High-vacuum drains rival conventional underwater-seal drains after pediatric heart surgery

Newcomb, Andrew; Alphonso, Nelson; Nørgaard, Martin Agge; Cochrane, Andrew; Karl, Tom R.

doi:10.1016/j.ejcts.2004.11.023

Cited by 7 publications

(16 citation statements)

References 11 publications

(12 reference statements)

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“…The high vacuum was well tolerated in this study. This drainage technique used in pediatric or adult cardiac surgery (instead of conventional underwater‐seal drains) does not have any hemodynamic drawback (except for Norwood stage 1), does not damage surrounding tissue, shortens antibiotic therapy duration, prevents fungal super infection, and results in an overall infection eradication rate of 100% . The technique is also cost‐effective.…”

Section: Treatmentmentioning

confidence: 99%

Mediastinitis Following Pediatric Cardiac Surgery

et al. 2013

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Younger age, malnutrition, preoperative respiratory tract infection, high American anesthesiology score, longer duration of surgery, prolonged ventilation, and ICU stay were definite risk factors for mediastinitis. Early primary closure over drains, vacuum-assisted closure, muscle flap, and omental flap remain the most frequently performed treatments for post-sternotomy mediastinitis. Vacuum-assisted closure has emerged as the technique of choice in recent years.

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Section: Treatmentmentioning

confidence: 99%

Mediastinitis Following Pediatric Cardiac Surgery

et al. 2013

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“…In order to address such potential drawbacks of CCDS, a novel high vacuum chest drainage system (HVCDS) has been developed. It can potentially provide the same or eventually superior draining capacity and completeness compared to CCDS while having a smaller cross-sectional diameter, which causes less pain during removal and virtually prevents subcutaneous emphysema [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

EXPERIMENTAL CARDIOVASCULAR AND LUNG RESEARCH A novel high vacuum chest drainage system – a pilot study

Mrówczyński¹,

Tille

Khabiri³

et al. 2014

kitp

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AimTo assess the safety and feasibility of use of a novel high vacuum chest drainage system (HVCDS) and its influence on the cardiovascular system compared to a conventional system (CCDS).Material and methodsFive anesthetized pigs underwent a median sternotomy. Three drains were placed in retrocardiac, retrosternal and left pleural positions. The animals received a HVCDS (22 Fr with 180 2-mm holes, n = 2) or a CCDS (n = 2). In the fifth animal off pump coronary artery bypass graft (OPCABG) stabilizers were tested. After chest closure animals had three 30 min runs of artificial bleeding (5 ml/min) under different negative aspiration pressures (–2, –20, –40 kPa) for both groups, followed by standardized surgical bleeding (–40 kPa – HVCDS, – 2 kPa – CCDS). Hemodynamic parameters and each drain's output were registered every 5 minutes and the residual blood was assessed. All catheters, the heart and left lung underwent macroscopic and histopathological examination.ResultsThe application of the different pressures showed neither hemodynamic changes nor differences in blood drainage with both systems in two bleeding models. The HVCDS enabled drainage comparable to the CCDS but showed relevant clotting. Application of –20 kPa and –40 kPa caused macroscopic epicardial and pulmonary lesions in all tested devices including OPCABG stabilizers consisting of sub-epicardial or sub-pleural hemorrhage without myocyte or alveolar damage.ConclusionsThe novel and conventional chest drainage systems used at pressures up to 40 kPa induced no hemodynamic instability. Both systems showed adequate equal drainage, despite major HVCDS clotting. High negative pressure drainage with both systems showed focal sub-epicardial and subpleural hemorrhage. Thus, long-term assessment of high pressure drainage and potential interaction with fragile structures (coronary bypass graft) should be carried out.

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“…This drainage is used in pediatric or adult cardiac surgery (instead of conventional underwater-seal drains) without hemodynamic drawback [86] (except for Norwood stage 1) and without damage to surrounding tissue; (4) The high-vacuum avoids any residual cavity and helps filling all of the mediastinum with healthy wellvascularized tissue; (5) Duration of antibiotic therapy is short: 11 d in cases without organ failure and 15 d in patients with organ failure; namely, respiratory failure, renal failure or ECMO; (6) A short antibiotic course is probably the best way to avoid fungal superinfection and to prevent catheter-related complications; (7) The efficiency of the short antibiotic course is due to the efficiency of the mediastinal drainage; (8) The overall infection eradication rate is 100% on a group of 64 patients treated during a 10-year period [5] ; (9) There is no need for sophisticated or expensive material and the technique is not time consuming for the medical staff; and (10) As a result of these advantages, the technique is cost effective.…”

Section: Treatmentmentioning

confidence: 99%

Mediastinitis in pediatric cardiac surgery: Prevention, diagnosis and treatment

Durandy¹

2010

WJC

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In spite of advances in the management of mediastinitis following sternotomy, mediastinitis is still associated with significant morbidity. The prognosis is much better in pediatric surgery compared to adult surgery, but the prolonged hospital stays with intravenous therapy and frequent required dressing changes that occur with several therapeutic approaches are poorly tolerated. Prevention includes nasal decontamination, skin preparation, antibioprophylaxis and air filtration in the operating theater. The expertise of the surgical team is an additional factor that is difficult to assess precisely. Diagnosis is often very simple, being made on the basis of a septic state with wound modification, while retrosternal puncture and CT scan are rarely useful. Treatment of mediastinitis following sternotomy is always a combination of surgical debridement and antibiotic therapy. Continued use of numerous surgical techniques demonstrates that there is no consensus and the best treatment has yet to be determined. However, we suggest that a primary sternal closure is the best surgical option for pediatric patients. We propose a simple technique with high-vacuum Redon's catheter drainage that allows early mobilization and short term antibiotherapy, which thus decreases physiological and psychological trauma for patients and families. We have demonstrated the efficiency of this technique, which is also cost-effective by decreasing intensive care and hospital stay durations, in a large group of patients.

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High-vacuum drains rival conventional underwater-seal drains after pediatric heart surgery

Cited by 7 publications

References 11 publications

Mediastinitis Following Pediatric Cardiac Surgery

Mediastinitis Following Pediatric Cardiac Surgery

EXPERIMENTAL CARDIOVASCULAR AND LUNG RESEARCH A novel high vacuum chest drainage system – a pilot study

Mediastinitis in pediatric cardiac surgery: Prevention, diagnosis and treatment

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