Effect of Intraparenchymal Blood Patch on Rates of Pneumothorax and Pneumothorax Requiring Chest Tube Placement After Percutaneous Lung Biopsy
56
Citation
20
Reference
10
Related Paper
Citation Trend
Abstract:
The purpose of this study was to determine whether an autologous intraparenchymal blood patch reduces the rate of pneumothorax and the rate of pneumothorax requiring chest tube placement after percutaneous lung biopsy.A prospective randomized controlled trial enrolling 242 patients was conducted. Adult patients undergoing percutaneous biopsy of lung or mediastinal lesions of undetermined cause were candidates. Patients were excluded if aerated lung tissue was not crossed during the biopsy. A standard biopsy procedure was followed for all patients until an adequate tissue sample was obtained. Patients were then randomized. For patients randomized to the treatment group, an intraparenchymal blood patch was administered through the guiding needle on removal. The same postbiopsy procedures were followed for both the treatment and control groups. Data collected included development of pneumothorax and placement of a chest tube.The rate of pneumothorax was reduced from 35% to 26% (p = 0.12) with the use of the blood patch, but the reduction was not significant. The rate of pneumothorax requiring chest tube placement was significantly reduced from 18% to 9% (p = 0.048). There was a greater benefit in the blood patch group when a 19-gauge guiding needle was used: Pneumothorax requiring chest tube placement was reduced from 19% to 3% whereas an increase from 16% to 20% was seen with a 17-gauge needle (p = 0.029).The use of an autologous intraparenchymal blood patch significantly reduces the rate of pneumothorax requiring chest tube placement. It seems to be more beneficial when a 19-gauge guiding needle is used.Keywords:
Chest tube
Lung biopsy
Lung biopsy
Cite
Citations (32)
Chest tube
Lung biopsy
Cite
Citations (189)
The purpose of this study is to determine how long patients who developed pneumothorax were followed up on in the emergency department, how many patients required chest tube placement, and what factors influenced the need for a chest tube in patients who underwent computed tomography (CT)-guided percutaneous transthoracic fine needle aspiration biopsy (PTFNAB).
Chest tube
Cite
Citations (1)
Introduction: The purpose of this study was to evaluate the risk factors for developing a pneumothorax requiring chest tube placement in patients undergoing CT-guided needle biopsy of the lung. Materials and methods: In 150 patients, 156 CT-guided needle biopsies of the lung were performed. Patient age, position during biopsy, presence of emphysema, lesion size, depth and location, number of pleural punctures and pleural-puncture angle were analysed as independent risk factors for chest tube placement for pneumothorax. Results: Pneumothorax occurred in 93 of 156 procedures (59.6%), and chest tube placement was required in 12 cases (7.7% of all biopsies, 12.9% of all pneumothoraces). Among patients with a pneumothorax, the proportion of cases biopsied in the supine position was significantly greater in the chest tube placement group (58.3%; 7/12) than in the nonchest tube placement group (28.4%; 23/81) (P = 0.026). Patient age, presence of emphysema, lesion size, needle path length, location of pulmonary lesions, number of pleural punctures and the smallest angle between the pleura and the needle showed no significant differences between the two groups. Conclusion: Chest tube insertion was required more frequently in patients biopsied in the supine versus prone position. The prone position is considered preferable to reduce the risk of significant pneumothorax requiring chest tube insertion.
Supine position
Chest tube
Lung biopsy
Cite
Citations (28)
The purpose of this study was to determine whether an autologous intraparenchymal blood patch reduces the rate of pneumothorax and the rate of pneumothorax requiring chest tube placement after percutaneous lung biopsy.A prospective randomized controlled trial enrolling 242 patients was conducted. Adult patients undergoing percutaneous biopsy of lung or mediastinal lesions of undetermined cause were candidates. Patients were excluded if aerated lung tissue was not crossed during the biopsy. A standard biopsy procedure was followed for all patients until an adequate tissue sample was obtained. Patients were then randomized. For patients randomized to the treatment group, an intraparenchymal blood patch was administered through the guiding needle on removal. The same postbiopsy procedures were followed for both the treatment and control groups. Data collected included development of pneumothorax and placement of a chest tube.The rate of pneumothorax was reduced from 35% to 26% (p = 0.12) with the use of the blood patch, but the reduction was not significant. The rate of pneumothorax requiring chest tube placement was significantly reduced from 18% to 9% (p = 0.048). There was a greater benefit in the blood patch group when a 19-gauge guiding needle was used: Pneumothorax requiring chest tube placement was reduced from 19% to 3% whereas an increase from 16% to 20% was seen with a 17-gauge needle (p = 0.029).The use of an autologous intraparenchymal blood patch significantly reduces the rate of pneumothorax requiring chest tube placement. It seems to be more beneficial when a 19-gauge guiding needle is used.
