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Correspondence |

Thoracentesis and Chest Tube Management in Critical Care Medicine: A Multicenter Survey of Current Practices FREE TO VIEW

Nicolas Mongardon, MD; Benjamin Tremey, MD; Jean Marty, MD, PhD
Author and Funding Information

From the Department of Anesthesiology and Critical Care Medicine, Henri Mondor Teaching Hospital, Assistance-Publique des Hopîtaux de Paris, Université Paris XII.

Correspondence to: Nicolas Mongardon, MD, Department of Anesthesiology and Critical Care Medicine, CHU Henri Mondor, 51 avenue du Maréchal de Lattre de Tassigny, 94000 Créteil, France; e-mail: nmongardon@yahoo.fr


Financial/nonfinancial disclosures: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2010 American College of Chest Physicians


Chest. 2010;138(6):1524-1525. doi:10.1378/chest.10-1193
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Chest tube insertion is commonly performed in the ICU. As with all invasive techniques, adherence to current guidelines and consensus-based practices should reduce potential iatrogenic life-threatening complications. Although recommendations have been published,1 nothing is known about thoracocentesis practices in the ICU.

To investigate these points, a 25-item questionnaire was sent individually to the 634 senior intensivists working in the Ile-de France area (the region of Paris and suburbs with 11,700,000 inhabitants, covering 18% of the total French population). The list was obtained from the database of the French Society for Intensive Care Medicine. The questionnaire focused on modality of analgesia, details of procedure (including tracking, size of tube, insertion site, and method of insertion), and details of removal procedure (see e-Appendix). Questionnaires were posted in February 2008; two reminders were mailed 4 and 8 weeks later.

The questionnaire was completed by 178 intensivists (28%). Mean professional experience was 12 years, and the mean number of chest drains inserted was 12 per year. Reasons for thoracentesis were pleural effusion (48%) or pneumothorax (52%). The main responses are summarized in Table 1. In the absence of a life-threatening indication for pleural drainage, the median prothrombin time and platelet count required were 50% (interquartile range, 40-50) and 50,000/mm3 (50-80). In the case of pneumothorax drainage, a small-bore tube was the first option for 53% of the physicians. Pleural effusions were equally drained with an indwelling small lumen catheter, small-bore chest tube (≤14 F), or larger-bore tube. Only 62 physicians (35%) were aware of the British Thoracic Society guidelines.

Table Graphic Jump Location
Table 1 —Main Responses to the Questionnaire

Data are presented as No. (%).

This French multicenter survey, which is the first report dedicated to ICU practices that we are aware of, reveals that the adherence to current guidelines is very heterogeneous. First, pain management seems acceptable, but these findings contrast with a recent study that found that <25% of painful procedures were anticipated.2 Second, we confirm the increasing use of ultrasound, particularly among young physicians, with >50% of respondents using this procedure to confirm the insertion site.3 Third, insertion techniques appear dramatically disparate and may lead to severe iatrogenic complications. We highlight some potentially dangerous practices, such as absence of needle suctioning or trocar use for pleural penetration.

These large variations in practice and heterogeneous implementation of guidelines are similar to those of other domains of care in pulmonology4 or critical care medicine.5 This survey underlines the need among ICU clinicians for a heightened awareness of current recommendations for chest tube management.

Additional Information: The e-Appendix can be found in the Online Supplement at http://chestjournal.chestpubs.org/content/138/6/1524.1/suppl/DC1.

Laws D, Neville E, Duffy J. Pleural Diseases Group, Standards of Care Committee, British Thoracic Society Pleural Diseases Group, Standards of Care Committee, British Thoracic Society BTS guidelines for the insertion of a chest drain. Thorax. 2003;58Suppl 2:ii53-ii59. [CrossRef] [PubMed]
 
Payen JF, Chanques G, Mantz J, et al. Current practices in sedation and analgesia for mechanically ventilated critically ill patients: a prospective multicenter patient-based study. Anesthesiology. 2007;1064:687-695. [CrossRef] [PubMed]
 
Mayo PH, Beaulieu Y, Doelken P, et al. American College of Chest Physicians/La Société de Réanimation de Langue Française statement on competence in critical care ultrasonography. Chest. 2009;1354:1050-1060. [CrossRef] [PubMed]
 
Marchi E, Vargas FS, Madaloso BA, Carvalho MV, Teixeira LR. Pleurodesis practice in South and Central American countries. Chest. 2010;1373:739-740. [CrossRef] [PubMed]
 
Quenot JP, Mentec H, Feihl F, et al; TECLA Study Group TECLA Study Group Bedside adherence to clinical practice guidelines in the intensive care unit: the TECLA study. Intensive Care Med. 2008;348:1393-1400. [CrossRef] [PubMed]
 

Figures

Tables

Table Graphic Jump Location
Table 1 —Main Responses to the Questionnaire

Data are presented as No. (%).

References

Laws D, Neville E, Duffy J. Pleural Diseases Group, Standards of Care Committee, British Thoracic Society Pleural Diseases Group, Standards of Care Committee, British Thoracic Society BTS guidelines for the insertion of a chest drain. Thorax. 2003;58Suppl 2:ii53-ii59. [CrossRef] [PubMed]
 
Payen JF, Chanques G, Mantz J, et al. Current practices in sedation and analgesia for mechanically ventilated critically ill patients: a prospective multicenter patient-based study. Anesthesiology. 2007;1064:687-695. [CrossRef] [PubMed]
 
Mayo PH, Beaulieu Y, Doelken P, et al. American College of Chest Physicians/La Société de Réanimation de Langue Française statement on competence in critical care ultrasonography. Chest. 2009;1354:1050-1060. [CrossRef] [PubMed]
 
Marchi E, Vargas FS, Madaloso BA, Carvalho MV, Teixeira LR. Pleurodesis practice in South and Central American countries. Chest. 2010;1373:739-740. [CrossRef] [PubMed]
 
Quenot JP, Mentec H, Feihl F, et al; TECLA Study Group TECLA Study Group Bedside adherence to clinical practice guidelines in the intensive care unit: the TECLA study. Intensive Care Med. 2008;348:1393-1400. [CrossRef] [PubMed]
 
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