Efficacy of chest X‐rays after drain removal in adult and pediatric patients undergoing cardiac and thoracic surgery: A systematic review

Background Chest X‐rays are routinely obtained after the removal of chest drains in patients undergoing cardiac and thoracic surgical procedures. However, a lack of guidelines and evidence could question the practice. Routine chest X‐rays increase exposure to ionizing radiation, increase health‐care...

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Veröffentlicht in:Journal of cardiac surgery 2022-12, Vol.37 (12), p.5320-5325
Hauptverfasser: Thet, Myat S., Han, Khin P. P., Hlwar, Khun E., Thet, Khaing S., Oo, Aung Y.
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container_end_page 5325
container_issue 12
container_start_page 5320
container_title Journal of cardiac surgery
container_volume 37
creator Thet, Myat S.
Han, Khin P. P.
Hlwar, Khun E.
Thet, Khaing S.
Oo, Aung Y.
description Background Chest X‐rays are routinely obtained after the removal of chest drains in patients undergoing cardiac and thoracic surgical procedures. However, a lack of guidelines and evidence could question the practice. Routine chest X‐rays increase exposure to ionizing radiation, increase health‐care costs, and lead to overutilisation of available resources. This review aims to explore the evidence in the literature regarding the routine use of chest X‐rays following the removal of chest drains. Materials & Method A systematic literature search was conducted in PubMed, Medline via Ovid, Cochrane central register of control trials (CENTRAL), and ClinicalTrials. gov without any limit on the publication year. The references of the included studies are manually screened to identify potentially eligible studies. Results A total of 375 studies were retrieved through the search and 18 studies were included in the review. Incidence of pneumothorax remains less than 10% across adult cardiac, and pediatric cardiac and thoracic surgical populations. The incidence may be as high as 50% in adult thoracic surgical patients. However, the reintervention rate remains less than 2% across the populations. Development of respiratory and cardiovascular symptoms can adequately guide for a chest X‐ray following the drain removal. As an alternative, bedside ultrasound can be used to detect pneumothorax in the thorax after the removal of a chest drain without the need for ionizing radiation. Conclusion A routine chest X‐ray following chest drain removal in adult and pediatric patients undergoing cardiac and thoracic surgery is not necessary. It can be omitted without compromising patient safety. Obtaining a chest X‐ray should be clinically guided. Alternatively, bedside ultrasound can be used for the same purpose without the need for radiation exposure.
doi_str_mv 10.1111/jocs.17114
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P. ; Hlwar, Khun E. ; Thet, Khaing S. ; Oo, Aung Y.</creator><creatorcontrib>Thet, Myat S. ; Han, Khin P. P. ; Hlwar, Khun E. ; Thet, Khaing S. ; Oo, Aung Y.</creatorcontrib><description>Background Chest X‐rays are routinely obtained after the removal of chest drains in patients undergoing cardiac and thoracic surgical procedures. However, a lack of guidelines and evidence could question the practice. Routine chest X‐rays increase exposure to ionizing radiation, increase health‐care costs, and lead to overutilisation of available resources. This review aims to explore the evidence in the literature regarding the routine use of chest X‐rays following the removal of chest drains. Materials &amp; Method A systematic literature search was conducted in PubMed, Medline via Ovid, Cochrane central register of control trials (CENTRAL), and ClinicalTrials. gov without any limit on the publication year. The references of the included studies are manually screened to identify potentially eligible studies. Results A total of 375 studies were retrieved through the search and 18 studies were included in the review. Incidence