Active clearance of chest tubes after cardiac surgery: a propensity score matched analysis
AIMS OF THE STUDY Chest tubes inserted to drain shed mediastinal blood after cardiac surgery often become clogged, limiting their capacity to evacuate blood, and leading to blood retention and retained blood syndrome. The aim of this study was the assessment of the efficacy of an active...
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| Format: | Article |
| Language: | English |
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SMW supporting association (Trägerverein Swiss Medical Weekly SMW)
2020-12-01
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| Series: | Swiss Medical Weekly |
| Subjects: | |
| Online Access: | https://www.smw.ch/index.php/smw/article/view/2925 |
| _version_ | 1797974899072958464 |
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| author | Vasileios Ntinopoulos Achim Haeussler Nestoras Papadopoulos Dragan Odavic Patricia Fodor Daniele Brugnetti Laura Rings Stak Dushaj Omer Dzemali |
| author_facet | Vasileios Ntinopoulos Achim Haeussler Nestoras Papadopoulos Dragan Odavic Patricia Fodor Daniele Brugnetti Laura Rings Stak Dushaj Omer Dzemali |
| author_sort | Vasileios Ntinopoulos |
| collection | DOAJ |
| description |
AIMS OF THE STUDY
Chest tubes inserted to drain shed mediastinal blood after cardiac surgery often become clogged, limiting their capacity to evacuate blood, and leading to blood retention and retained blood syndrome. The aim of this study was the assessment of the efficacy of an active tube clearance (ATC) system in the reduction of retained blood syndrome after cardiac surgery.
METHODS
This study included 2461 adult patients undergoing major cardiac surgery. Patients receiving conventional chest tubes only (n = 1980) were compared with patients receiving an ATC tube in the retrosternal position (n = 481) for interventions caused by retained blood syndrome (re-exploration for bleeding or tamponade and interventions for pleural effusion or pneumothorax), kidney replacement therapy, postoperative atrial fibrillation, sternal infection and chest tube output before and after propensity score matching.
RESULTS
Propensity score matching generated 471 patient-pairs balanced for their baseline characteristics. Matched patients with an ATC tube in the retrosternal position had no statistically significant difference in the rate of intervention for retained blood syndrome (33% vs 31%, p = 1), re-exploration because of bleeding or tamponade (2.5% vs 4%, p = 1), intervention for pneumothorax (4.7% vs 4.9%, p = 1) and intervention for pleural effusion (28% vs 28%, p = 1), but had statistically significantly less chest tube output on the first postoperative day (median 480, IQR 316–700 ml vs median 590, IQR 380–905 ml; p <0.0001) and second postoperative day (median 505, IQR 342–800 ml vs median 597, IQR 383–962 ml; p = 0.0012) in comparison with patients with conventional chest tubes only.
CONCLUSION
An ATC tube in the retrosternal position reduced chest tube output but showed no reduction in the rate of intervention for retained blood syndrome. Further research should be performed to test the combination of ATC in the retrosternal and the inferior pericardial space.
