Outcome Analysis of Cirrhotic Patients Undergoing Chest Tube Placement

Liu, Lawrence U.; Haddadin, Hassan A.; Bodian, Carol; Sigal, Samuel H.; Korman, Jessica D.; Bodenheimer, Henry C.; Schiano, Thomas D.

doi:10.1378/chest.126.1.142

Cited by 94 publications

(69 citation statements)

References 26 publications

(25 reference statements)

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“…Although numerous case reports have been published on the topic [13,14,[16][17][18], only the study by Liu et al [7] examined the outcomes of a sizeable group of cirrhotic patients with chest tubes. Their findings were similar to ours, with an 80% complication rate and 27% mortality.…”

Section: Discussionmentioning

confidence: 99%

“…Treatments of hepatic hydrothorax are similar to those of ascites, as the pathogenesis of both conditions is related. Sodium restriction and diuresis are currently the mainstay of therapy [3,4,6,7]. In patients with refractory hydrothorax, recommended therapies include therapeutic thoracentesis, TIPS [8,9], and pleurodesis [10][11][12].…”

Section: Introductionmentioning

confidence: 99%

“…Chest tube insertion in patients with cirrhosis is fraught with complications including pneumothorax, hemothorax, empyema, electrolyte abnormalities, and renal failure [7,13,14]. Although various authors have cautioned against chest tube insertion in patients with cirrhosis [14], this procedure is still performed.…”

Section: Introductionmentioning

confidence: 99%

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Outcomes of patients with chest tube insertion for hepatic hydrothorax

Orman

Lok

2009

Hepatol Int

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Purpose Case reports and small case series have reported a high rate of complications associated with chest tube placement for hepatic hydrothorax. We describe the inhospital and 3-month outcomes of patients who have had this procedure. Methods A retrospective medical record review was performed of all patients admitted to a tertiary care center over a 10-year period with a chest tube placed for hepatic hydrothorax. Demographic data and outcomes were collected and analyzed. Results Seventeen patients were identified; 12 were taking diuretics and 8 were taking multiple diuretics at the time of admission. MELD score was 14 (range = 7-34). During hospitalization, 16 had at least 1 and 12 had more than 1 complications. The most common complications were acute kidney injury (n = 11), pneumothorax (n = 7), and empyema (n = 5). Two patients died during the index admission and four others within 3 months of that admission. Six of seven patients who received TIPS survived. Conclusions Chest tube insertion for hepatic hydrothorax carries significant morbidity and mortality, with questionable benefit.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Outcomes of patients with chest tube insertion for hepatic hydrothorax

Orman

Lok

2009

Hepatol Int

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“…Percutaneous drainage, and chest tube placement can be used in some cases [77,78] . The standard of care treatment for refractory HH is TIPS placement with response rates of 70% to 80% [79,80] . Video assisted thoracoscopy (VATS) with pleurodesis is a potential treatment alternative for patients with refractory HH, who are not eligible for or who have failed TIPS [81][82][83] .…”

Section: Portal Hypertensionmentioning

confidence: 99%

Hepato-cardiac disorders

Fouad¹,

Yehia²

2014

WJH

111

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Understanding the mutual relationship between the liver and the heart is important for both hepatologists and cardiologists. Hepato�cardiac diseases can be classified into heart diseases affecting the liver, liver diseases affecting the heart, and conditions affecting the heart and the liver at the same time. �ifferential diagnoses of liver injury are extremely important in a cardiologist's clinical practice calling for collaboration between cardiologists and hepatologists due to the many other diseases that can affect the liver and mimic haemodynamic injury. Acute and chronic heart failure may lead to acute ischemic hepatitis or chronic conges� tive hepatopathy. Treatment in these cases should be directed to the primary heart disease. In patients with advanced liver disease, cirrhotic cardiomyopathy may develop including hemodynamic changes, diastolic and systolic dysfunctions, reduced cardiac performance and electrophysiological abnormalities. Cardiac evaluation is important for patients with liver diseases especially before and after liver transplantation. Liver transplanta� tion may lead to the improvement of all cardiac chang� es and the reversal of cirrhotic cardiomyopathy. There are systemic diseases that may affect both the liver and the heart concomitantly including congenital, metabolic and inflammatory diseases as well as alcoholism. This review highlights these hepatocardiac diseases

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“…Placement of a chest tube carries the risk of uncontrollable fluid loss and high mortality [10], however, some pulmonologists are still performing this maneuver and even in their experienced hands there still exists high mortality and difficulty in removal of the chest tube in a considerable number of patients [11].…”

Section: Introductionmentioning

confidence: 99%

Towards an easier pleurodesis: Ultrasound-guided iodopovidone sclerotherapy in cirrhotic patients with hepatic hydrothorax

Abdelhafeez¹,

Zakaria²,

Fathalah³

et al. 2013

OJGas

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Background and Aim: Hepatic hydrothorax is one of the complications encountered in end stage liver disease. Pleural drainage carries the risk of massive protein and electrolyte depletion as well as the risk of bleeding and hepatic encephalopathy. Pleurodesis following pleural aspiration decreases the chance of pleural effusion recurrence, and has been a widely used long-standing method of controlling recurrent pleural effusions. The aim of this study is to evaluate the effect of pleurodesis using ultrasound-guided iodopovidone sclerotherapy in hepatic hydrothorax. Patients and Methods: This prospective study included 56 patients with clinical, laboratory and radiological evidence of liver cirrhosis and symptomatic right sided hepatic hydrothorax. All patients were subjected to repeated thoracentesis. Ten ml of lidocaine 2% were injected in the pleural space followed by 20 ml of iodopovidone. The follow-up was done after 3 months. Results: The sclerotherapy procedure was successful in 40 out of 56 cases (71.4%), and the success rate was 66.7% in massive effusion and reached 80% in moderate effusion. Twenty eight patients (50%) had to repeat the procedure for a second time, sixteen of which (28.6%) failed despite the second trial and twelve cases (21.4%) showed no fluid reaccumulation. Conclusion: Ultrasound-guided iodopovidone sclerotherapy is an effective approach for a successful pleurodesis in hepatic hydrothorax.

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Outcome Analysis of Cirrhotic Patients Undergoing Chest Tube Placement

Cited by 94 publications

References 26 publications

Outcomes of patients with chest tube insertion for hepatic hydrothorax

Outcomes of patients with chest tube insertion for hepatic hydrothorax

Hepato-cardiac disorders

Towards an easier pleurodesis: Ultrasound-guided iodopovidone sclerotherapy in cirrhotic patients with hepatic hydrothorax

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