of pneumothorax remains less than 10% across adult cardiac, and pediatric cardiac and thoracic surgical populations. The incidence may be as high as 50% in adult thoracic surgical patients. However, the reintervention rate remains less than 2% across the populations. Development of respiratory and cardiovascular symptoms can adequately guide for a chest X‐ray following the drain removal. As an alternative, bedside ultrasound can be used to detect pneumothorax in the thorax after the removal of a chest drain without the need for ionizing radiation. Conclusion A routine chest X‐ray following chest drain removal in adult and pediatric patients undergoing cardiac and thoracic surgery is not necessary. It can be omitted without compromising patient safety. Obtaining a chest X‐ray should be clinically guided. Alternatively, bedside ultrasound can be used for the same purpose without the need for radiation exposure.</description><identifier>ISSN: 0886-0440</identifier><identifier>EISSN: 1540-8191</identifier><identifier>DOI: 10.1111/jocs.17114</identifier><identifier>PMID: 36335600</identifier><language>eng</language><publisher>United States: John Wiley and Sons Inc</publisher><subject>Adult ; cardiac surgery ; chest drain ; chest tube ; chest X‐ray ; Child ; Heart ; Humans ; Pneumothorax ; Radiography, Thoracic ; Regular Issue Papers ; Review ; Thoracic Surgery ; Thoracic Surgical Procedures - methods ; X-Rays</subject><ispartof>Journal of cardiac surgery, 2022-12, Vol.37 (12), p.5320-5325</ispartof><rights>2022 The Authors. published by Wiley Periodicals LLC.</rights><rights>2022 The Authors. 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P.</creatorcontrib><creatorcontrib>Hlwar, Khun E.</creatorcontrib><creatorcontrib>Thet, Khaing S.</creatorcontrib><creatorcontrib>Oo, Aung Y.</creatorcontrib><title>Efficacy of chest X‐rays after drain removal in adult and pediatric patients undergoing cardiac and thoracic surgery: A systematic review</title><title>Journal of cardiac surgery</title><addtitle>J Card Surg</addtitle><description>Background Chest X‐rays are routinely obtained after the removal of chest drains in patients undergoing cardiac and thoracic surgical procedures. However, a lack of guidelines and evidence could question the practice. Routine chest X‐rays increase exposure to ionizing radiation, increase health‐care costs, and lead to overutilisation of available resources. This review aims to explore the evidence in the literature regarding the routine use of chest X‐rays following the removal of chest drains. Materials &amp; Method A systematic literature search was conducted in PubMed, Medline via Ovid, Cochrane central register of control trials (CENTRAL), and ClinicalTrials. gov without any limit on the publication year. The references of the included studies are manually screened to identify potentially eligible studies. Results A total of 375 studies were retrieved through the search and 18 studies were included in the review. Incidence of pneumothorax remains less than 10% across adult cardiac, and pediatric cardiac and thoracic surgical populations. The incidence may be as high as 50% in adult thoracic surgical patients. However, the reintervention rate remains less than 2% across the populations. Development of respiratory and cardiovascular symptoms can adequately guide for a chest X‐ray following the drain removal. As an alternative, bedside ultrasound can be used to detect pneumothorax in the thorax after the removal of a chest drain without the need for ionizing radiation. Conclusion A routine chest X‐ray following chest drain removal in adult and pediatric patients undergoing cardiac and thoracic surgery is not necessary. It can be omitted without compromising patient safety. Obtaining a chest X‐ray should be clinically guided. Alternatively, bedside ultrasound can be used for the same purpose without the need for radiation exposure.