequately confirmed, as well as the careful handling of the tube and the constant monitoring of the patient(AU)
Assuntos
Humanos , Tubos Torácicos/efeitos adversos , Cavidade Torácica/lesões , Literatura de Revisão como Assunto , Bases de Dados BibliográficasRESUMO
OBJECTIVE: to identify variables related to pleural complications in patients undergoing tube thoracostomies due to traumatic injuries. METHOD: we conducted a prospective observational study from May/2019 to January/2021 including adult trauma patients submitted to tube thoracostomies after hospital admission. Patients undergoing thoracotomies as the initial treatment were not included. We excluded patients with suspected and confirmed COVID-19 diagnosis during the hospitalization. Pleural complications were defined as clotted hemothorax, residual pneumothorax and empyema. Students t, Mann Whitneys, Chi square and Fishers exact test were used to compare variables between groups. We considered p<0.05 as significant. RESULTS: we analyzed 68 patients. The mean age was 36.0 + 12.6 years and 91.2% were male. The mean RTS and ISS were, respectively, 7.0 ± 1.6 and 15.9 ± 7.6. The most frequent trauma mechanism was stab wounds in 50.0%, followed by blunt trauma in 38.2%. The severity of thoracic injuries was stratified (AIS) as 2 (4.4%), 3 (80.9%), 4 (13.2%), e 5 (1.5%). Pleural complications happened in 14 (20.5%) patients, being clotted / residual hemothorax (11.8%), residual pneumothorax (4.4%), empyema (2.9%) and miscellaneous (1.4%). These patients were treated by thoracoscopy (5), thoracotomy (3), chest re-drainage (3) and clinical measures alone (3). There was a significant association between pleural complications with the time of permanence (p<0,001) and the necessity of relocation (p<0,001) of the drain. CONCLUSION: the predictors of pleural complications in this series were time of permanence and the necessity of relocation of the drain.
Assuntos
COVID-19 , Empiema , Pneumotórax , Traumatismos Torácicos , Adulto , Teste para COVID-19 , Tubos Torácicos/efeitos adversos , Empiema/etiologia , Feminino , Hemotórax/etiologia , Hemotórax/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Pneumotórax/epidemiologia , Pneumotórax/etiologia , Pneumotórax/cirurgia , Estudos Prospectivos , Traumatismos Torácicos/complicações , Traumatismos Torácicos/cirurgia , Toracostomia , Toracotomia , Adulto JovemRESUMO
PURPOSE: Tube thoracostomy (TT) is a simple and a life-saving procedure; nevertheless, it carries morbidity, even after its removal. Currently, TT is managed and removed by chest X-ray (CXR) evaluation. There are limitations and these are directly linked to complications. The use of thoracic ultrasound (US) has already been established in the diagnosis of pneumothorax (PTX) and hemothorax (HTX); its use, in substitution of CXR can lead to improvement in care. Our aim is to evaluate the efficiency and safety of US in the management of TT. METHODS: Prospective and randomized study with patients requiring TT. They were divided in groups according to their thoracic injuries (PTX and HTX) and randomized into two groups according to TT management: US and CXR. Data collected included gender, age, mechanism of injury, days to TT removal, complications after TT removal and presence of mechanical ventilation. RESULTS: Sixty-one patients were randomized, of which 68.8% were male. The most frequent diagnosis was PTX, present in 37 cases. Median time for TT removal was 2.5 days in the US group and 4.9 in the control group (p = 0.009). The complication rate was 6.6%, with no morbidity in the US group. TT removal in patients with mechanical ventilation did not increase the incidence of complications. CONCLUSIONS: The use of US in the management is efficient and safe. It allows early TT removal regardless the cause of the thoracic injury.
