OPTIMIZATION OF THE TECHNIQUE OF DRAINING OF THE PLEURAL CAVITY IN PNEUMOHYDROTORAXIS (EXPERIMENTAL STUDY)
https://doi.org/10.17238/issn2072-3180.2021.2.32-40
Abstract
Objective: to test the effectiveness of devices that facilitate the positioning of drainage tubes in the pleural cavity under experimental conditions.
Methods: The study was prospective, quasi-randomized, controlled. Subject of the study: 30 corpses of both sexes. Three series of installation of drains were carried out 1. without the use of positioning devices (n = 10); 2. with usage of tracheostomy tube (n = 10); 3. using the original trocar adapter (n = 10). Draining of both pleural cavities was performed with the installation of two drains in each (to the apex and pleural sinus). The positioning of the drainage and kinking were visually monitored, and the distance to the drainage zone was measured. All experiments were performed by five surgeons who had no experience in pleural cavity draining, each of whom performed two experiments from each series.
Results: 1. Draining without the use of positioning devices: translocation took place in 7 (18%) cases; kinking was recorded in 14 (35%) cases, and in 5 cases it was combined with drainage translocation. 2. Drainage using a tracheostomy tube: the success was achieved in 38 (95%) cases; in one case (2.5%) there was a drainage kinking, in one (2.5%) — translocation. 3. Drainage using a trocar adapter: success was achieved in all 40 (100%) cases, the drains were localized at the planned points, without kinks.
Conclusion: The use of positioning devices facilitates the process of drainage of the pleural cavity, avoids typical complications and surpasses the results of “routine” drainage in terms of efficiency. The technique of simultaneous drainage of the upper and lower levels of the pleural cavity using a trocar adapter is easily performed by surgeons who do not have the appropriate experience.
About the Authors
D. Sh. Salimov
Central Military Clinical Hospital named after P.V. Mandryka of the Ministry of Defense of Russia
Russian Federation
Russian Federation
Salimov Dmitry Shamilevich - PhD, lieutenant colonel of the medical service, head of the surgical department
107014, Bolshaya Olenya, 8A, Moscow
N. O. Travin
Central Military Clinical Hospital named after P.V. Mandryka of the Ministry of Defense of Russia
Russian Federation
Russian Federation
Travin Nikolay Olegovich - Doctor of Medicine, Docent, Head of the Department of Artificial Circulation of the Center for Cardiovascular Surgery
107014, Bolshaya Olenya, 8A, Moscow
P. E Kraynyukov
Central Military Clinical Hospital named after P.V. Mandryka of the Ministry of Defense of Russia
Russian Federation
Russian Federation
Kraynyukov Pavel Evgenievich - Doctor of Medicine, Docent, Major General of the Medical Service, Head
107014, Bolshaya Olenya, 8A
A. A. Vorobiev
Volgograd State Medical University of the Ministry of Health of Russia
Russian Federation
Russian Federation
Vorobiev Alexander Alexandrovich - Doctor of Medicine, Professor, Honored Scientist of the Russian Federation, Head of the Department of Operative Surgery and Topographic Anatomy of the Federal State Budgetary Educational Institution
400066, g. Volgograd, pl. Pavshih Borcov, 1
References
1. Harris A., O’Driscoll B., Turkington P. Survey of major complications of intercostal chest drain insertion in the UK. Postgrad. Med. J., 2010, 86, pp. 68–72. https://doi.org/10.1136/pgmj.2009.087759
2. Lamont T., Surkitt-Parr M., Scarpello[A] J., Durand M., Hooper C., Maskell N. et al. Insertion of chest drains: summary of a safety report from the National Patient Safety Agency. BMJ, 2009, 339, b4923. https://doi.org/10.1136/bmj.b4923
3. Maskell N. British Thoracic Society Pleural Disease Guidelines – 2010 update. Thorax, 2010, 65, рр. 667–669. https://doi.org/10.1136/thx.2010.140236
4. Izmailov E.P., Trukhanova I.G., Titov AN, Nagoga A.G., Komarov G.S. Rezul’taty lecheniya bol’nyh s travmoj grudi, oslozhnennoj pnevmo- ili gemotoraksom [Results of treatment patients with pneumothorax or hemothorax complicated chest injuries]. Emergency Doctor , 2012, No. 12, рр. 39–42. (In Russ.)
5. Titov A.N., Izmailov E.P. Effektivnost’ uchastiya torakal’nogo hirurga v lechenii bol’nyh s izolirovannoj travmoj grudi, oslozhnennoj pnevmo- i gemotoraksom, v dezhurnom hirurgicheskom stacionare [Effective participation thoracic surgeon in the treatment of patients with isolated chest trauma, complicated by pneumonia and hemothorax in standby surgery hospital]. Postgraduate Bulletin of the Volga Region, 2017, No. 1–2, рр. 140–145. (In Russ.)
6. Schmelz J.O., Johnson D., Norton J.M., Andrews M., Gordon P.A. Effects of position of chest drainage tube on volume drained and pressure. American Journal of Critical Care, 1999, 8 (5), рр. 319–323. https://doi.org/10.4037/ajcc1999.8.5.319.PMID10467469
7. Feliciano D.V., Mattox K.L., Moore E.E. Trauma. 9-th edition. Mc-Graw-Hill Professional Publishing, 2020, 1415 p. ISBN-13: 978-1260143348.
8. Munnell E.R. Thoracic Drainage. Ann. Thorac. Surg., 1997, 63, рр. 1497–1502.
9. Leech C., Porter K., Steyn R. et al. The pre-hospital management of life-threatening chest injuries: a consensus statement. Trauma, 2016, 19(1). https://doi.org/10.1177/1460408616664553
10. Miller K.S., Sahn S.A. Chest tubes. Indications, technique, management and complications. Chest, 1987, 91 (2), рр. 258–264. https://doi.org/10.1378/chest.91.2.258.PMID3542404
11. Kerger H., Blaettner T. et al. Perforation of the left atrium by a chest tube in a patient with cardiomegaly: management of a rare, but life threatening complication. Resuscitation, 2007, 74, рр. 178, e82.
12. Laws D., Neville E., Duffy J. BTS guidelines for the insertion of a chest drain. Thorax, 2003, 58 (Suppl 2) (90002), рр. 53–59. https://doi.org/10.1136/thorax.58.suppl_2.ii53.PMC1766017.PMID12728150
Review
For citations:
Salimov D.Sh., Travin N.O., Kraynyukov P.E., Vorobiev A.A. OPTIMIZATION OF THE TECHNIQUE OF DRAINING OF THE PLEURAL CAVITY IN PNEUMOHYDROTORAXIS (EXPERIMENTAL STUDY). Moscow Surgical Journal. 2021;(2):32-39. (In Russ.) https://doi.org/10.17238/issn2072-3180.2021.2.32-40
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