Safe chest tube placement in a patient with tension pneumothorax receiving rivaroxaban therapy for non-valvular atrial fibrillation.

The number of patients treated with direct oral anticoagulants is increasing worldwide. Although bleeding complications associated with direct oral anticoagulants are lower than those associated with vitamin K antagonists, the increased number of patients treated with these anticoagulants suggests that a higher absolute number of patients are at risk. Tube thoracostomy is an invasive procedure with a high risk of bleeding. To date, among direct oral anticoagulants, only dabigatran has a well-studied antidote to reverse its effects during emergency procedure or surgery. This report describes a case in which emergency placement of a tube thoracostomy, in a patient with type 2 respiratory failure due to left tension pneumothorax and receiving the anticoagulant rivaroxaban, in the pharmacokinetics phase with greater anticoagulant effect, did not result in bleeding greater than that typically encountered during such interventions. The procedure ended successfully with no acute complications.

Pleural procedures and patient safety: a national BTS audit of practice.

The BTS pleural procedures audit collected data over a 2-month period in June and July 2011. In contrast with the 2010 audit, which focussed simply on chest drain insertions, data on all pleural aspirations and local anaesthetic thoracoscopy (LAT) was also collected. Ninety hospitals submitted data, covering a patient population of 33 million. Twenty-one per cent of centres ran a specialist pleural disease clinic, 71% had a nominated chest drain safety lead, and 20% had thoracic surgery on site. Additionally, one-third of centres had a physician-led LAT service.

Valoración de la digitopresión del cuff externo como método práctico para la determinación del volumen y la presión del globo del tubo endotraqueal / Assessment of acupressure of the outer cuff as a practical method for the determination of the volume and pressure of the endotracheal tube balloon

Introducción: En la anestesia general, la presión que ejerce el manguito del tubo endotraqueal (TET) sobre la mucosa debe mantenerse en un rango de seguridad que evite complicaciones por sobreinflación o desinsuflación. En el hospital Loayza, los instrumentos de medición objetiva del cuff no son de uso común, se usa la digitopresión para este fin. Objetivo: Valorar la digitopresión del cuff externo como método de determinación de presión adecuada del manguito del tubo endotraqueal. Materiales y métodos: Estudio transversal prospectivo observacional. En pacientes intubados, se describió la apreciación de la presión del cuff externo por digitopresión del asistente y residente. Luego se midió la presión del cuff y se corrigió adecuadamente (rango adecuado de presión de 20 a 30 cm H20). Resultados: De los 200 casos, 54.5 por ciento fueron mujeres (39.3+/-13.5 años vs 47.1+/-14 en hombres). Las mujeres tienen menores presiones (38.2 cm H20 versus 48.9 cm H20 en hombres). Los residentes insuflaron el 93 por ciento de casos, lo hicieron adecuadamente solo en 19.9 por ciento versus 55.5 por ciento del asistente. Los residentes apreciaron el cuff adecuadamente en un 15.5 por ciento versus 3.5 por ciento del asistente. Conclusión: el estudio muestra la discordancia entre el método subjetivo y objetivo para determinar si el cuff del TET está adecuadamente inflado. Se sugiere el empleo de métodos más objetivos para su determinación.

Introduction: In general anesthesia, the pressure of the cuff of the endotracheal tube (TET) on the mucosa must be kept in a safe range that avoids complications overinflation or deflation. At the Hospital Loayza, the objective measurement instruments cuff are commonly used acupressure is used for this purpose. Objective: To assess the external cuff acupressure as a method of determining proper pressure of the endotracheal tube cuff. Materials and Methods: Prospective observational cross-sectional study. In intubated patients, described the assessment of external cuff pressure by acupressure and resident assistant. Then measured cuff pressure and corrected properly (proper pressure range 20-30 cm IDO). Results: Of the 200 cases, 54.5 per cent were women (39.3 + /-13.5 years vs 47.1 + /- 14 for men). Women have less pressure (48.9 cm H20 versus 38.2 cm H20 in men). Residents breathed 93 per cent of cases, properly made only in 19.9 per cent versus 55.5 per cent in the wizard. Residents appreciated the cuff properly by 15.5 per cent versus 3.5 per cent in the wizard. Conclusion: The study shows the discrepancy between subjective and objective method to determine if the ETT cuff is properly inflated. It suggests the use of more objective methods for its determination.