Purpose of reviewComplications from pleural drainage procedures are common, but their incidence is often underrecognized. Significant morbidity and mortality can arise, particularly as a result of poor procedural technique, lack of training and inadequate supervision. This review discusses safety co
Background The optimal choice of chest tube size for the treatment of pleural infection is unknown, with only small cohort studies reported describing the efficacy and adverse events of different tube sizes. Methods A total of 405 patients with pleural infection were prospectively enrolled into a multicenter study investigating the utility of fibrinolytic therapy. The combined frequency of death and surgery, and secondary outcomes (hospital stay, change in chest radiograph, and lung function at ...
A symptomatic pleural effusion is a common cause of presentation to medical admission units across the UK. Traditionally, large-bore Argyle-type drains were inserted but, over the past decade, there has been a move to inserting small-bore 10–12 French gauge drains using the Seldinger technique.1 In a recently published report, over 20 000 units of one Seldinger-type drain were sold in the UK in 2004.2 The reasons for this include a perceived reduction in patient discomfort and invasiveness, and ...
Malignant pleural effusions in the presence of trapped lung remain notoriously difficult to treat. Various methods exist ranging from minimally invasive procedures including repeated needle thoracocentesis to the need for a formal surgical procedure such as placement of a pleuroperitoneal shunt and even thoracotomy and decortication. Controversy exists as to what is the optimum treatment for this condition. Any planned treatment should balance the therapeutic benefit provided against convalesce ...
Last. James Cernilia(UC Davis: University of California, Davis)H-Index: 1
view all 11 authors...
Abstract Purpose: Patients with end-stage malignancies often have refractory ascites or pleural effusions requiring repeated paracenteses or thoracenteses. Subcutaneous peritoneal and pleural port catheters are an alternative therapeutic option. We evaluate the clinical utility of this approach and the impact on quality of life (QOL) and home/hospice care. Materials and methods: Thirty ports were placed, 16 peritoneal and 14 pleural, in patients with a mean age of 62 years. Retrospective chart r...
Pleural procedures are commonly performed by physicians from a range of specialities. These procedures vary in complexity, from relatively straightforward pleural aspiration to more challenging procedures such as pleuroscopy. After appropriate training, even complex pleural procedures have a low risk of complications. Nevertheless, an appreciation of procedural risks is essential for physician training and forms the crux of a valid patient consent process. This review presents a systematic evalu...
Background: It has been suggested that no upper limit of the fluid amount drained is necessary when performing ultrasound-guided thoracentesis, but the risk of pneumothorax when large amounts of fluid are drained has not been studied in detail.Purpose: To study the amount of drained fluid at ultrasound-guided thoracentesis and the subsequent risk of pneumothorax.Material and Methods: Prospectively collected information on all ultrasound-guided thoracenteses performed at a county hospital between...
Last. Suzanne Bell(Princess Alexandra Hospital)H-Index: 1
view all 3 authors...
The insertion of a chest drain catheter for the management of a pneumothorax in an 82-year-old woman resulted in the unusual complication of liver penetration. The position of the drain was assessed by contrast-enhanced computed tomographic scan. Because the patient was hemodynamically stable and no damage to major vessels was seen on computed tomographic scan, the patient was treated in a nonoperative manner. A procedure was performed under controlled conditions using techniques used during tra...
#2Eero Sihvo(HYKS: Helsinki University Central Hospital)H-Index: 22
Last. Aija Knuuttila(HYKS: Helsinki University Central Hospital)H-Index: 20
view all 5 authors...
Aims: Talc pleurodesis using talc slurry via chest tube is a primary option in malignant pleural effusion, since life expectancy is short and surgical decortication is hazardous. Incomplete lung expansion after fluid evacuation, and/or excessive fluid secretion predicts failure of pleurodesis. A mini-invasive alternative was investigated. Methods: Between March 2004 and September 2005, 51 consecutive patients with malignant pleural effusion, and clinically considered unsuitable for talc pleurode...
Background We studied the reasons why patients undergoing thoracenteses performed in our outpatient pulmonary clinic had a higher frequency of iatrogenic pneumothorax compared to that in the concurrent radiology practice in our institution, which utilizes ultrasound guidance. We reviewed our practice model and implemented a unique experiential training paradigm in a zero-risk simulation environment to improve efficacy, timeliness, service orientation, and safety. Methods We retrospectively deter...
Last. Philippe Vignon(French Institute of Health and Medical Research)H-Index: 45
view all 13 authors...
Objective To define competence in critical care ultrasonography (CCUS). Design The statement is sponsored by the Critical Care NetWork of the American College of Chest Physicians (ACCP) in partnership with La Societe de Reanimation de Langue Francaise (SRLF). The ACCP and the SRLF selected a panel of experts to review the field of CCUS and to develop a consensus statement on competence in CCUS. Results CCUS may be divided into general CCUS (thoracic, abdominal, and vascular), and echocardiograph...
Last. Luis Valdés(University of Santiago de Compostela)H-Index: 6
view all 6 authors...
