Validity of CT classification on management of occult pneumothorax: a prospective study.

Wolfman, Neil T.; W, Myers; Glauser, S. J.; Meredith, J. Wayne; Chen, M. Y. M.

doi:10.2214/ajr.171.5.9798871

Cited by 86 publications

(54 citation statements)

References 8 publications

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“…residual pneumothorax after thoracic sympathectomy, with or without closed pleural drainage, assessed by tomography scans, (30) this study was designed to evaluate the possible influence of such residual air on postoperative pain.…”

Section: Discussionmentioning

confidence: 99%

Incidência de pneumotórax residual após simpatectomia torácica videotoracoscópica com e sem drenagem pleural e sua possível influência na dor pós-operatória

Lima¹,

Marcondes²,

Teixeira³

et al. 2008

J. bras. pneumol.

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Objective: To determine the incidence of residual pneumothorax after video-assisted thoracic sympathectomy, with and without postoperative pleural drainage, and to evaluate the possible influence of this type of pneumothorax on postoperative pain within the first 28 postoperative days. Methods: All patients presenting symptoms consistent with primary palmoplantar hyperhidrosis and treated at the Thoracic Surgery Outpatient Clinic of the State Hospital of Sumaré between July and December of 2006 were included. All were submitted to sympathectomy up to the third ganglion using video-assisted thoracoscopy and were randomized to receive or not receive postoperative pleural drainage for 3 h. Chest X-rays and low-dose computed tomography scans of the chest were performed on the first postoperative day in order to determine the incidence of residual pneumothorax. At different time points up to postoperative day 28, patient pain was assessed using a visual numeric scale and by measuring the quantity of opioid analgesics required. Results: This study comprised 56 patients, 27 submitted to bilateral pleural drainage and 29 not submitted to drainage. There was no statistical difference between the two groups in terms of the incidence of post-sympathectomy residual pneumothorax. Residual pneumothorax diagnosed through any of the methods did not influence pain within the first 28 postoperative days. Conclusion: Performing closed pleural drainage for 3 h immediately after video-assisted thoracic sympathectomy did not affect lung re-expansion or the incidence of residual pneumothorax. When residual pneumothorax was present, it did not affect pain within the first 28 postoperative days.Keywords: Hyperhidrosis; Sympathectomy; Pain, postoperative; Pneumothorax; Drainage; Pleura. ResumoObjetivo: Avaliar se o pneumotórax residual após simpatectomia torácica videotoracoscópica tem incidência diferente quando utilizada a drenagem pleural pós-operatória ou não e se este pneumotórax residual, quando presente, pode influenciar a dor pós-operatória até o 28º dia. Métodos: Foram incluídos todos os pacientes com queixa de hiperidrose palmoplantar primária atendidos no Ambulatório de Cirurgia Torácica do Hospital Estadual Sumaré, de julho a dezembro de 2006. Todos foram submetidos à simpatectomia do terceiro gânglio torácico por videotoracoscopia e aleatorizados para receber ou não drenagem pleural pós-operatória por 3 h. Todos foram avaliados no pós-operatório imediato com radiogramas de tórax e tomografia computadorizada de tórax de baixa emissão de energia para detecção de pneumotórax residual. Foram avaliados quanto à dor pós-operatória em diferentes momentos até o 28º dia de pós-operatório, por meio de escala numérica visual e dosagem requerida de analgésicos opióides. Resultados: Foram incluídos 56 pacientes neste estudo, 27 com drenagem pleural bilateral e 29 sem drenagem pleural. Não houve diferença estatística entre a incidência de pneumotórax residual após simpatectomia com e sem drenagem pleural. O pneumotórax residual, q...

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Section: Discussionmentioning

confidence: 99%

Incidência de pneumotórax residual após simpatectomia torácica videotoracoscópica com e sem drenagem pleural e sua possível influência na dor pós-operatória

Lima¹,

Marcondes²,

Teixeira³

et al. 2008

J. bras. pneumol.

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“…A large-bore (28-36 F) chest tube may be introduced following this procedure for continuous drainage, which may serve not only for evacuation of air but also of blood; hemothorax may be present in up to 20 % of patients with chest trauma [7]. Although some reports recommend observation without placing a chest tube after needle aspiration in pneumothoraces classified by CT according to their size, from miniscule to limited anterior to anterolateral [8,9], there is ample evidence that after traumatic pneumothorax the possibility of developing a life-threatening tension pneumothorax is high, especially when general anesthesia or positive pressure ventilation will be administered [7,10,11]. Reluctance to place a chest tube stems from concerns related to increased pain, decreased lung expansion, and infection.…”

