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Crit Care Med. 2019 Apr 10. doi: 10.1097/CCM.0000000000003761. [Epub ahead of print]

Reducing Iatrogenic Pneumothoraces: Using Real-Time Ultrasound Guidance for Pleural Procedures.

Author information

1
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Mayo Clinic, Jacksonville, FL.
2
Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, FL.
3
Department of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN.

Abstract

OBJECTIVES:

Awareness of the impact of bedside ultrasound to reduce iatrogenic pneumothoraces while performing bedside pleural procedures has increased but with little understanding in how ultrasound is used for these procedures.

DESIGN AND SETTING:

We conducted a retrospective chart review at a tertiary referral center in the United States from January 1, 2014, to March 31, 2017. Our study assessed adverse effect rates between real-time ultrasound-guided and ultrasound-marked thoracenteses and thoracostomy tube placements.

PATIENTS:

Three-hundred ninety-four ICU patients were included in this study.

MEASUREMENTS AND MAIN RESULTS:

There was a significant difference in the rate of adverse effects between real-time ultrasound-guided (0.63% [95% CI, 0.11-3.4%]) and ultrasound-marked (6.89% [95% CI, 4.15-11.24%]; p ≤ 0.01) procedures. More specifically, the rate of pneumothoraces was different between the two procedures (0.63% [95% CI, 0.11-3.4%] vs 4.43% [95% CI, 2.35-8.21%]; p = 0.02). In patients mechanically ventilated, there was a significant difference in overall adverse effect rates between groups of ultrasound use (p = 0.01).

CONCLUSIONS:

The use of real-time ultrasound guidance was associated with a lower rate of iatrogenic pneumothoraces.

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