Assessment of Pleural Effusion and Small Pleural Drain Insertion by Resident Doctors in an Intensive Care Unit: An Observational Study
Autor: | Rossano Girometti, Silvia Delrio, Daniele Orso, Luigi Vetrugno, Stefano D’Incà, Tiziana Bove, Federico Barbariol, Giovanni Maria Guadagnin, Giovanni Volpicelli |
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Jazyk: | angličtina |
Rok vydání: | 2019 |
Předmět: |
Pulmonary and Respiratory Medicine
intensive care Lung ultrasound pleural drainage pleural effusion respiratory failure medicine.medical_specialty lcsh:Diseases of the circulatory (Cardiovascular) system Percutaneous Pleural effusion Intensivist law.invention 03 medical and health sciences 0302 clinical medicine law Intensive care medicine Original Research lcsh:RC705-779 business.industry 030208 emergency & critical care medicine lcsh:Diseases of the respiratory system medicine.disease Intensive care unit Surgery Catheter 030228 respiratory system Respiratory failure Pneumothorax lcsh:RC666-701 Cardiology and Cardiovascular Medicine business |
Zdroj: | Clinical Medicine Insights: Circulatory, Respiratory and Pulmonary Medicine, Vol 13 (2019) Clinical Medicine Insights. Circulatory, Respiratory and Pulmonary Medicine |
Popis: | Small-bore pleural drainage device insertion has become a first-line therapy for the treatment of pleural effusions (PLEFF) in the intensive care unit; however, no data are available regarding the performance of resident doctors in the execution of this procedure. Our aim was to assess the prevalence of complications related to ultrasound-guided percutaneous small-bore pleural drain insertion by resident doctors. In this single-center observational study, the primary outcome was the occurrence of complications. Secondary outcomes studied were as follows: estimation of PLEFF size by ultrasound and postprocedure changes in PaO2/FiO2 ratio. In all, 87 pleural drains were inserted in 88 attempts. Of these, 16 were positioned by the senior intensivist following a failed attempt by the resident, giving a total of 71 successful placements performed by residents. In 13 cases (14.8%), difficulties were encountered in advancing the catheter over the guidewire. In 16 cases (18.4%), the drain was positioned by a senior intensivist after a failed attempt by a resident. In 8 cases (9.2%), the final chest X-ray revealed a kink in the catheter. A pneumothorax was identified in 21.8% of cases with a mean size (±SD) of just 10 mm (±6; maximum size: 20 mm). The mean size of PLEFF was 57.4 mm (±19.9), corresponding to 1148 mL (±430) according to Balik’s formula. Ultrasound-guided placement of a small-bore pleural drain by resident doctors is a safe procedure, although it is associated with a rather high incidence of irrelevant pneumothoraces. |
Databáze: | OpenAIRE |
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