Previous randomized controlled trials have compared the efficacy and safety of single chest drain (SCD) and double chest drains (DCD) in the patients undergone pulmonary lobectomy, yet the results remain inconsistent. Therefore, we aimed to conduct this present systematic review and meta-analysis to evaluate the role of SCD and DCD in the patients undergone pulmonary lobectomy. PubMed, Medline, EMBASE, Cochrane library, Web of Science, China National Knowledge Infrastructure, Wanfang, Weipu, and China Biomedical Literature databases were searched up to February 28, 2020, to identify the potential RCTs on SCD and DCD in the patients undergone pulmonary lobectomy. The main outcomes including verbal pain score, the duration of drainage (days), the length of hospital stay (days), and the incidence of air leak and re-drainage were collected and analyzed. All the data were processed and analyzed with software RevMan 5.3. We calculated and analyzed the odds ratios (OR) for dichotomous outcomes and the mean difference (MD) for continuous outcomes. A total of 11 RCTs with 1214 patients were included, in which 589 patients received SCD treatment and 625 patients DCD treatment. The verbal pain score (MD = − 0.54, 95%CI (− 0.87, − 0.21)), the duration of drainage (MD = − 0.65, 95%CI (− 1.04, − 0.26)), and the length of hospital stay (MD = − 0.55, 95%CI (− 0.80, − 0.29)) in SCD group were significantly less than that of DCD group. There were no significant differences on the incidence of air leak (OR = 1.35, 95%CI (0.86, 2.11)) and re-drainage (OR = 0.88, 95%CI (0.41, 1.90)) among the two groups. SCD is a safe option, and it has the advantages of less postoperative pain, shortened duration of drain, and reduced length of hospital stay when compared with DCD in the patients undergone pulmonary lobectomy.

/pdf/single-versus-double-chest-drains-after-pulmonary-lobectomy-1fi876s58s.pdf

Single versus double chest drains after pulmonary lobectomy: a systematic review and meta-analysis

In carefully selected patients with severe chronic obstructive pulmonary disease, characterized by emphysema and hyperinflation, lung volume reduction is an option to reduce lung hyperinflation, improve lung function, quality of life, and exercise capacity. Currently, there are several bronchoscopic and surgical treatment options to achieve lung volume reduction. It is important to carefully phenotype these patients, to select the optimal treatment option, with consideration of possible adverse events or contraindications, and it is highly recommended to discuss these treatment strategies in a multidisciplinary team. The treatment with one-way endobronchial valves has been investigated most extensively and more data are available regarding the treatment of more "marginal cases," or subsequent lung volume reduction surgery. Other bronchoscopic lung volume reduction options include treatment with coils, thermal vapor ablation, and sclerosant agents. In this review, we aim to summarize the current clinical evidence on the bronchoscopic lung volume reduction therapies and important aspects regarding optimal patient selection.

/pdf/bronchoscopic-lung-volume-reduction-for-emphysema-review-and-wdpdzv3x.pdf

Bronchoscopic Lung Volume Reduction for Emphysema: Review and Update.

Chronic Obstructive Pulmonary Disease (COPD) is a highly prevalent and morbid disease marked by irreversible structural changes in the lungs. Bronchoscopic therapies have significantly expanded the treatment armamentarium for patients with persistent symptoms by reducing the physiologic detriments of hyperinflation in a less invasive fashion than surgical lung volume reduction. The spectrum of bronchoscopic techniques to reduce hyperinflation includes endobronchial valves, coils, thermal ablation, and biologic sealants. Other therapies focus on reducing parasympathetic tone and mucus hypersecretion and include targeted lung denervation, bronchial rheoplasty, and cryospray techniques. In this article, we will review the variety of techniques for bronchoscopic lung volume reduction, both established and investigational, along with their respective benefits and complications and will briefly review other investigational therapies for COPD.

/pdf/bronchoscopic-management-of-copd-and-advances-in-therapy-353y1tf8.pdf

Bronchoscopic Management of COPD and Advances in Therapy

BACKGROUND The pleural space can resorb 0.11-0.36 ml/kg of body weight/hour (h) per hemithorax. There are only a limited number of studies on thresholds for chest drain removal (CDR) and all are based on arbitrary amounts, for example, 300 ml/day. We studied an individualized size-based threshold for CDR-specifically 5 ml/kg, a simple, easily applicable measure. METHODS This is a single-center prospective randomized trial enrolling 80 patients undergoing VATS lobectomy. There were two groups: an experimental (E) group, in which once the daily output went down to 5 ml/kg the chest drain was removed and a control (C) group, with chest drain removal as per our current practice of less than 250 ml/day. RESULTS The groups did not differ in pre- and peri- and postoperative characteristics, except for chest drain duration (mean, SD 2.02 ± 0.97 vs. 3.25 ± 1.39 days, p < 0.001) and length of hospital stay (median, IQR 4.5; 3 vs. 6; 2.75 days, p = 0.008) in favor of E group. The re-intervention rate was the same in both groups (once in each group). CONCLUSION The new threshold for chest drain removal following thoracoscopic lobectomy of 5 ml/kg/d leads to both shorter chest drainage and hospital stay without apparent increase in morbidity. (Clinical registration number: DRKS00014252).

