Forouzan Nia Skh, Mirhosseini Sj, Moshtaghion Sh, Abdollahi Mh, Hosseini H, Dehghanizadeh H, Bani Fateme Sa, Hosseini Sm,
Volume 68, Issue 12 (3-2011)
Abstract
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Background: Proper drainage of the mediastinal and pleural spaces following Off-Pump Coronary
Artery Bypass (OPCAB) surgery is essential
for the prevention of pleural and pericardial effusions, cardiac tamponade and
late complications such as constrictive pericarditis. Drainage tubes themselves
may induce some complications which can negatively affect the result of the
surgery. In this study we assessed a new technique for chest drainage following
OPCAB.
Methods: In this clinical trial, 171 patients were
allocated to two groups. In the control group, the drainage technique included
one drain in the left pleural cavity and another in the mediastinum, while in
the case group the drainage technique included one drain in the left plural
and one in the right pleural cavity.
Results: The amount of drainage in the case group was more than the control group (p=0.001).
We found significant reductions in the incidence of arrhythmias in the case
group (p=0.005). While one patient (1.2%)
needed reoperation for bleeding control in the control group, no patients
needed reexploration in the case group (p=0.497).
The duration of hospital (p=0.022) and ICU
(p=0.002) stays was shorter in the case group.
Conclusions: Based
on the results of this study, changing the position of mediastinal drains in
patients undergoing OPCAB surgery and shifting it to
the right pleural cavity, reduces complications, such as arrhythmia and
pericardial effusion, aside from establishing a better drainage.
Mohsen Sokouti , Behnam Yazdani , Shima Jafari Jebeli ,
Volume 76, Issue 9 (12-2018)
Abstract
Background: Approach to treat empyema following pulmonary infection, especially in the second stage, is disputed. Therefore, this research aimed to compare the effect of simple tube thoracostomy versus surgical debridement in complicated parapneumonic empyema management.
Methods: This prospective randomized trial was conducted in Thoracic Surgery Department of Imam Khomeini Hospital of Tabriz and Dr. Shariati Hospital of Isfahan cities, Iran from March 2003 to September 2015. 104 patients with stage II empyema, divided into two groups (52 patients in each group). Group 1 was treated with simple tube thoracostomy and group 2 with surgical debridement with thoracotomy or thoracoscopy and patients had at least 2 referral after discharge. Personal information, medical history and information of complications and recurrence were recorded in two forms. Finally, data analysis was done by SPSS software version 22 (IBM SPSS, Armonk, NY, USA) and methods of Chi-square test and independent sample t-test.
Results: The age-mean of patients under study was 48.17±11.13 years in group 1 and 46.21±13.58 years in group 2 and the most patients were middle-aged (between 40 to 50 years). The number of men in both groups was more than women. 44.23% of patients in group 1 and 38.46% of patients in group 2 had a history of smoking. Duration of hospitalization (P=0.005), a chest tube duration (P=0.004) and duration of treatment (P=0.005) in group 2 was significantly higher than group 1. The complications (P=0.172) and recurrence (P=0.324) in group 2 are non-significantly more than group 1. The complications of treatment, after a week in group 1, are non-significantly higher than group 2 (P=0.690), but complications of treatment after a month in both groups were equal (P=1).
Conclusion: Duration of hospitalization, chest tube insertion time and duration of treatment in simple chest tube drainage treatment is shorter than surgery treatment (thoracoscopy or thoracotomy) and simple chest tube drainage treatment is more effectiveness way to treat patients with complicated parapneumonic empyema in stage 2.
Mahmoud Saeidi, Zahra Eshaghian Dorcheh ,
Volume 79, Issue 10 (1-2022)
Abstract
Background: Pericardial effusion is one of the most important complications of cardiac surgeries. Administration of a low-power suction to the mediastinal or pleural chest tube of patients helps better and constant drainage of pericardial or pleural secretions after surgeries. This technique might change the secretion and discharges of patients and might change the outcomes of surgeries.
Methods: This clinical trial was performed in 2017-2018 from April to March in Chamran Hospital of Isfahan on 91 patients who were candidates of cardiac surgeries. Patients are selected according to inclusion and exclusion criteria and finally, the study population is formed. In all patients after cardiac surgery, two Chest tubes were inserted, either in pericardial space or one in pericardia space and the other in left or right pleural space. After inserting chest tubes in patients and after sutures, patients were divided into two groups. In the first group, their chest tube was attached to the low power suctioning device, which resulted in active blood withdrawal or discharge of the site of surgery, the second group was also treated normally without binding to the suction device. The diagnosis of pericardial effusion or tamponade in patients who were hospitalized was made by clinical symptoms, portable chest graph as well as echocardiography, and in patients who had been discharged it was diagnosed by being referred to a specialist, clinical symptoms, chest radiography as well as echocardiography. Data regarding surgery duration, intubation duration, the prevalence of pericardial effusion, and cardiac tamponade were collected and analyzed.
Results: Administration of a low-pressure suction to the chest tube of patients was associated with decreased frequency of pericardial effusion (P=0.01). The frequency of tamponade was also significantly lower in patients with suction on chest tubes (P=0.04). Duration of intubation after ICU admission of patients was significantly lower in patients with suctions (P<0.001).
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Conclusion: Generally, we indicated that the use of suction in cardiac surgeries is associated with decreased intubation time and of course decreased recovery time and decreased pericardial effusion. Therefore, this method could be used in cardiac surgeries.
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