COMPARISON OF WIRE GUIDED TUBE THORACOSTOMY IN COMPARISON TO CLASSICAL SURGICAL CHEST TUBE PLACEMENT

Abstract

Cilj istraživanja: Torakalna drenaža standardni je postupak koji se izvodi radi drenaže zraka i tekućine iz pleuralnog prostora. Cilj ovog istraživanja bio je dokazati da se korištenjem ciljane žicom vodiljom potpomognute tehnike torakalne drenaže s patentnim izumom, odnosno zakrivljenim dilatatorom, može postići brže, preciznije, jednostavnije i bezbolnije postavljanje torakalnog drena s manje komplikacija i kraćim boravkom u bolnici u odnosu na klasičnu kiruršku tehniku. Ispitanici i metode: Istraživanje je obuhvatilo 80 bolesnika s pleuralnim izljevom i pneumotoraksom kojima je bilo indicirano postavljanje torakalne drenaže. Bolesnici su podijeljeni u dvije skupine. Bolesnicima u jednoj skupini (39 bolesnika) torakalni dren je postavljen ciljanom žicom vodiljom potpomognutom tehnikom torakalne drenaže (C skupina), a u drugoj skupini (41 bolesnik) klasičnom kirurškom tehnikom (K skupina). Svakom bolesniku zabilježeni su opći podaci (matični broj, dob, spol, visina, težina), klinički parametri neposredno prije postavljanja drena (svijest, krvni tlak, broj udaha u minuti, puls), podaci o broju dana od postavljanja do vađenja torakalnog drena, broj re-drenaža, potreba za antibioticima, bolnost mjerena VAS-ljestvicom tijekom postupka i 24 h nakon, trajanju boravka nakon torakalne drenaže. Rezultati: Dokazali smo da je preciznost postavljanja u C skupini statistički značajno veća nego u K skupini. Kod svih bolesnika bez obzira na dijagnozu preciznost postavljanja torakalnog drena bila je 78.4% u C skupini u odnosu na 36.6% u K skupini, (p < 0,001), u skupinii bolesnika sa pleuralnim izljevom, 78,2% u C u odnosu na 37,5% K skupini (p = 0,005), u bolesnika sa pneumotoraksom, 78.6% u C skupini u odnosu na 35.3% u K skupini (p = 0.029). U C skupini bilo je statistički značajno manje curenja tekućine uz dren (p<0,0014). Ukupno u C skupini bilo je statistički značajno manje bolesnika s komplikacijama (p<0,005) i korištenjem antibiotika. Po vremenu izvođenja postupka drenaže, bolnosti tijekom izvođenja postupka i 24 h nakon, pojavi subkutanog emfizema, infekciji mjesta insercije, vremenu na torakalnoj drenaži, broju redrenaža i boravku u bolnici skupine se nisu statistički značajno razlikovale. Zaključak: Korištenjem ciljane žicom vodiljom potpomognute tehnike torakalne drenaže s patentnim izumom, odnosno zakrivljenim dilatatorom, može se postići preciznije postavljanje torakalnog drena, sa značajno manje komplikacija nego klasičnom kirurškom tehnikom.Objective: Thoracic drainage is the standard procedure performed for drainage of air or fluid from the pleural space. The objective of this study was to prove that using the targeted wire guide technique (TWG) with curve dilator can achieve faster, more accurate, easier and less painful for patients indicated for chest tube placement with fewer complications and less time spent in hospital, in comparison to classical surgical technique (CS). Patients and methods: Our clinical study included total of 80 patients with indication of thoracic drainage, due to pneumothorax or pleural effusion. The experimental group consisted of consisted of 39 patients with chest tube placed with TWG technique. The control group consisted of 41 patients whose chest tube was placed using the CS technique. We registered for all the patients their personal records (i.e. PIN, age, gender, height and weight). We also registered their clinical data (i.e. consciousness, blood pressure, respiratory rate, pulse), number of days spent in the hospital after tube placement, number of redreinage, use of antibiotics, soreness according to VAS scale during procedure and 24 hours after. Results: The TWG technique with curve dilator was significantly more successful in achieving precise chest tube placement, irrespective of patient diagnosis (TWG vs. CS in all patients, 78.4% vs. 36.6%, p < 0.001). In the pleural effusion group, TWG and CS had success rates of 78.2% and 37.5% (p = 0.005), respectively, while in pneumothorax group, TWG and CS had success rates of 78.6% and 35.3% (p = 0.029), respectively. In the TWG technique group was a significantly lesser leakage of fluid along the drain compared to the CS technique group (p = 0.0014). In the TWG technique group was significantly lesser complication rate (p = 0.005) and usage of antibiotics (p = 0.0434). There were no significant differences between the two groups concerning time spent for the procedure, pain measurements, infections of tube insertion sites, number of redreinage, number of days spent in the hospital after tube placement. Conclusion: We found that using the TWG technique with the curved dilator for thoracic drainage statistically significant advantage to the TWG technique in comparison to the CS technique regarding precise chest tube placement within the pleural cavity. In CS technique we found statistically higher noumber of complications