Martin Kathryn, Emil Sherif, Zavalkoff Samara, Lo Andrea, Ganey Michael, Baird Robert, Gaudreault Josee, Mandel Romain, Perreault Thérèse, Pharand Andréane
Division of Pediatric General and Thoracic Surgery, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada.
Eur J Pediatr Surg. 2013 Oct;23(5):389-93. doi: 10.1055/s-0033-1333641. Epub 2013 Feb 26.
Tube thoracostomies in children are required for multiple indications and can be associated with significant discomfort. In 2010, a multidisciplinary team at our institution developed a protocol to replace stiff chest tubes with 8.5-French soft pleural catheters in children requiring pleural drainage.
Before initiating the protocol, an audit sheet was developed to prospectively capture data regarding insertion, removal, complications, and success. After 8 months of new protocol utilization, these data were reviewed, along with a retrospective review of the patients' charts.
Twenty-three patients had 33 pleural catheters inserted over an 8-month period. Mean age was 6.7 years (1 day to 17 years). Indications for insertion were pneumothorax (24%), simple effusion (24%), chylothorax (27%), parapneumonic effusion/empyema (21%), and malignant effusion (3%). Complications included premature dislodgment (33%), blockage (15%), pneumothorax (3%), and bleeding (3%). Mean duration of pleural drainage was 7.27 days (0 to 37 days). Pleural drainage was successful in 91% of patients.
Soft pleural catheters are an acceptable alternative to traditional stiff chest tubes in the pediatric population. Premature dislodgment was the most common problem. Prospective audits are extremely valuable in assessing new procedural protocols and practice changes.
儿童胸腔闭式引流术有多种适应证，且可能会带来明显不适。2010年，我们机构的一个多学科团队制定了一项方案，在需要胸腔引流的儿童中用8.5法式软质胸膜导管取代硬质胸管。
在启动该方案之前，设计了一份审核表，以前瞻性收集有关置入、拔除、并发症和成功率的数据。在新方案实施8个月后，对这些数据进行了回顾，并对患者病历进行了回顾性分析。
在8个月期间，23例患者共置入了33根胸膜导管。平均年龄为6.7岁（1天至17岁）。置入的适应证包括气胸（24%）、单纯胸腔积液（24%）、乳糜胸（27%）、肺炎旁胸腔积液/脓胸（21%）和恶性胸腔积液（3%）。并发症包括过早移位（33%）、堵塞（15%）、气胸（3%）和出血（3%）。胸腔引流的平均持续时间为7.27天（0至37天）。91%的患者胸腔引流成功。
在儿科患者中，软质胸膜导管是传统硬质胸管的可接受替代物。过早移位是最常见的问题。前瞻性审核在评估新的操作方案和实践变化方面极具价值。