/pdf/a-simple-size-tailored-algorithm-for-the-removal-of-chest-5zfgxpwfs9.pdf

A simple size-tailored algorithm for the removal of chest drain following minimally invasive lobectomy: a prospective randomized study.

: Background: Management of traumatic hemothorax (HTx) with pigtail catheters has not been widely adopted due to concerns about blood evacuation rates. We compared pigtail catheters with standard chest tubes for the drainage of acute HTx in a swine model. Methods: Seven hundred-fifty milliliters of blood was withdrawn from each femoral artery and instilled into each pleural space in mechanically ventilated swine. A 32F chest tube was placed in one randomly assigned hemothorax; a 14 F pigtail catheter was placed in the other. Output from each drain was measured every minute for 5 minutes, then every 5 minutes for 40 minutes. Results: Blood drainage was more rapid from the chest tube during the first three minutes compared to the pigtail catheter (348 I 09 mL/min vs. 17653 mL/min) but this difference was not statistically significant (p=0.19). Thereafter, the rates of drainage between the two tubes were not substantially different. The chest tube drained a higher total percentage of the blood from the chest (87.3 vs 70.3 ), but this difference did not reach statistical significance (p=0.21 ). Conclusion: We found no statistically significant difference in the volume of blood drained by a 14F pigtail catheter compared to a 32F chest tube.

A Pilot Study of Chest Tube Versus Pigtail Catheter Drainage of Acute Hemothorax in Swine (Sus scrofa)

Background Endoscopic lung volume reduction (ELVR) with valves has been suggested to be the key strategy for patients with severe emphysema and concomitant low diffusing capacity of the lung for carbon monoxide (D LCO). However, robust evidence is still missing. We therefore aim to compare clinical outcomes in relation to D LCO for patients treated with ELVR. Methods We assessed D LCO at baseline and 3 months follow-up and compared pre- and postprocedural pulmonary function test, quality of life, exercise capacity and adverse events. This is a retrospective subanalysis of prospectively collected data from the German Lung Emphysema Registry. Results In total, 121 patients treated with ELVR were analysed. Thirty-four patients with a D LCO ≤20% and 87 patients with a D LCO >20% showed similar baseline characteristics. After ELVR, there was a decrease of residual volume (both p 20% (p 20%: 16.1%; p=0.728). However, there were no significant differences in other adverse events between both groups. Conclusions ELVR improves lung function as well as quality of life in patients with D LCO >20% and D LCO ≤20%. Adverse events did not differ between groups. Therefore, ELVR should be considered as a treatment option, even in patients with a very low D LCO.

https://openres.ersjournals.com/content/erjor/7/1/00449-2020.full.pdf

Endoscopic lung volume reduction with endobronchial valves in very low DLCO patients: results from the German Registry - Lungenemphysemregister e.V.

Einleitung Thoraxdrainagen sind ein wichtiges Arbeitsinstrument, nicht nur in der Thoraxchirurgie, wo sie taglich eingelegt, modifiziert und entfernt werden, sondern in vielen Fachrichtungen bei Auftreten von thorakalen Problemen wie Pneumothorax oder Pleuraergussen. Ziel dieser Arbeitsgruppe der Deutschen Gesellschaft fur Thoraxchirurgie war die Erarbeitung eines Konsensus anhand des Delphi-Verfahrens bez. der Handhabung von Thoraxdrainagen. Methodik Die Arbeitsgruppe erarbeitete 2 elektronische Delphi-Fragerunden. Als Konsens wurde eine Ubereinstimmung in ≥ 75% definiert. Nach der statistischen Auswertung der Ergebnisse der elektronischen Fragerunde erfolgte eine Expertenkonferenz, die in einer finalen Delphi-Abstimmung versucht hat, weiteren Konsens uber noch strittige Themen zu erreichen. Ergebnisse Dreizehn Fragen bez. der Handhabung von Thoraxdrainagen konnten formuliert und abgestimmt werden. Konsens konnte fur folgende Themen erreicht werden: Bedingungen der Anlage, Grose der Thoraxdrainage, Anlagetechnik, Diagnostik nach Anlage und vor Entfernung, postinterventionelle Handhabung der Thoraxdrainage, Dokumentation, Zahl der Drainagen nach anatomischer Lungenresektion, Verwendung von Fibrinolytika, Art der Unterdruckerzeugung. Kein Konsens konnte fur folgende Themen erreicht werden: Eigenblutpleurodese, Reduktion des angewendeten Sogs bei persistierender Fistelung. Fazit Die vorliegende Arbeit fasst die Ergebnisse eines Delphi-Prozesses zusammen, der 2017 – 2018 mit Experten aus zertifizierten Kliniken oder hochvolumigen thoraxchirurgischen Einheiten gefuhrt wurde. Insgesamt zeigte sich eine sehr hohe Konsensrate bez. Drainagenanlage, perinterventionellem Management und Entfernungsalgorithmus. Die Handhabung bei hohem Fistelvolumen war der Hauptpunkt, bei dem ein Konsens nicht erreicht werden konnte. Die o. g. Empfehlungen sollen als Ausgangspunkt fur die Entwicklung von klinikinternen Standards dienen, da sie auf konsentierten Expertenmeinungen basieren.

