Pulmonary Self-Study Resources-Sundaralingam, Frequency, Risk factors and Management of Cx from Pleural Procedures, CHEST 2022

Pdf Summary

The narrative review "The Frequency, Risk Factors, and Management of Complications From Pleural Procedures" by Anand Sundaralingam and colleagues provides an extensive examination of complications arising from pleural interventions like thoracocentesis, intercostal drains (ICDs), indwelling pleural catheters (IPCs), and local anesthetic thoracoscopy (LAT). Despite the widespread use of these procedures, the rates and risk factors for complications remain inconsistent in the literature. <br /><br />The review conducted a structured search of relevant studies from 2010 onwards, focusing on post-ultrasound guidance era data. From 4,308 studies, 48 were selected for detailed analysis based on specific criteria.<br /><br />Key findings include:<br />- **Thoracocentesis:** Iatrogenic pneumothorax is the most common complication, with an incidence of 3.3% but drops to 0.6% with ultrasound guidance. Major bleeding and re-expansion pulmonary edema (RPE) are rare.<br />- **Intercostal Drains (ICDs):** Most frequent issues are drain blockages (6.3%) and displacement (6.8%). Infection rates are relatively low. Data suggests that ultrasound and careful procedural planning can mitigate these complications.<br />- **Indwelling Pleural Catheters (IPCs):** Infection rates are approximately 5.8%. Other complications like drain blockage (3.5%), displacement (1.5%), and loculated effusions (6.4%) also pose significant management issues.<br />- **Local Anesthetic Thoracoscopy (LAT):** The overall mortality rate is 0.1%, with bleeding (1.6%), infection (4.5%), hypoxemia (1.3%), and less common but serious complications like organ puncture being reported.<br /><br />The review acknowledges the methodological limitations of existing studies, including small sample sizes and retrospective designs, which might introduce recall biases. To improve patient safety and optimize outcomes, the review underscores the need for standardized procedures and thorough operator training, emphasizing that well-prepared care plans are crucial for handling complications efficiently. Novel study methods and better post-procedural monitoring could further enhance understanding and management of these interventions' risks.

Meta Tag

Asset Type PDF

Curriculum Category Pleural Disease

Curriculum Subcategory Diagnostic and therapeutic procedures

Keywords

pleural procedures

thoracocentesis

intercostal drains

indwelling pleural catheters

local anesthetic thoracoscopy

complications

ultrasound guidance