(精选)胸廓造口术的并发症及抗生素预防用药(英文课件)Tube Thoracostomy： Complications and the Role of Prophylactic Antibiotics教学课件.pptVIP

* Tube Thoracostomy: Complications and the Role of Prophylactic Antibiotics By Ashley Laird Indications for TT PTX (spontaneous, iatrogenic, traumatic) Hemothorax Chylothorax Decreased breath sounds in unstable patient after blunt or penetrating trauma Multiple rib fractures, sucking chest wound, subcutaneous air in intubated trauma patient Complicated pleural effusion, empyema, lung abscess Thoracotomy, decortication Pleural lavage for active rewarming for hypothermia Complications Undrained PTX, hemothorax, or effusion despite TT ? clotted hemothorax, empyema, fibrothorax Improper placement +/- iatrogenic injuries (lung, diaphragm, subclavian, right atrium) Recurrent PTX after tube removal Intrapleural collections following tube removal Thoracic empyema Factors Influencing Complications: Louisville study Prior studies report TT complication rates of 3-36% Etoch SW, Bar-Natan MF, Miller FB, Richardson JD. Tube Thoracostomy: Factors related to complications. Arch Surg. 1995; 130:521-525. Retrospective chart review (U of Louisville) 379 trauma pts, 599 tubes Factors Influencing Complications: Louisville study Complications: Empyema Undrained PTX or effusion Improper tube placement (+/- iatrogenic injury) Post-tube PTX Other Measures: Rate of complications in association w/ TT setting, operator, patient characteristics, MOI, and severity of injury Factors Influencing Complications: Louisville study Overall rate of complications: 21% per patient (16% per tube) 8.2% of complications required thoracotomy Factors Influencing Complications: Setting 48% of tubes placed in ED, 23% in OR, 12% in ICU, 7% on floor, and 9% at OSH prior to transfer Significantly higher complication rate when TT performed in outside hospital prior to transfer (33%, p.0001) No significant difference in complication rates between TT in ED (9%) vs. TT in other areas of study hospital (7%) Factors influencing Complications: Operator 59% of tubes placed by surgeons, 26% by ED physicians, 8% by