Chest Tubes

1- What are chest tubes used for?

2- Where exactly is a chest placed?

3- How does the three-chamber system work?

4- Can suction be bad for the patient?

5- What is the difference between exudate and transudate, and why do we care?

6- What is an effusion?

7- How are effusions treated?

8- When should a chest tube for effusions be removed?

9- What is pleurodesis?

10-  How are malignant effusions treated?

11- What is streptokinase used for when it is given through a chest tube?

12- What is empyema?

13- What exactly is an air leak?

14- How can you tell if the chest tube port is out of the chest?

15- How can this be fixed?

16- Are air leaks good or bad?

17- Would that be a bad situation?

18- What is the black button on top of the pleurevac for?

19- What is tube “stripping”?

20- How could I tell if a patient were developing a tension situation in her chest?

21- What is a pulsus paradoxus?

22- Should you ever clamp a chest tube?

23- What if the chest tube gets pulled out by mistake?

24- What is “water seal”?

25- What is subcutaneous emphysema, and what does it have to do with chest tubes?

Continue Reading Complete Tutorial in PDF

Pneumothorax

• Definition

Air accumulation in the pleural space with secondary lung

collapse

• Sources

–Visceral pleura

–Ruptured esophagus

–Chest wall defect

–Gas-forming organisms

• Factors determining gasreabsorption

–Diffusion properties of the gases

–Pressure gradients

–Area of contact

–Permeability of pleural surface

Read Further:

Pneumothorax and Chest Tubes PDF

Ventilating patients in the Cardiac Surgery Intensive Care Unit is typically straight forward. Moderate tidal volumes with an elevated Fi02, followed by a wean to pressure support ventilation once level of consciousness returns.

Typically this occurs within 4-6 hours upon the patients arrival into the CSICU.
However, there are situations where more aggressive ventilation strategies are required such as increased blood loss from mediastinal chest tubes (?peep), refractory hypoxemia from postoperative pulmonary dysfunction (PPD) (?peep and Fi02, PC ventilation, addition of NO, etc.), ?BP and circulation, etc.

There is a very good article in AMERICAN JOURNAL OF CRITICAL CARE, September 2004, Volume 13, No. 5 which helps explain its occurrence.
Please see tables 1 and 2 in this article for plausible explanations.

Read the full article here.