Chest tube
Lung biopsy
Cite
Citations (56)
Abstract Background: We conducted a prospective study to investigate the efficacy of pleural blood patching to reduce the need for chest tube placement in pneumothorax of CT-guided percutaneous lung biopsy. Methods: We enrolled each 77 patients in study and control groups. If the patient of study group developed pneumothorax ≥1 cm on post-biopsy CT, we drew 15 mL blood, then performed simple aspiration followed by pleural blood patching. In control group, we performed only simple aspiration or no interventions. Results: Of the 77 patients of study group, 41 developed pneumothorax, 9 of which were ≥ 1 cm, and 8 patients underwent pleural blood patching. None of these 8 patients (0%) required chest tube placement. In comparison between study group and control group, pleural blood patching reduced the chest tube insertion rate from 23.1% to 11.1% in patients pneumothorax ≥ 1 cm, but not statistically significant ( p =0.26) Conclusion: Selective pleural blood patching reduced chest tube insertion rate in patients pneumothorax ≥ 1 cm, large-scale studies are warranted to confirm the result. Trial registration: This study was registered in the UMIN Clinical Trials Registry (trial number: 000007586).
Chest tube
Cite
Citations (0)
BACKGROUND: Spontaneous pneumothorax have been managed with a variety of methods. The technique most frequently used is chest tube drainage. Small caliber catheters were first used in the management of pneumothorax complicating the percutaneous needle aspiration lung biopsy, and the try to treat spontaneous pneumothorax also has been reported. However, the value of small caliber catheters in spontaneous pneumothorax has not been fully evaluated. So, we tried to elucidate the efficacy of 8 French catheter in the management of spontaneous pneumothorax. METHOD: From January, 1990, to April, 1994, 44 patients with spontaneous pneumothorax treated at Chung-Ang university hospital were reviewed. The patients were sub-divide into 8 French catheter insertion group (n=21) and chest tube insertion group (n=23). We compared the presence of underlying lung disease, the extent of the collapse, the duration of indwelling catheter and complication between two groups. RESULTS: 1) The duration of indwelling showed no significant difference between 8 French catheter group and chest tube. But, complication after insertion as subcutaneous emphysema was developed in only chest tube group. (p<0.05) 2) In the primary spontaneous pneumothorax, all case of the pneumothorax of which size was less than 50% showed complete healing with 8 French catheter insertion. Whereas the success rate in patients with large pneumothorax (more than 50%) was tended to be dependent on the age. 3) In the patients with secondary spontaneous pneumothorax who were managed with 8 French catheter, the success rate was trended to be high if the underlying disease of pneumothorax was not COPD and if the patient was young. CONCLUSION: These results show that 8 French catheter insertion probably was effective in the pneumothorax less than 50%, the primary spontaneous pneumothorax, young age or secondary pneumothorax not associated with COPD.
Chest tube
Cite
Citations (0)
For treatment of pneumothorax in Korea, many institutions hospitalize the patient after chest tube insertion. In this study, a portable small-bore chest tube (Thoracic Egg; Sumitomo Bakelite Co. Ltd., Tokyo, Japan) was used for pneumothorax management in an outpatient clinic.Between August 2014 and March 2015, 56 pneumothorax patients were treated using the Thoracic Egg.After Thoracic Egg insertion, 44 patients (78.6%) were discharged from the emergency room for follow-up in the outpatient clinic, and 12 patients (21.4%) were hospitalized. The mean duration of Thoracic Egg chest tube placement was 4.8 days, and the success rate was 73%; 20% of patients showed incomplete expansion and underwent video-assisted thoracoscopic surgery. For primary spontaneous pneumothorax patients, the success rate of the Thoracic Egg was 76.6% and for iatrogenic pneumothorax, it was 100%. There were 2 complications using the Thoracic Egg.Outpatient treatment of pneumothorax using the Thoracic Egg could be a good treatment option for primary spontaneous and iatrogenic pneumothorax.
Chest tube
Cardiothoracic surgery
Outpatient clinic
Cite
Citations (6)
Pneumothorax is the most common complication after computed tomography (CT)-guided lung biopsy. The presence of a pneumothorax per se does not complicate patient management, but an increasing pneumothorax, making chest tube placement necessary, is highly problematic.To evaluate the efficacy and limitations of simple aspiration of air from the pleural space to prevent increased pneumothorax and avoid chest tube placement in cases of pneumothorax following CT-guided lung biopsy.The subjects of our study were 642 consecutive lung lesions in 594 patients for which percutaneous needle lung biopsies were performed using CT guidance. While patients were on the CT scanner table, percutaneous manual aspiration was performed in all patients with a non-small pneumothorax demonstrated on post-biopsy chest CT images. The frequency of pneumothorax, management of each such case, and factors influencing the incidence of worsening pneumothorax that finally required chest tube placement were evaluated.Post-biopsy pneumothorax occurred in 243 of 642 (38%) procedures. Of the 243 cases, 112 were treated with manual aspiration immediately after biopsy. In 210 (86.4%), the pneumothorax had resolved completely on follow-up chest radiographs without chest tube placement. Only 33 patients required chest tube placement. Requirement of chest tube insertion significantly increased in parallel with the degree of pneumothorax as shown on post-biopsy CT images. The rate of chest tube insertion was statistically higher in subjects with values for aspirated air above 543 ml.Percutaneous manual aspiration of biopsy-induced pneumothorax performed immediately after biopsy may prevent worsening of pneumothorax and avoid chest tube placement. The amount of aspirated air can be predictive of the requirement for chest tube placement.
Chest tube
Lung biopsy
Chest radiograph
Cite
Citations (35)
Chest tube
Thoracostomy
Lung biopsy
Cite
Citations (0)