Introduction: Thoracentesis is a common pulmonary procedure;however, great variability still exists in provider practices. Standard of care methods ranges from vacuum assisted to manual aspiration to use of wall sucti...Introduction: Thoracentesis is a common pulmonary procedure;however, great variability still exists in provider practices. Standard of care methods ranges from vacuum assisted to manual aspiration to use of wall suctioning. Few studies have compared efficiency, safety or patient comfort between different methods of pleural fluid evacuation. We sought to investigate which of three standard of care methods implemented most frequently at our institution took the least amount of time to perform and caused the least symptoms and complications. Methods: We performed a single center, randomized controlled study to determine which method of thoracentesis (wall suctioning [N = 15], manual aspiration [N = 8], or vacuum drainage [N = 12]) was the most efficient in terms of procedural time and post-procedural symptoms. 35 patients undergoing therapeutic thoracentesis were randomized to the study. Procedural time was recorded from the onset of pleural fluid drainage and was measured at 500 mL, 750 mL, 1000 mL and at termination of drainage. Pain and dyspnea scores were assessed on a verbal numerical pain rating sale (NRS) and Modified Borg Dyspnea Scale (MBS). Scores were reported pre-procedure, after thoracentesis catheter placement before fluid removal, after termination of drainage prior to removal of catheter, immediately after catheter removal, 5 minutes post-procedure, and 24 hours post-procedure. Results: The differences in procedural time among groups were significant (p p p = 0.006 and p = 0.004;respectively. Discussion: This study comparing various methods of pleural fluid drainage reveals reduced procedural time with vacuum bottle drainage and suggests that vacuum bottle drainage in our study population was more efficient with less associated symptoms compared to the other two standard of care methods. These findings would benefit from further analysis in a larger, randomized study to corroborate our findings.展开更多
BACKGROUND Ovarian hyperstimulation syndrome(OHSS)is a life-threatening complication that can occur in the luteal phase or early pregnancy after controlled ovarian stimulation.This case report highlights a unique mani...BACKGROUND Ovarian hyperstimulation syndrome(OHSS)is a life-threatening complication that can occur in the luteal phase or early pregnancy after controlled ovarian stimulation.This case report highlights a unique manifestation of OHSS involving pleural effusion(PE)in a patient without identifiable risk factors.CASE SUMMARY A 39-year-old woman who underwent controlled ovarian hyperstimulation for an in vitro fertilization(IVF)cycle experienced dyspnea on the eleventh day of post oocyte retrieval.The diagnosis was severe OHSS with a unique manifestation of PE without ascites.Clinical management involved fluid balance and treatment with albumin,furosemide,thromboembolic prophylaxis,and thoracentesis.A continued drainage of the pleural cavity was performed.The patient had a favo-rable outcome,and a dichorionic diamniotic gestation passed without incident.CONCLUSION OHSS and its potential complications can include respiratory distress and PE,as well as thromboembolic disorders.展开更多
Central venous catheters （CVCs） are widely used in various puncture and drainage operations in intensive care units （ICUs） in recent years. Compared to conventional operating devices, CVC was welcomed by clinician...Central venous catheters （CVCs） are widely used in various puncture and drainage operations in intensive care units （ICUs） in recent years. Compared to conventional operating devices, CVC was welcomed by clinicians because of the advantages of easy use, less damage to the body and convenient fixation pro- cess. We came across a patient with severe acute pancreatitis （SAP） who developed cardiac arrest due to thoracic cavity massive bleeding 24 h after thoracoceotesis with CVC. Thoracotomy surgery was carried out immediately, which confirmed an intercostal artery injury. The patient was discharged from hospital without any neurological complications two months later. Here we report this case to remind all the emergency department and ICU physicians to pay more attention to the complication of thoracic cavity bleeding following thoracocentesis conducted by CVC.展开更多
文摘Introduction: Thoracentesis is a common pulmonary procedure;however, great variability still exists in provider practices. Standard of care methods ranges from vacuum assisted to manual aspiration to use of wall suctioning. Few studies have compared efficiency, safety or patient comfort between different methods of pleural fluid evacuation. We sought to investigate which of three standard of care methods implemented most frequently at our institution took the least amount of time to perform and caused the least symptoms and complications. Methods: We performed a single center, randomized controlled study to determine which method of thoracentesis (wall suctioning [N = 15], manual aspiration [N = 8], or vacuum drainage [N = 12]) was the most efficient in terms of procedural time and post-procedural symptoms. 35 patients undergoing therapeutic thoracentesis were randomized to the study. Procedural time was recorded from the onset of pleural fluid drainage and was measured at 500 mL, 750 mL, 1000 mL and at termination of drainage. Pain and dyspnea scores were assessed on a verbal numerical pain rating sale (NRS) and Modified Borg Dyspnea Scale (MBS). Scores were reported pre-procedure, after thoracentesis catheter placement before fluid removal, after termination of drainage prior to removal of catheter, immediately after catheter removal, 5 minutes post-procedure, and 24 hours post-procedure. Results: The differences in procedural time among groups were significant (p p p = 0.006 and p = 0.004;respectively. Discussion: This study comparing various methods of pleural fluid drainage reveals reduced procedural time with vacuum bottle drainage and suggests that vacuum bottle drainage in our study population was more efficient with less associated symptoms compared to the other two standard of care methods. These findings would benefit from further analysis in a larger, randomized study to corroborate our findings.
文摘BACKGROUND Ovarian hyperstimulation syndrome(OHSS)is a life-threatening complication that can occur in the luteal phase or early pregnancy after controlled ovarian stimulation.This case report highlights a unique manifestation of OHSS involving pleural effusion(PE)in a patient without identifiable risk factors.CASE SUMMARY A 39-year-old woman who underwent controlled ovarian hyperstimulation for an in vitro fertilization(IVF)cycle experienced dyspnea on the eleventh day of post oocyte retrieval.The diagnosis was severe OHSS with a unique manifestation of PE without ascites.Clinical management involved fluid balance and treatment with albumin,furosemide,thromboembolic prophylaxis,and thoracentesis.A continued drainage of the pleural cavity was performed.The patient had a favo-rable outcome,and a dichorionic diamniotic gestation passed without incident.CONCLUSION OHSS and its potential complications can include respiratory distress and PE,as well as thromboembolic disorders.
文摘Central venous catheters （CVCs） are widely used in various puncture and drainage operations in intensive care units （ICUs） in recent years. Compared to conventional operating devices, CVC was welcomed by clinicians because of the advantages of easy use, less damage to the body and convenient fixation pro- cess. We came across a patient with severe acute pancreatitis （SAP） who developed cardiac arrest due to thoracic cavity massive bleeding 24 h after thoracoceotesis with CVC. Thoracotomy surgery was carried out immediately, which confirmed an intercostal artery injury. The patient was discharged from hospital without any neurological complications two months later. Here we report this case to remind all the emergency department and ICU physicians to pay more attention to the complication of thoracic cavity bleeding following thoracocentesis conducted by CVC.