Symptomatic malignant pleural effusion is a common clinical problem. This condition is associated with very high mortality, with life expectancy ranging from 3 to 12 months. Studies are contributing evidence on an increasing number of therapeutic options (therapeutic thoracentesis, thoracoscopic pleurodesis or thoracic drainage, indwelling pleural catheter, surgery, or a combination of these therapies). Despite the availability of therapies, the management of malignant pleural effusion is challe...
#1Zhidi Lin(Guangzhou Medical University)H-Index: 2
#2Donghong Wu(Guangzhou Medical University)H-Index: 1
Last. Mingkai Huang(Guangzhou Medical University)H-Index: 1
view all 5 authors...
BACKGROUND AND OBJECTIVE Undiagnosed pleural effusions (UPEs) are a common problem of respiratory medicine, leading to an increased diagnostic burden globally. However, the most efficient and cost-effective approaches to UPEs remain controversial. This study aimed to assess the diagnostic value of ultrasound-guided needle biopsy (UGNB) in UPEs. METHODS We conducted a search of PubMed, Embase, the Cochrane Library and reference lists of retrieved studies with no publication data limitation. Artic...
: Malignant pleural effusion frequently complicates both solid and hematologic malignancies and is associated with high morbidity, mortality, and health care costs. Although no pleura-specific therapy is known to impact survival, both pleurodesis and indwelling pleural catheter (IPC) placement can significantly alleviate symptoms and improve quality of life. The optimal choice of therapy in terms of efficacy and particularly cost-effectiveness depends on patient preferences and individual charac...
#1Edward T.H. Fysh(SCGH: Sir Charles Gairdner Hospital)H-Index: 14
#2Portia Smallbone(SCGH: Sir Charles Gairdner Hospital)H-Index: 1
Last. Y. C. Gary Lee(UWA: University of Western Australia)H-Index: 47
view all 8 authors...
Objectives: The prevalence and optimal management of clinically significant pleural effusion, confirmed by thoracic ultrasound, in the critically ill is unknown. This study aimed to determine: 1) the prevalence, characteristics, and outcomes of patients treated in intensive care with clinically significant effusion and 2) the comparative efficacy and safety of pleural drainage or expectant medical management. Design: A prospective multicenter cohort study. Setting: ICUs in four teaching hospital...
Ultrasound is cost-effective, portable, real-time, and safe. Ease of use and training makes it an ideal tool to increase the accuracy and safety for many thoracic procedures. Ultrasound is standard of care for pleural procedures such as thoracentesis and chest tube (including indwelling pleural catheter (IPC)) placement as well as for pulmonary procedures such as percutaneous needle biopsy and medical thoracoscopy. In this chapter we will describe the techniques and evidence regarding the use of...
Last. Graeme P. Currie(ARI: Aberdeen Royal Infirmary)H-Index: 16
view all 5 authors...
BACKGROUND: Indwelling pleural catheters (IPCs) are most frequently used in those with malignant pleural effusions, although their use is expanding to patients with non-malignant diseases. AIM: To provide an overview of IPCs and highlight how, when and why they can be used including our own real-life experience. DESIGN: Data were collected retrospectively from a large tertiary centre for all individuals who received an IPC between June 2010 and February 2018 inclusive. The data collected include...
Last. Tiziana Bove(University of Udine)H-Index: 23
view all 10 authors...
Abstract Purpose The effects on the respiratory or hemodynamic function of drainage of pleural effusion on critically ill patients are not completely understood. First outcome was to evaluate the PiO2/FiO2 (P/F) ratio before and after pleural drainage. Secondary outcomes: evaluation of A-a gradient, End-Expiratory lung volume (EELV), heart rate (HR), mean arterial pressure (mAP), left ventricular end-diastolic volume (LVEDV), stroke volume (SV), cardiac output (CO), ejection fraction (EF), and E...
#2Steven Walker(UoB: University of Bristol)H-Index: 21
Last. Nick A Maskell(UoB: University of Bristol)H-Index: 51
view all 3 authors...
ABSTRACTIntroduction: The presence of a malignant pleural effusion (MPE) is a marker of advanced disease and associated with a poor prognosis. Patients are in a palliative stage of their disease an...
#1Lindsay Taylor(VCU: Virginia Commonwealth University)H-Index: 2
#2Michael J. Vitto(VCU: Virginia Commonwealth University)H-Index: 4
Last. David Evans(VCU: Virginia Commonwealth University)H-Index: 7
view all 5 authors...
Traditional landmark thoracostomy technique has a known complication rate up to 30%. The goal of this study is to determine whether novice providers could more accurately identify the appropriate intercostal site for thoracostomy by ultrasound guidance. 33 emergency medicine residents and medical students volunteered to participate in this study during routine thoracostomy tube education. A healthy volunteer was used as the standardized patient for this study. An experienced physician sonographe...
Last. Tiziana Bove(University of Udine)H-Index: 23
view all 6 authors...
Thoracic ultrasound is a powerful diagnostic imaging technique for pleural space disorders. In addition to visualising pleural effusion, thoracic ultrasound also helps clinicians to identify the best puncture site and to guide the drainage insertion procedure. Thoracic ultrasound is essential during these invasive manoeuvres to increase safety and decrease potential life-threatening complications. This paper provides a technical description of pigtail-type drainage insertion using thoracic ultra...