Section: Resuscitation Phasementioning

confidence: 99%

Thoracic and Abdominal Injuries

Capan

Miller

2014

Anesthesia for Trauma

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Injuries to the thorax and the abdomen-the torso-contribute significantly to trauma-related mortality and morbidity. While the vulnerability of the closely organized vital organs to injury in this region plays an important role in morbidity and mortality, the noncompressible nature of hemorrhage in this area also contributes immensely to otherwise preventable trauma deaths. While it is estimated that one fourth of trauma deaths is secondary to chest trauma alone and claims about 16,000 lives per year [1], hemorrhage in the torso (thorax, abdomen, and pelvis) also results in a mortality of as much as 70-80 % after otherwise survivable noncerebral and noncardiac injuries in both civilian and military populations [2]. The overall mortality from exsanguination, which remains second to central nervous system (CNS) injury as a cause of death, primarily originates from injuries of the thorax, abdomen, and pelvis; there has been a reduction in death from extremity bleeding because of effective control with tourniquets or topical hemostatic agents, but not from torso bleeding. With increasing use of anticoagulant agents for prophylaxis and management of cardio-and cerebrovascular disorders, bleedingrelated mortality from truncal injuries is probably more frequent. For example, the predominant injury site in patients with cardiovascular disease who died after trauma in one study was chest in 15 % and abdomen in 3 % of instances; head and neck was the injury site in 69 % of patients [3].In 2008, of the more than 42 million injuryrelated emergency room visits in the United States only 4 % were due to torso injuries; the corresponding percentages for upper extremity injuries, lower extremity injuries, head and neck injuries, and vertebral injuries were 18 %, 15 %, 14 %, and 5 %, respectively [4]. Other diagnoses such as poisoning, adverse effects, ill-defined conditions, and mental disorders made up the remaining injury-related emergency room admissions [4]. Thus, although torso injuries represent a relatively small percentage of the emergency room load, they appear to cause a greater proportion of morbidity and mortality than other injuries.Up to 80 % of thoracic injuries coexist with other injuries in major trauma patients, but they require major surgery and anesthesia relatively infrequently. Yet undetected, relatively minor thoracic injuries may result in life-threatening events during surgery for associated injuries or intensive care management of the multiple trauma patient. Pneumothorax and hemothorax are perfect examples of this clinical situation. On the other hand, because of their sometimes silent nature, even major thoracic injuries (e.g., esophageal, diaphragmatic, and airway trauma) may be missed if appropriate diagnostic

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“…Wolfman observed OPTX's in 36 patients. Thirteen of 16 ''miniscule'' occult PTXs, and 11 of 20 moderate (anterior) PTXs were managed successfully without chest tube for a 11% failure rate of observation, including one tension pneumothorax [66]. The eight remaining antero-lateral PTXs were all treated with tube thoracostomy, whether intubated or not.…”

Section: The Condition: Occult Pneumothoracesmentioning

confidence: 99%

“…The eight remaining antero-lateral PTXs were all treated with tube thoracostomy, whether intubated or not. They concluded that only small and moderate occult PTXs without mechanical ventilation could be safely observed based on their results as they had not randomized the larger OPTXs [66]. Guerrero-Lopez [55] stated that OPTXs did not always necessitate treatment despite mechanical ventilation, if they were ''small and without complications''.…”

Section: The Condition: Occult Pneumothoracesmentioning

confidence: 99%

Opening Pandora’s box: the potential benefit of the expanded FAST exam is partially confounded by the unknowns regarding the significance of the occult pneumothorax

et al. 2010

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Introduction Point of care (POC) ultrasound brings another powerful dimension to the physical examination of the critically ill. A contemporary challenge for all care providers, however, is how to best incorporate ultrasound into contemporary algorithms of care. When POC ultrasound corroborates pre-examination clinical suspicion, incorporation of the findings into decision-making is easier. When POC ultrasound generates new or unexpected findings, decision-making may be more difficult, especially with conditions that were previously not appreciated with older diagnostic technologies. Pneumothoraces (PTXs), previously seen only on computed tomography and not on supine chest radiographs known as occult pneumothoraces (OPTXs), which are now increasingly appreciated on POC ultrasound, are such an example.Methods The relevant literature concerning POC ultrasound and PTXs was reviewed after an electronic search using PubMed supplemented by ongoing research by the Canadian Trauma Trials Collaborative of the Trauma Association of Canada. Results OPTXs are frequently encountered in the critically injured who often require mechanical ventilation with positive pressure breathing (PPB). Standard recommendations for post-traumatic PTXs and the setting of PPB mandate chest drainage, recognizing a significant rate of complications related to this procedure itself. Whether these standard recommendations generated in response to obvious overt PTXs apply to these more subtle OPTXs is currently unknown, and evidence-based recommendations regarding appropriate therapy are impossible due to the lack of clinical studies. Conclusions OPTXs are a condition that illustrates how incorporation of POC ultrasound findings brings further responsibilities to critically appraise the significance of these findings in terms of patient outcomes and overall care. Adequately powered and adequately followed-up clinical trials addressing the treatment are required.Keywords Point of care ultrasound Á Critical ultrasound Á Pneumothorax Á Occult pneumothorax Á Critical care Á Mechanical ventilation Electronic supplementary material The online version of this article (

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Validity of CT classification on management of occult pneumothorax: a prospective study.

Cited by 86 publications

References 8 publications

Incidência de pneumotórax residual após simpatectomia torácica videotoracoscópica com e sem drenagem pleural e sua possível influência na dor pós-operatória

Incidência de pneumotórax residual após simpatectomia torácica videotoracoscópica com e sem drenagem pleural e sua possível influência na dor pós-operatória

Thoracic and Abdominal Injuries

Opening Pandora’s box: the potential benefit of the expanded FAST exam is partially confounded by the unknowns regarding the significance of the occult pneumothorax

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