Outpatient chest tube management
Outpatient chest tube management
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DOI：
10.1016/s0003-4975(97)00853-9
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发表时间：
1997-11-01
影响因子：
4.6
通讯作者：
Federico, JA
中科院分区：
文献类型：
--
作者：
Ponn, RB;Silverman, HJ;Federico, JA
背景。传统上，为了排出胸腔空气而插入留置胸管的患者在医院接受治疗。当前对成本效益医疗护理的重视以及最近的一份报告描述了接受肺减容手术且持续漏气的患者提前出院的情况，这促使我们回顾了普通胸外科实践中门诊插管的总体经验。方法。我们回顾了过去 7 年来出院时使用胸管和海姆立克瓣膜排出胸腔空气的患者的记录。动态插管管理在三个诊断组中总共使用了 240 次：气胸（176 例）、术后长时间漏气（45 例）和门诊胸腔镜肺楔形切除术（19 例）。失败被定义为因管插入或功能并发症而入院。结果。全组失败10例（4.2%），其中气胸失败4.5%，术后漏气2%，门诊胸腔镜失败5.3%。没有死亡或危及生命的问题。至少节省了 1,263 个住院日的费用。结论。存在胸管，无论是否漏气，并不总是需要住院治疗。大多数原发性自发性气胸患者和特定的其他原因气胸患者可以避免入院。对于许多肺切除术后漏气时间较长的患者来说，术后住院时间可以缩短。动态插管管理还使得门诊胸腔镜检查对于非渗出过程变得可行。
Background. Patients with indwelling chest tubes inserted for the purpose of evacuating pleural air traditionally are treated in the hospital. The current emphasis on cost-effective medical care and a recent report describing the early discharge of patients who had undergone lung volume reduction operations and had a persistent air leak prompted us to review our overall experience with outpatient tubes in a general thoracic surgical practice.Methods. We reviewed the records of patients who had been discharged from the hospital with chest tubes and Heimlich valves in place for venting pleural air over the past 7 years. Ambulatory tube management was used on a total of 240 occasions in three diagnostic groups: pneumothorax (176 cases), prolonged postresection air leak (45 cases), and outpatient thoracoscopic pulmonary wedge excision (19 cases). Failure was defined as hospital admission for complications of tube insertion or function.Results. There were 10 failures in the entire group (4.2%), 4.5% for pneumothorax, 2% for postresection air leak, and 5.3% for outpatient thoracoscopy. There were no deaths or instances of life-threatening problems. The cost of at least 1,263 inpatient hospital days was saved.Conclusions. The presence of a chest tube, with or without an air leak, does not always require hospitalization. Admission can be avoided in most patients with primary spontaneous pneumothorax and in selected patients with pneumothorax of other causes. The postoperative hospital stay can be shortened for many patients who have a prolonged air leak after pulmonary resection. Ambulatory tube management also makes feasible outpatient thoracoscopy for noneffusive processes.