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| first_indexed | 2024-04-11T04:27:00Z |
| format | Article |
| id | doaj.art-654b5c5ec0594e05906978fcae731147 |
| institution | Directory Open Access Journal |
| issn | 1424-3997 |
| language | English |
| last_indexed | 2024-04-11T04:27:00Z |
| publishDate | 2020-12-01 |
| publisher | SMW supporting association (Trägerverein Swiss Medical Weekly SMW) |
| record_format | Article |
| series | Swiss Medical Weekly |
| spelling | doaj.art-654b5c5ec0594e05906978fcae7311472022-12-29T16:02:07ZengSMW supporting association (Trägerverein Swiss Medical Weekly SMW)Swiss Medical Weekly1424-39972020-12-01150515310.4414/smw.2020.20394Active clearance of chest tubes after cardiac surgery: a propensity score matched analysisVasileios Ntinopoulos0Achim Haeussler1Nestoras Papadopoulos2Dragan Odavic3Patricia Fodor4Daniele Brugnetti5Laura Rings6Stak Dushaj7Omer Dzemali8Department of Cardiac Surgery, Triemli Hospital, Zurich, SwitzerlandDepartment of Cardiac Surgery, Triemli Hospital, Zurich, SwitzerlandDepartment of Cardiac Surgery, Triemli Hospital, Zurich, SwitzerlandDepartment of Cardiac Surgery, Triemli Hospital, Zurich, SwitzerlandDepartment of Intensive Care Medicine and Anaesthesiology, Triemli Hospital, Zurich, SwitzerlandDepartment of Cardiac Surgery, Triemli Hospital, Zurich, SwitzerlandDepartment of Cardiac Surgery, Triemli Hospital, Zurich, SwitzerlandDepartment of Cardiac Surgery, Triemli Hospital, Zurich, SwitzerlandDepartment of Cardiac Surgery, Triemli Hospital, Zurich, Switzerland AIMS OF THE STUDY Chest tubes inserted to drain shed mediastinal blood after cardiac surgery often become clogged, limiting their capacity to evacuate blood, and leading to blood retention and retained blood syndrome. The aim of this study was the assessment of the efficacy of an active tube clearance (ATC) system in the reduction of retained blood syndrome after cardiac surgery. METHODS This study included 2461 adult patients undergoing major cardiac surgery. Patients receiving conventional chest tubes only (n = 1980) were compared with patients receiving an ATC tube in the retrosternal position (n = 481) for interventions caused by retained blood syndrome (re-exploration for bleeding or tamponade and interventions for pleural effusion or pneumothorax), kidney replacement therapy, postoperative atrial fibrillation, sternal infection and chest tube output before and after propensity score matching. RESULTS Propensity score matching generated 471 patient-pairs balanced for their baseline characteristics. Matched patients with an ATC tube in the retrosternal position had no statistically significant difference in the rate of intervention for retained blood syndrome (33% vs 31%, p = 1), re-exploration because of bleeding or tamponade (2.5% vs 4%, p = 1), intervention for pneumothorax (4.7% vs 4.9%, p = 1) and intervention for pleural effusion (28% vs 28%, p = 1), but had statistically significantly less chest tube output on the first postoperative day (median 480, IQR 316–700 ml vs median 590, IQR 380–905 ml; p <0.0001) and second postoperative day (median 505, IQR 342–800 ml vs median 597, IQR 383–962 ml; p = 0.0012) in comparison with patients with conventional chest tubes only. CONCLUSION An ATC tube in the retrosternal position reduced chest tube output but showed no reduction in the rate of intervention for retained blood syndrome. Further research should be performed to test the combination of ATC in the retrosternal and the inferior pericardial space. https://www.smw.ch/index.php/smw/article/view/2925chest tube occlusionPleuraFlow chest tubeactive tube clearance |
| spellingShingle | Vasileios Ntinopoulos Achim Haeussler Nestoras Papadopoulos Dragan Odavic Patricia Fodor Daniele Brugnetti Laura Rings Stak Dushaj Omer Dzemali Active clearance of chest tubes after cardiac surgery: a propensity score matched analysis Swiss Medical Weekly chest tube occlusion PleuraFlow chest tube active tube clearance |
| title | Active clearance of chest tubes after cardiac surgery: a propensity score matched analysis |
| title_full | Active clearance of chest tubes after cardiac surgery: a propensity score matched analysis |
| title_fullStr | Active clearance of chest tubes after cardiac surgery: a propensity score matched analysis |
| title_full_unstemmed | Active clearance of chest tubes after cardiac surgery: a propensity score matched analysis |
| title_short | Active clearance of chest tubes after cardiac surgery: a propensity score matched analysis |
| title_sort | active clearance of chest tubes after cardiac surgery a propensity score matched analysis |
| topic | chest tube occlusion PleuraFlow chest tube active tube clearance |
| url | https://www.smw.ch/index.php/smw/article/view/2925 |
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