Chest Tube Selection in Cardiac and Thoracic Surgery: A Survey of Chest Tube‐Related Complications and Their Management

  title={Chest Tube Selection in Cardiac and Thoracic Surgery: A Survey of Chest Tube‐Related Complications and Their Management},
  author={Shanaz Shalli and Diyar Saeed and Kiyotaka Fukamachi and Alan Marc Gillinov and William E. Cohn and Louis P Perrault and Edward M. Boyle},
  journal={Journal of Cardiac Surgery},
Abstract  Background: Blood accumulating inside chest cavities can lead to serious complications if it is not drained properly. Because life‐threatening conditions can result from chest tube occlusion after thoracic surgery, large‐bore tubes are generally employed to optimize patency. Aims: The aim of this study was to better define problems with current paradigms for chest drainage. Materials and Methods: A survey was conducted of North American cardiothoracic surgeons and specialty cardiac… 

Incidence of chest tube clogging after cardiac surgery: a single-centre prospective observational study.

  • J. KarimovA. Gillinov K. Fukamachi
  • Medicine
    European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
  • 2013
The status of urgency, reoperations and use of blood products can be contributing factors increasing the incidence of chest tube clogging, and Clinicians likely underestimate the prevalence of this failure to drain.

Does more than a single chest tube for mediastinal drainage affect outcomes after cardiac surgery?

The use of multiple mediastinal chest tubes after cardiac surgery confers no advantage over a single chest tube in preventing return to the operating room for bleeding or tamponade.

Active clearance vs conventional management of chest tubes after cardiac surgery: a randomized controlled study

The implementation of active clearance of chest tubes reduced re-exploration and chest tube clogging in patients after cardiac surgery further supporting recommendations to consider this modality postoperatively.

Active clearance of chest tubes after cardiac surgery: a propensity score matched analysis.

An ATC tube in the retrosternal position reduced chest tube output but showed no reduction in the rate of intervention for retained blood syndrome, and the combination of ATC in the Retrosternal and the inferior pericardial space should be performed.

Novel Chest Tube Design to Alleviate Clogging and Facilitate Video-Assisted Thoracoscopic Surgery

The novel CT design proposed by the authors aims to address issues with clogging by allocating side ports for frequent catheter suctioning and thoracoscopic instrumentation while keeping a sealed continuous suctioned.

Effectiveness of Active Chest Tube Clearance Versus Conventional Chest Tube in Reducing Postoperative Complications After Cardiac Surgery: a Systematic Review and Meta-analysis

This meta-analysis provides evidence on the positive effect of active maintenance of chest tube patency during the first hours of cardiac surgery, which resulted in reducing the incidence of complications.

Coaxial Drainage versus Standard Chest Tube after Pulmonary Lobectomy: A Randomized Controlled Study

In conclusion, Smart Drain Coaxial chest tube seems a feasible option after thoracotomy for pulmonary lobectomy as the SDC group showed a shorter hospitalization and decreased analgesic drugs use and, thus, a reduction of costs.

Active clearance of chest tubes is associated with reduced postoperative complications and costs after cardiac surgery: a propensity matched analysis

Evidence supports the concept that efforts to actively maintain chest tube patency in early recovery is useful in improving outcomes and reducing resource utilization and costs after cardiac surgery.

Tamponade Relief by Active Clearance of Chest Tubes.




Is manipulation of mediastinal chest drains useful or harmful after cardiac surgery?

There was insufficient evidence to recommend one type of drain manipulation technique over another, or to support or refute the need for drain manipulation at all, and it was concluded that in most patients drainage tube manipulation should not be performed.

Mediastinal chest drain clearance for cardiac surgery.

There are insufficient studies which compare differing methods of chest drain clearance to support or refute the relative efficacy of the various techniques in preventing cardiac tamponade, nor can the need to manipulate chest drains be supported or refuted by results from RCT's.

What size chest tube? What drainage system is ideal? And other chest tube management questions

  • M. Baumann
  • Medicine
    Current opinion in pulmonary medicine
  • 2003
Large-bore chest tubes are generally required for patients with pneumothoraces, regardless of etiology, if the patient is mechanically ventilated, or for patients requiring drainage of viscous pleural liquids such as blood, or in patients with limited production of pleural air or of free-flowing pleural liquid.

Small size new silastic drains: life-threatening hypovolemic shock after thoracic surgery associated with a non-functioning chest tube.

Predicting the need for thoracoscopic evacuation of residual traumatic hemothorax: chest radiograph is insufficient.

Although CXR is useful as a screening tool, it cannot be used to reliably select patients for surgical evacuation of retained traumatic hemothorax and decision-making should be based on thoracic CT findings.

Efficacy and complications of small-bore, wire-guided chest drains.

Seldinger-type chest drains are a well-tolerated and effective method of draining pneumothoraces and uncomplicated effusions but have a comparable failure rate in pneumothsorax to large-bore drains.

Empyema and Restrictive Pleural Processes after Blunt Trauma: An Under-Recognized Cause of Respiratory Failure

Although difficult to diagnose, empyema should be considered in blunt trauma patients with respiratory failure and an abnormal chest radiograph, and the results of surgical treatment are excellent.

A study of the complications of small bore ‘Seldinger’ intercostal chest drains

Use of small bore chest drains (<14F), inserted via the Seldinger technique, has increased globally over the last few years and is now used as first line interventions in most acute medical situations when thoracostomy is required.

Diagnostic dilemmas and current controversies in blunt chest trauma.