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Followup Chest X-Rays May Not Be Needed After Chest-Tubes Removal in Postoperative Cardiothoracic Patients
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A5031 - Followup Chest X-Rays May Not Be Needed After Chest-Tubes Removal in Postoperative Cardiothoracic Patients
Author Block: I. Ratnani, F. Hirani, D. Bawa; DeBakey Heart and Vascular Center, Houston, TX, United States.
Introduction/Hypothesis:
Chest X-ray (CXR) is performed on most cardiothoracic patients postoperatively after removal of chest tube(s) to rule out complications, e.g. pneumothorax. Review of literature showed the detection of pathology on followup CXR in post cardiothoracic surgery patients anywhere from 2% to 40% (1). We hypothesized that in the ICU, followup chest X-rays can be avoided in cardiothoracic patients after uncomplicated removal of chest tube(s).
Methods:47 patients underwent removal of chest tubes on 1st to 8th post-operative day of cardio-thoracic surgery. We followed their post chest tube removal chest X-rays to look for the complications. The X-rays were read at bedside by an intensivist and concurred with radiologists' report.
Results:Out of 47 patients, 36 were male and 11 were female. The mean age of the patients was 61.72. Patients were divided into three groups. 1) 20 chest tubes were mediastinal, 2) 8 were pleural and 3) 19 patients had both mediastinal and pleural chest tubes. 12 patients had Coronary artery bypass grafting (CABG), 15 had valve replacement/repair, 5 patients had Left Ventricular Assist Device (LVAD), 2 had CABG with valvular repair, 5 had Orthotopic heart transplant (OHT) and 9 had other cardiothoracic procedures (mscl.). Only 1 out of 47 patients in group 1 developed apical pneumothorax, both from bedside reading by an intensivist and reported by the radiologist (P value less than .05). None of the other 46 patient had any pneumothorax from either reader.
Conclusions:In uncomplicated removal of chest tubes in wide array of cardiothoracic patients, most patients (1/47) didn't develop any complication. Although study is limited with small sample size, we concluded that followup CXR may not be required after uneventful removal of chest tube among these patients. This may convert into significant cost saving and avoidance of unnecessary radiation exposure, though clinical vigilance is required.
Reference:
Sepehripour et al: Is routine chest radiography indicated following chest drain removal after cardiothoracic surgery? Interactive Cardiovascular and Thoracic Surgery, 14(6), 834-838, 2012
Author Block: I. Ratnani, F. Hirani, D. Bawa; DeBakey Heart and Vascular Center, Houston, TX, United States.
Introduction/Hypothesis:
Chest X-ray (CXR) is performed on most cardiothoracic patients postoperatively after removal of chest tube(s) to rule out complications, e.g. pneumothorax. Review of literature showed the detection of pathology on followup CXR in post cardiothoracic surgery patients anywhere from 2% to 40% (1). We hypothesized that in the ICU, followup chest X-rays can be avoided in cardiothoracic patients after uncomplicated removal of chest tube(s).
Methods:47 patients underwent removal of chest tubes on 1st to 8th post-operative day of cardio-thoracic surgery. We followed their post chest tube removal chest X-rays to look for the complications. The X-rays were read at bedside by an intensivist and concurred with radiologists' report.
Results:Out of 47 patients, 36 were male and 11 were female. The mean age of the patients was 61.72. Patients were divided into three groups. 1) 20 chest tubes were mediastinal, 2) 8 were pleural and 3) 19 patients had both mediastinal and pleural chest tubes. 12 patients had Coronary artery bypass grafting (CABG), 15 had valve replacement/repair, 5 patients had Left Ventricular Assist Device (LVAD), 2 had CABG with valvular repair, 5 had Orthotopic heart transplant (OHT) and 9 had other cardiothoracic procedures (mscl.). Only 1 out of 47 patients in group 1 developed apical pneumothorax, both from bedside reading by an intensivist and reported by the radiologist (P value less than .05). None of the other 46 patient had any pneumothorax from either reader.
Conclusions:In uncomplicated removal of chest tubes in wide array of cardiothoracic patients, most patients (1/47) didn't develop any complication. Although study is limited with small sample size, we concluded that followup CXR may not be required after uneventful removal of chest tube among these patients. This may convert into significant cost saving and avoidance of unnecessary radiation exposure, though clinical vigilance is required.
Reference:
Sepehripour et al: Is routine chest radiography indicated following chest drain removal after cardiothoracic surgery? Interactive Cardiovascular and Thoracic Surgery, 14(6), 834-838, 2012
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