Assuntos
Pneumotórax , Traumatismos Torácicos , Tubos Torácicos/efeitos adversos , Hemotórax/diagnóstico por imagem , Hemotórax/etiologia , Hemotórax/cirurgia , Humanos , Masculino , Projetos Piloto , Pneumotórax/diagnóstico por imagem , Pneumotórax/etiologia , Estudos Prospectivos , Estudos Retrospectivos , Traumatismos Torácicos/complicações , Traumatismos Torácicos/diagnóstico por imagem , Traumatismos Torácicos/cirurgia , Toracostomia/métodosRESUMO
INTRODUCTION: What has been published so far regarding safe methods to deal with chest tube insertion during COVID-19. METHODS: A descriptive study of the literature available in the Medline/PubMed, Lilacs, Scopus databases and specialized books. The search was carried out using the terms "infectious diseases"; "COVID-19"; "Chest tubes". RESULTS: This paper aggregates and consolidates some old concepts to new tactics to minimize the contamination of teams who deal with chest tubes, before, during, and after the procedure. CONCLUSIONS: Health officials are under increasing pressure to control the spread of COVID-19, which is a very virulent disease. Our analysis brought together old rules against contamination along with new tactics for professionals who deal with chest drains in order to minimize the contamination of teams during the Pandemic.
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Tubos Torácicos/efeitos adversos , Infecções por Coronavirus/prevenção & controle , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Transmissão de Doença Infecciosa do Profissional para o Paciente/prevenção & controle , Equipamento de Proteção Individual , Pneumonia Viral/prevenção & controle , Betacoronavirus , COVID-19 , Infecções por Coronavirus/epidemiologia , Humanos , Pandemias , Pneumonia Viral/epidemiologia , SARS-CoV-2Assuntos
Fístula Biliar/cirurgia , Derrame Pleural/cirurgia , Cirurgia Torácica Vídeoassistida/métodos , Ferimentos por Arma de Fogo/complicações , Bile , Fístula Biliar/complicações , Fístula Biliar/diagnóstico , Tubos Torácicos/efeitos adversos , Terapia Combinada , Tratamento Conservador/métodos , Serviço Hospitalar de Emergência , Humanos , Masculino , Derrame Pleural/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento , Adulto JovemRESUMO
SUMMARY INTRODUCTION What has been published so far regarding safe methods to deal with chest tube insertion during COVID-19. METHODS A descriptive study of the literature available in the Medline/PubMed, Lilacs, Scopus databases and specialized books. The search was carried out using the terms "infectious diseases"; "COVID-19"; "Chest tubes". RESULTS This paper aggregates and consolidates some old concepts to new tactics to minimize the contamination of teams who deal with chest tubes, before, during, and after the procedure. CONCLUSIONS Health officials are under increasing pressure to control the spread of COVID-19, which is a very virulent disease. Our analysis brought together old rules against contamination along with new tactics for professionals who deal with chest drains in order to minimize the contamination of teams during the Pandemic.
Assuntos
Humanos , Pneumonia Viral/prevenção & controle , Tubos Torácicos/efeitos adversos , Transmissão de Doença Infecciosa do Profissional para o Paciente/prevenção & controle , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Infecções por Coronavirus/prevenção & controle , Equipamento de Proteção Individual , Pneumonia Viral/epidemiologia , Infecções por Coronavirus , Infecções por Coronavirus/epidemiologia , Pandemias , BetacoronavirusRESUMO
Pulmonary expansion edema is a rare complication of the management of primary spontaneous pneumothorax. We report a 20 year old male admitted with a right primary spontaneous pneumothorax. A chest tube connected to a water seal was placed, achieving lung expansion. Immediately, the patient presented hypotension and a reduction in arterial oxygen saturation to 78%. Non-invasive ventilation was started. A chest X ray showed extensive right lung edema. The patient was managed with noradrenaline and albumin infusion with good response. Pulmonary edema resolved on day 3 but air leak was persistant so, the patient required surgery to excise apical bullae in the right lung. He was discharged during the following days in good condition.
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Humanos , Masculino , Adulto Jovem , Pneumotórax/complicações , Pneumotórax/terapia , Edema Pulmonar/etiologia , Edema Pulmonar/terapia , Drenagem/efeitos adversos , Edema Pulmonar/diagnóstico por imagem , Radiografia Torácica , Tubos Torácicos/efeitos adversos , Fatores de Risco , Resultado do TratamentoRESUMO
Pulmonary expansion edema is a rare complication of the management of primary spontaneous pneumothorax. We report a 20 year old male admitted with a right primary spontaneous pneumothorax. A chest tube connected to a water seal was placed, achieving lung expansion. Immediately, the patient presented hypotension and a reduction in arterial oxygen saturation to 78%. Non-invasive ventilation was started. A chest X ray showed extensive right lung edema. The patient was managed with noradrenaline and albumin infusion with good response. Pulmonary edema resolved on day 3 but air leak was persistant so, the patient required surgery to excise apical bullae in the right lung. He was discharged during the following days in good condition.
