When size matters: changing opinion in the management of pleural space—the rise of small-bore pleural catheters

Filosso, Pier Luigi; Sandri, Alberto; Guerrera, Francesco; Ferraris, Andrea; Marchisio, Filippo; Bora, Giulia; Costardi, Lorena; Solidoro, Paolo; Ruffini, Enrico; Oliaro, A

doi:10.21037/jtd.2016.06.25

Cited by 21 publications

(15 citation statements)

References 24 publications

(18 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Drainage insertion via blunt dissection poses significantly fewer risks and is the chest drainage technique-of-choice in a surgical context [ 12 ]. The major complications linked to large-bore catheters are pain, lung laceration, and infection [ 53 , 54 ]. Trocars are no longer recommended as they can lead to complications and damage involving the underlying viscera [ 55 ].…”

Section: Diagnosis Of Pleural Effusionmentioning

confidence: 99%

Thoracic ultrasound for pleural effusion in the intensive care unit: a narrative review from diagnosis to treatment

et al. 2017

View full text Add to dashboard Cite

Pleural effusion (PLEFF), mostly caused by volume overload, congestive heart failure, and pleuropulmonary infection, is a common condition in critical care patients. Thoracic ultrasound (TUS) helps clinicians not only to visualize pleural effusion, but also to distinguish between the different types. Furthermore, TUS is essential during thoracentesis and chest tube drainage as it increases safety and decreases life-threatening complications. It is crucial not only during needle or tube drainage insertion, but also to monitor the volume of the drained PLEFF. Moreover, TUS can help diagnose co-existing lung diseases, often with a higher specificity and sensitivity than chest radiography and without the need for X-ray exposure. We review data regarding the diagnosis and management of pleural effusion, paying particular attention to the impact of ultrasound. Technical data concerning thoracentesis and chest tube drainage are also provided.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-017-1897-5) contains supplementary material, which is available to authorized users.

show abstract

Section: Diagnosis Of Pleural Effusionmentioning

confidence: 99%

Thoracic ultrasound for pleural effusion in the intensive care unit: a narrative review from diagnosis to treatment

et al. 2017

View full text Add to dashboard Cite

show abstract

“…LBTTs have a trocar to allow their insertion, and they have traditionally been used for the drainage of dense and thick material from the pleural space (Sigrist, 2015;Filosso et al, 2016;Hallifax et al, 2017). However, general anesthesia is usually required for their insertion, and many complications could occur during or after insertion in cats, such as laceration of the intrathoracic organs, hemorrhage, arrhythmias, and pain and discomfort (Demetriou et al, 2002;Waddell et al, 2002;Barrs et al, 2005;Valtolina and Adamantos, 2009).…”

Section: Introductionmentioning

confidence: 99%

The use of small-bore wire-guided chest drains for the management of feline pyothorax: A retrospective case series

et al. 2021

View full text Add to dashboard Cite

Background: Pyothorax in cats is routinely managed, at least initially, with thoracic tube placement associated with systemic antimicrobial administration. Traditionally, large-bore trocar-type thoracostomy tubes have preferentially been used for the drainage of thick material from the pleural space. In recent years, the use of small-bore wire-guided thoracic drains has increased in both small animals and in humans. Few studies have highlighted the efficacy of smallbore wire-guided thoracostomy tubes.Aim: The purpose of this study was to describe the use of small-bore wire-guided thoracostomy tubes in feline pyothorax in terms of efficacy, safety, and outcome.Methods: Cats with pyothorax managed with small-bore thoracostomy tubes (SBTTs) (2015–2018) were retrospectively studied. The number of drains inserted, the need for anesthesia and analgesia for chest tube placement and maintenance, and related major and minor complications were reviewed. Clinical data, diagnostic results, treatment, and outcome were recorded.Results: Ten cats were enrolled. Thoracostomy tube placement was unilateral in 7/10 cats, despite the presence of bilateral effusion in 9/10 cats, and required sedation (8/10) or anesthesia (2/10). Three cats experienced minor complications during the chest tube insertion, including self-limiting pneumothorax (1/3) and malpositioning (2/3). One cat had a major complication (non-functional malposition) requiring reposition of the drain. Pain management was adequately achieved using opioids (8/10) or opioids plus nonsteroidal anti-inflammatory drugs (2/10). Partialchest tube occlusion occurred in three cases and it was resolved with lavage. In one case, the occlusion was complete, requiring drain removal. Three out of 10 cats were treated medically, combining thoracostomy tubes and antibiotics, while 7/10 cats underwent surgery. All the cats survived.Conclusion: SBTTs represent a safe and effective option for the initial management of feline pyothorax. In fact, mainly minor complications were reported during insertion and usage. The SBTTs were well tolerated by the cats with a satisfactory performance in terms of exudate drainage in most cases. The combined use of a small-bore thoracostomy drain together with the common practice of surgical treatment might have resulted in the successful management of the cases presented.

show abstract

“…Chest tubes were more often used than less invasive equipment such as pleurocath or pigtail catheters, even though small bore chest drains are recommended [1, 25, 26]. Some barriers to the use of less invasive strategies include the lack of reliable specific equipment, low awareness of techniques by physicians who are more accustomed to conventional drainage, or the absence of therapeutic consensus [27].…”

Section: Discussionmentioning

confidence: 99%

How spontaneous pneumothorax is managed in emergency departments: a French multicentre descriptive study

et al. 2019

View full text Add to dashboard Cite

BackgroundManagement of spontaneous pneumothorax (SP) is still subject to debate. Although encouraging results of recent studies about outpatient management with chest drains fitted with a one-way valve, no data exist concerning application of this strategy in real life conditions. We assessed how SP are managed in Emergency departments (EDs), in particular the role of outpatient management, the types of interventions and the specialty of the physicians who perform these interventions.MethodsFrom June 2009 to May 2013, all cases of spontaneous primary (PSP) and spontaneous secondary pneumothorax (SSP) from EDs of 14 hospitals in France were retrospectively included. First line treatment (observation, aspiration, thoracic drainage or surgery), type of management (admitted, discharged to home directly from the ED, outpatient management) and the specialty of the physicians were collected from the medical files of the ED.ResultsAmong 1868 SP included, an outpatient management strategy was chosen in 179 PSP (10%) and 38 SSP (2%), mostly when no intervention was performed. Only 25 PSP (1%) were treated by aspiration and discharged to home after ED admission. Observation was the chosen strategy for 985 patients (53%). In 883 patients with an intervention (47%), it was performed by emergency physicians in 71% of cases and thoracic drainage was the most frequent choice (670 patients, 76%).ConclusionsOur study showed the low level of implementation of outpatient management for PS in France. Despite encouraging results of studies concerning outpatient management, chest tube drainage and hospitalization remain preponderant in the treatment of SP.Electronic supplementary materialThe online version of this article (10.1186/s12873-018-0213-2) contains supplementary material, which is available to authorized users.

show abstract

When size matters: changing opinion in the management of pleural space—the rise of small-bore pleural catheters

Cited by 21 publications

References 24 publications

Thoracic ultrasound for pleural effusion in the intensive care unit: a narrative review from diagnosis to treatment

Thoracic ultrasound for pleural effusion in the intensive care unit: a narrative review from diagnosis to treatment

The use of small-bore wire-guided chest drains for the management of feline pyothorax: A retrospective case series

How spontaneous pneumothorax is managed in emergency departments: a French multicentre descriptive study

Contact Info

Product

Resources

About