Active clearance of chest drainage catheters reduces retained blood
Active clearance of chest drainage catheters reduces retained blood
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DOI：
10.1016/j.jtcvs.2015.10.015
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发表时间：
2016-03-01
影响因子：
6
通讯作者：
Fischlein, Theodor
中科院分区：
文献类型：
--
作者：
Sirch, Joachim;Ledwon, Miroslaw;Fischlein, Theodor
目的：心脏手术后，胸腔导管用于清除心脏和肺周围的血液，但它们会被血块堵塞，导致血液滞留综合征(RBS)。我们试图检查RBS的发生率和相关的发病率，并确定预防性主动胸管清除(ATC)方案对这些结果的影响。方法：一个多学科团队开发了一种简单的方案来建立ATC，在心脏手术后的第一个24小时内预防性清除胸管内的凝块。在普遍实施(第一阶段)之前，进行了广泛的在职教育。结果：在倾向匹配的患者中，19.9%的患者接受了RBS的干预(0阶段)。在实施ATC(第二阶段)后，接受RBS干预的患者比例降至11.3%，RBS减少了43%(P=0.0087)。这些患者术后房颤的发生率从0期的30%(78/256)下降到2期的20%(52/256)(P=.013)。结论：ATC与RBS和术后房颤干预需求的减少有关。我们的研究结果强调了心脏手术后早期保持胸管通畅的重要性。
Objective: Chest tubes are used to clear blood from around the heart and lungs after heart surgery, but they can be obstructed by a blood clot, leading to retained blood syndrome (RBS). We sought to examine the frequency of RBS and associated morbidity, and to determine the influence of a preventative active chest tube clearance (ATC) protocol on these outcomes.Methods: A multidisciplinary team developed a simple protocol to institute ATC to preventatively clear chest tubes of clot during the first 24 hours after heart surgery. An extensive educational in-service was performed before universal implementation (phase 1). We retrospectively compared data collected prospectively from 1849 patients before universal implementation (phase 0) with data from 256 patients collected prospectively after universal implementation (phase 2), and then used propensity matching for outcomes assessment.Results: In propensity-matched patients, 19.9% of patients had interventions for RBS (phase 0). After the implementation of ATC (phase 2), the percent of patients with interventions for RBS was reduced to 11.3%, representing a 43% reduction in RBS (P = .0087). These patients had a 33% reduced incidence of postoperative atrial fibrillation from 30% (78 out of 256) in phase 0 to 20% (52 out of 256) in phase 2. (P = .013).Conclusions: ATC is associated with a reduced need for interventions for RBS and postoperative atrial fibrillation. Our findings underscore the importance of maintaining chest tube patency in the early hours after cardiac surgery.