Search

Study objectives: To evaluate the safety and efficacyof smaller-caliber drains in patients undergoing open heartsurgery. Design: A retrospective analysis of themedical records and chest radiographs assembled data on total amount ofdrainage, number of days of drainage, length of postoperative stay, appearance of postoperative chest radiographs, and need for furtherdrainage from either the pleural or pericardial spaces. Setting: A large university-based teaching hospital, where>800 open-heart procedures are performed yearly. Patientsand interventions: A total of 202 patients underwent standardopen heart surgery by one surgeon, and postoperative pleural andpericardial decompression was undertaken using small caliber, moreflexible drains connected to bulb suction. Results: Tubes were left in an average of 2.4 days, with a mean of 826.7 m, Lcollected during that time. The average postoperative length of staywas 6.7 days (median, 5 days). At or before 6-week follow-up, chestradiographs revealed moderate or large effusions in 19 patients (9.4%)in a pleural space that had been drained postoperatively. Twelvepatients (5.9%) required an additional postoperative procedure forpleural drainage (eight thoracenteses, four tube thoracostomies). Fourpatients (2.0%) required reexploration of the pericardium fortamponade. Conclusions: Use of smaller-caliber drainshave been found at our institution to be an adequate means ofdecompression of the pleural and pericardial spaces following openheart surgery, with patients rarely having clinically significantpleural effusions at 6-week follow-up.

A 41-year-old woman with end-stage mitral and aortic stenosis developed the cycle of low cardiac output, peripheral vasoconstriction, increased core temperature, and cardiac decompensation. This was interrupted by core cooling utilizing iced gastric lavage. We propose that her severe hyperthermia was caused or abetted by her low cardiac output.