This Article Full Text (PDF) References Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via Google Scholar Google Scholar Articles by de Waele, J. J. Articles by Colardyn, F. Search for Related Content PubMed PubMed Citation Articles by de Waele, J. J. Articles by Colardyn, F. Social Bookmarking                   What's this?

The Effect of Tube Thoracostomy on Oxygenation in ICU Patients

Intensive Care Unit, Ghent University Hospital, Gent, Belgium, jan.dewaele{at}rug.ac.be

E. Hoste, MD

Intensive Care Unit, Ghent University Hospital, Gent, Belgium

D. Benoit, MD

Intensive Care Unit, Ghent University Hospital, Gent, Belgium

K. Vandewoude, MD

Intensive Care Unit, Ghent University Hospital, Gent, Belgium

S. Delaere, MD

Department of Surgery, Ghent University Hospital, Gent, Belgium

F. Berrevoet, MD

Department of Surgery, Ghent University Hospital, Gent, Belgium

F. Colardyn, MD, PhD

Intensive Care Unit, Ghent University Hospital, Gent, Belgium

Previous research found that in noncritically ill patients, thoracocentesis has an unpredictable effect on oxygenation, possibly due to re-expansion pulmonary edema and systemic hypotension. The authors performed a retrospective analysis to study the effect of tube thoracostomy on oxygenation in ICU patients, and the complications associated with it. The authors reviewed the charts of 58 ICU patients in whom 74 procedures were performed. Demographic data, APACHE II score, and indication for thoracocentesis were retrieved from the patient’s file. The P_aO₂/FiO₂ ratio was calculated before, 12, 24, and 48 hours after tube thoracostomy. P_aO₂/FiO₂ ratios at the mentioned time intervals were compared using 1-way analysis of variances (ANOVA) with repeated measures. Logistic regression analysis was used to identify factors associated with a good response to treatment. Age of the patients was 53 ± 19.0 years (range, 17-88), APACHE II score was 21 ± 8.3 (range, 6-38), and median length of stay was 13.5 days (interquartile range, 7-25). The volume drained during the first 24 hours was 1077 ± 667 ml. P_aO₂/FiO₂ ratio was 185 ± 79.3 before chest drainage, 197 ± 79.1 at 12 hours, 217 ± 88.9 at 24 hours, and 233 ± 99.8 at 48 hours. In only 54% of the procedures, a response to therapy was present. Multivariate analysis identified a P_aO₂/FiO₂ below 180 to be independently associated with improvement in oxygenation. At 24 and 48 hours, the P_aO₂/FiO₂ ratio was significantly higher than before drainage (P < .001). There were 13 complications in 11 procedures (14.9%). The authors’ results suggest that tube thoracostomy can be used as an adjunct in the treatment of selected patients with hypoxemic respiratory failure in the ICU. A low P_aO₂/FiO₂ seems to be a good predictor of response to therapy. However, the complication rate is considerable, especially in patients with a prolonged ICU stay.

Key Words: thoracostomy • pleural effusion • intensive care unit • oxygenation

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?