Assuntos
Drenagem/efeitos adversos , Pneumotórax/complicações , Pneumotórax/terapia , Edema Pulmonar/etiologia , Edema Pulmonar/terapia , Tubos Torácicos/efeitos adversos , Humanos , Masculino , Edema Pulmonar/diagnóstico por imagem , Radiografia Torácica , Fatores de Risco , Resultado do Tratamento , Adulto JovemRESUMO
BACKGROUND: The study aimed to establish the benefits of using chest tubes with negative pleural suction against trapped water in patients with penetrating or blunt chest trauma who underwent tube thoracostomy, in terms of the incidence of complications, such as persistent air leak, clotted hemothorax, empyema, and duration of stay. METHODS: Patients who underwent tube thoracostomy because of traumatic pneumothorax, hemothorax, or hemopneumothorax were randomly assigned into one of two groups: in Group 1, the three-bottle drainage system was connected to a negative suction; in Group 2, no suction was given. Patients who required mechanical ventilation or emergency surgery (thoracotomy or thoracoscopy) either at the time of admission to the institution or immediately after the tube thoracostomy, patients who had histories of thoracic procedures or chronic pulmonary diseases (chronic obstructive pulmonary disease, diffuse interstitial lung disease), and patients with multiple injuries with severe traumatic brain injury and a Glasgow Coma Scale (GCS) score less than 8 of 15 were excluded from the study. Hospital stay, duration of tube thoracostomy, prolonged fistula, and other clinical variables were compared. RESULTS: One hundred ten patients were included, 56 in the group with suction and 54 in the group without suction. There were no differences in the demographic characteristics of each group. There were no differences between the groups in terms of hospital stay (p = 0.22), duration of tube thoracostomy (p = 0.35) (3 days in each group), or complications. However, the probability of air leak presence in time was greater for the Group 1 patients with negative suction versus the Group 2 patients (p = 0.023). CONCLUSION: The use of negative pleural suction did not demonstrate advantages over the three-bottle chest drainage system without suction in patients with uncomplicated traumatic pneumothorax, hemothorax, or hemopneumothorax. LEVEL OF EVIDENCE: Therapeutic study, level II.
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Tubos Torácicos , Sucção/métodos , Traumatismos Torácicos/terapia , Adulto , Tubos Torácicos/efeitos adversos , Feminino , Hemopneumotórax/terapia , Hemotórax/terapia , Humanos , Tempo de Internação , Masculino , Pneumotórax/terapia , Sucção/efeitos adversos , Toracoscopia , Toracotomia , Resultado do Tratamento , Ferimentos não Penetrantes/terapia , Ferimentos Penetrantes/terapiaRESUMO
OBJECTIVE: A cadaver-based study was carried out in order to describe the pulmonary drainage surgical technique, to determine whether the site for the insertion of the chest tube is appropriate and safe, and to determine the anatomical relationship of the chest tube with the chest wall, lungs, large blood vessels, and mediastinum. METHODS: Between May and November of 2011, 30 cadavers of both genders were dissected. The cadavers were provided by the Santa Casa de São Paulo Central Hospital Mortuary, located in the city of São Paulo, Brazil. A 7.5-cm, 24 F steel chest tube was inserted into the second intercostal space along the midclavicular line bilaterally, and we measured the distances from the tube to the main bronchi, upper lobe bronchi, subclavian vessels, pulmonary arteries, pulmonary arteries in the upper lobe, superior pulmonary vein, azygos vein, and aorta. Weight, height, and chest wall thickness, as well as laterolateral and posteroanterior diameters of the chest, were measured for each cadaver. RESULTS: Of the 30 cadavers dissected, 20 and 10 were male and female, respectively. The mean distance between the distal end of the tube and the main bronchi (right and left) was 7.2 cm (for both). CONCLUSIONS: The placement of a fixed-size chest tube in the specified position is feasible and safe, regardless of the anthropometric characteristics of the patients.