Delphi Expert Consensus of the German Thoracic Surgery Society on the Management of Chest Tube Drainage

Pulmonary metastasectomy is a well-established contribution to the cure of oligometastatic cancers, but its exact effectiveness is poorly understood. Here we report the outcomes of repeat pulmonary metastasectomy from a multicenter trial. This retrospective study included patients who underwent re-do metastasectomies between January 2010 and December 2014. The exclusion criterion was metastasectomy without curative intent. We reviewed medical files of 621 consecutive patients who underwent initial pulmonary metastasectomy. Of those, 64 patients underwent repeat metastasectomies, and these patients were included in the analysis. All the 64 patients underwent a second metastasectomy, later 35 of them underwent a third metastasectomy, 12 underwent a fourth metastasectomy, and 6 underwent a fifth metastasectomy. The total number of re-do metastasectomies was 181. The median overall survival among the patients undergoing re-do metastasectomy was 66.0 ± 3.8 months. Three and 5-year survival rates were 82.3% and 63.3%, respectively. The 5-year survival rates were 63.3% after the first, 50.9% after the second, 74.4% after the third, 83.3% after the fourth, and 60.0% after the fifth metastasectomy. We conclude that at the current stage of knowledge, there is an indication for repeat re-do metastasectomy with curative intent.

Outcome of Repeat Pulmonary Metastasectomy.

Hintergrund Die thorakale Sympathektomie ist eine vielversprechende Therapieoption bei ausgewählten Herzrhythmusstörungen. Eingebunden in ein interdisziplinäres Therapiekonzept, kann die Sympathektomie den Unterschied herstellen, der zwischen einem kurativen Therapieansatz vs. bloßer Palliation im Sinne einer AV Knoten Ablation mit Herzschrittmacherimplantation. 

Videofalldemonstration einer erweiterten Sympathektomie bei
 inadäquater therapieresistenter Sinustachykardie

Die 62 –jährige Patientin entwickelte nach der Boosterimpfung 03/2022 gegen Corona einen Hustenreiz. Sie stellte sich beim Pneumologen vor, im CT Thorax 16.05.2022 zeigten sich bilaterale multiple, teilweise einschmelzende Herdbefunde apikal. Sie war Arzthelferin, keine Haustiere, aktuell Raucherin, 42 Pack/Years. Im CT- Thorax vom 14.10.2022 nach OP eines Zystadenolymphom der Glandula parotis waren keine Auffälligkeiten. Endobronchial war der Befund unauffällig, in der BAL 94.4% Makrophagen, 2 CD1a positive Zellen, die transbronchiale Biopsie nicht richtungsweisend, keine säurefesten Stäbchen. Laborchemisch keine Auffälligkeiten, Autoantikörper negativ, bodyplethysmographisch unauffällig und leichte Einschränkung der Diffusionskapazität. Wir diskutierten eine TBC, eine atypische Mykobakteriose, eine nekrotisierende Vaskulitis, eine Pilzinfektion oder eine Histiozytose X. Bei der Minimalität der Befunde entschlossen wir uns zur offenen Lungenbiopsie. Das Lungenparenchym zeigte ein geringes irreguläres Emphysem und Atelektasen, eine Raucherpneumopathie, weiterhin knotige Manifestation von Langerhans-Histiozytose mit immunhistochemischen Nachweis von CDa1 positiven Zellen. 

Manifestation einer pulmonalen Histiozytose X innerhalb von 9 Monaten

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Endoscopic lung volume reduction with endobronchial valves in very low DLCO patients: results from the German Registry - Lungenemphysemregister e.V.

Delphi Expert Consensus of the German Thoracic Surgery Society on the Management of Chest Tube Drainage

Outcome of Repeat Pulmonary Metastasectomy.

Videofalldemonstration einer erweiterten Sympathektomie bei inadäquater therapieresistenter Sinustachykardie

Manifestation einer pulmonalen Histiozytose X innerhalb von 9 Monaten