Chest roentgenogram (CR) performed as routine after thoracic tube withdrawal in heart surgery postoperatively (HS-PO): a useless examination?

Background

The CR has been used as routine in our hospital, after thoracic tube withdrawal in HS-PO. This study evaluates the utility of the CR after thoracic tube withdrawal.

Methods

A retrospective study, in which 407 patients admitted to HS-PO with one or more thoracic tubes were evaluated. A total of 310 patients were submitted to coronary artery bypass graft and the other 97 patients were submitted to other cardiac surgeries. The incidences of pneumothorax and pneumomediastinum were evaluated, including clinical repercussion, the treatment used, and the relationship with thoracic tube withdrawal.

Results

Thirteen patients (3.17%) had a diagnosis of pneumothorax in HS-PO. Five patients had a pneumothorax diagnosis at a later time (6 days), related to central venous catheterization (subclavian vein). Eight patients (1.9%) had the diagnosis related to surgery and thoracic tube withdrawal. In two of these patients, an air escape through one or more tubes were previously detected. In two other patients, subcutaneous emphysema was detected before the tube withdrawal. Three other patients had dyspnea, chest pain and low oxygen saturation after tube withdrawal and before the roentgenogram. One of these last three patients also presented subcutaneous emphysema. These seven patients were submitted to pneumothorax treatment using a 'pig-tail' catheter. The eighth patient, despite having no signs and symptoms that could suggest any complication, had a pneumothorax diagnosed by roentgenogram, performed after thoracic tube withdrawal. This patient was kept in observation and was dismissed from hospital 6 days after surgery. Among the eight patients, two did not have the complication diagnosed by roentgenogram, but through thorax computed tomography.

Conclusion

Among the 407 patients included in this study, CR was not essential for an early detection of complications after thoracic tube withdrawal in CS-PO. From the eight patients who had a pneumothorax diagnosis (1.9%) related to surgery and tube withdrawal, seven presented some kind of symptom suggesting the necessity of doing the examination. In only one patient did the examination detect the complication without any previous sign or symptom. We suggest a similar evaluation in other surgical intensive care units.