Safety and Tolerability of Vacuum Versus Manual Drainage During Thoracentesis: A Randomized Trial

This study compares the safety, pain level, and time involved in these techniques. Methods: We randomized 100 patients receiving ultrasound-guided unilateral thoracentesis in an academic medical center from December 2015 through September 2017 to either vacuum or manual drainage. Without using pleural manometry, the effusion was drained completely or until the development of refractory symptoms. Measurements included self-reported pain before and during the procedure (from 0 to 10), time for completion of drainage, and volume removed. Primary outcomes were rates of all-cause complications and of early termination of the procedure with secondary outcomes of change in pain score, drainage time, volume removed, and inverse rate of removal. Results: Patient characteristics in the manual (n=49) and vacuum (n=51) groups were similar. Rate of all-cause complications was higher in the vacuum group (5 vs. 0; P=0.03): pneumothorax (n=3), surgically treated hemothorax with subsequent death (n=1) and reexpansion pulmonary edema causing respiratory failure (n=1), as was rate of early termination (8 vs. 1; P=0.018). The vacuum group exhibited greater pain during drainage (P
Source: Journal of Bronchology and Interventional Pulmonology - Category: Respiratory Medicine Tags: Original Investigations Source Type: research

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Authors: Lesser T, Doenst T, Lehmann T, Mukdessi J Abstract BACKGROUND: Video-assisted thoracoscopy and atypical resection of lung parenchyma is a surgical procedure that is carried out very commonly around the world, mainly to determine the degree of malignancy of a suspect pulmonary nodule. A pleural drain is routinely inserted at the end of the procedure. The goal of our study was to evaluate the outcomes of this procedure with and without pleural drainage. METHODS: From June 2015 to January 2018, 74 patients were prospectively randomized to either the chest-tube group (CT group, 37 patients) or the no-chest...
Source: Deutsches Arzteblatt International - Category: General Medicine Tags: Dtsch Arztebl Int Source Type: research
ConclusionIn polytrauma cases with abdominal pain and unclear CT findings the decision to proceed with exploratory laparotomy is better than a conservative treatment, because any surgical delay can lead to severe complications.
Source: International Journal of Surgery Case Reports - Category: Surgery Source Type: research
BackgroundTo evaluate the efficacy and safety of artificial pneumothorax with position adjustment for computed tomograpy (CT) ‐guided percutaneous transthoracic microwave ablation (MWA) of small subpleural lung tumors.MethodsFifty ‐six patients with small subpleural lung tumors (
Source: Thoracic Cancer - Category: Cancer & Oncology Authors: Tags: Original Article Source Type: research
There is no defined gold standard for pain management after video-assisted thoracic surgery (VATS) for pneumothorax. In addition to systemic analgesia, various loco-regional analgesic techniques have been prop...
Source: BMC Anesthesiology - Category: Anesthesiology Authors: Tags: Research article Source Type: research
Ankylosing spondylitis, inflammatory bowel disease (IBD), and relapsing polychondritis are immune-mediated inflammatory diseases with variable involvement of lungs, heart and the chest wall. Ankylosing spondylitis is associated with anterior chest wall pain, restrictive lung disease, obstructive sleep apnea, apical fibrosis, spontaneous pneumothorax, abnormalities of cardiac valves and conduction system, and aortitis. Patients with IBD can develop necrobiotic lung nodules that can be misdiagnosed as malignancy or infection. Relapsing polychondritis involves large airways in at least half of the patients. Relapsing polychon...
Source: Clinics in Chest Medicine - Category: Respiratory Medicine Authors: Source Type: research
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Source: European Radiology - Category: Radiology Source Type: research
A 25-year-old female with a history of tuberous sclerosis presented to our hospital with acute onset dyspnea and right-sided chest pain. One month prior, the patient developed subjective fevers and productive cough. Symptoms initially resolved, but returned shortly thereafter, persisting until presentation. Upon arrival, she had noted tachypnea, tachycardia, and hypoxemic respiratory failure with oxygen desaturation to 80% on room air, responding well to nasal cannula. Physical examination was significant for absent breath sounds throughout the right lung fields.
Source: Mayo Clinic Proceedings - Category: Internal Medicine Authors: Tags: Medical image Source Type: research
​BY ALI OZCAN, MD; AYUSH GUPTA, MD; ISABEL NEACATO, MD; DAVID DONALDSON, DO; &SHANNA JONES, MDA 17-year-old boy presented to the pediatric emergency department complaining of a right shoulder injury and right clavicular pain for two hours. The pain started after he checked another player into the boards while playing hockey. He had no head injury, loss of consciousness, or other trauma. He took 600 mg of ibuprofen with no relief, so he came to the ED.He had no past medical or surgical problems, and reported his pain as 4/10 over the clavicle region. His review of system was otherwise negative. The patient's vitals we...
Source: The Case Files - Category: Emergency Medicine Tags: Blog Posts Source Type: research
CONCLUSION: Major lung resection has benefited from minimally invasive approaches and fast track to surgery. However, it is important to note the occurrence of new and specific complications related to those news surgical access. PMID: 31208887 [PubMed - as supplied by publisher]
Source: Revue des Maladies Respiratoires - Category: Respiratory Medicine Tags: Rev Mal Respir Source Type: research
This study had afatal flaw: they did not keep track of all the Non-STEMI patients who were NOT enrolled, but instead were sent for immediate angiogram.  It was done in Europe, where the guidelines suggest taking all shockable arrests emergently to the cath lab.  So it is highly likely that physicians were very reluctant to enroll patients; they did not want them to be randomized to no angiogram.  This strong suspicion is supported by their data:only 22 of 437 (5.0%) patients in this study had OMI.What percent of shockable arrests without STE have an OMI?  This large registry in Circulatio...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs
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