</description><subject>Adult</subject><subject>cardiac surgery</subject><subject>chest drain</subject><subject>chest tube</subject><subject>chest X‐ray</subject><subject>Child</subject><subject>Heart</subject><subject>Humans</subject><subject>Pneumothorax</subject><subject>Radiography, Thoracic</subject><subject>Regular Issue Papers</subject><subject>Review</subject><subject>Thoracic Surgery</subject><subject>Thoracic Surgical Procedures - methods</subject><subject>X-Rays</subject><issn>0886-0440</issn><issn>1540-8191</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>24P</sourceid><sourceid>WIN</sourceid><sourceid>EIF</sourceid><recordid>eNp9kc1OGzEURi1UVALthgeovK401B57Mh42CEX0B0XKApC6s-7Y14mjyUxkT4Jmx55Nn7FPgkkKKhu8saV7vnMtfYSccnbG0_m27Ew84yXn8oCMeCFZpnjFP5ARU2qcMSnZETmOcclYnkvBPpIjMRaiGDM2Io9XznkDZqCdo2aBsae__z78CTBECq7HQG0A39KAq24LDU1PsJump9BaukbroQ_e0DX0Hts-0k1rMcw7386pgZDGZkf2iy6ASWDchDmG4Zxe0jjEHlcpaJJ96_H-Ezl00ET8_O8-IXffr24nP7Pp7MevyeU0M6LgMoOqLHhtC4d1LgzWwNCakilQTo7B1BVKiaoynDubF8qWpaxyAcYCCsWgECfkYu9db-pVyqaPB2j0OvgVhEF34PXbSesXet5tNWesqlQpk-Hr3mBCF2NA9xrmTD93op870btOEvzl_3Wv6EsJCeB74N43OLyj0tezyc1e-gRH7J0g</recordid><startdate>202212</startdate><enddate>202212</enddate><creator>Thet, Myat S.</creator><creator>Han, Khin P. P.</creator><creator>Hlwar, Khun E.</creator><creator>Thet, Khaing S.</creator><creator>Oo, Aung Y.</creator><general>John Wiley and Sons Inc</general><scope>24P</scope><scope>WIN</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-2741-0339</orcidid></search><sort><creationdate>202212</creationdate><title>Efficacy of chest X‐rays after drain removal in adult and pediatric patients undergoing cardiac and thoracic surgery: A systematic review</title><author>Thet, Myat S. ; Han, Khin P. P. ; Hlwar, Khun E. ; Thet, Khaing S. ; Oo, Aung Y.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3514-a9751bd5feb23ceba0edc708a8f46acb9e44e89c11fd258d774923acdae380a53</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Adult</topic><topic>cardiac surgery</topic><topic>chest drain</topic><topic>chest tube</topic><topic>chest X‐ray</topic><topic>Child</topic><topic>Heart</topic><topic>Humans</topic><topic>Pneumothorax</topic><topic>Radiography, Thoracic</topic><topic>Regular Issue Papers</topic><topic>Review</topic><topic>Thoracic Surgery</topic><topic>Thoracic Surgical Procedures - methods</topic><topic>X-Rays</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Thet, Myat S.</creatorcontrib><creatorcontrib>Han, Khin P. P.</creatorcontrib><creatorcontrib>Hlwar, Khun E.</creatorcontrib><creatorcontrib>Thet, Khaing S.</creatorcontrib><creatorcontrib>Oo, Aung Y.</creatorcontrib><collection>Wiley-Blackwell Open Access Titles</collection><collection>Wiley Free Content</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Journal of cardiac surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Thet, Myat S.</au><au>Han, Khin P. P.</au><au>Hlwar, Khun E.</au><au>Thet, Khaing S.</au><au>Oo, Aung Y.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Efficacy of chest X‐rays after drain removal in adult and pediatric patients undergoing cardiac and thoracic surgery: A systematic review</atitle><jtitle>Journal of cardiac surgery</jtitle><addtitle>J Card Surg</addtitle><date>2022-12</date><risdate>2022</risdate><volume>37</volume><issue>12</issue><spage>5320</spage><epage>5325</epage><pages>5320-5325</pages><issn>0886-0440</issn><eissn>1540-8191</eissn><abstract>Background Chest X‐rays are routinely obtained after the removal of chest drains in patients undergoing cardiac and thoracic surgical procedures. However, a lack of guidelines and evidence could question the practice. Routine chest X‐rays increase exposure to ionizing radiation, increase health‐care costs, and lead to overutilisation of available resources. This review aims to explore the evidence in the literature regarding the routine use of chest X‐rays following the removal of chest drains. Materials &amp; Method A systematic literature search was conducted in PubMed, Medline via Ovid, Cochrane central register of control trials (CENTRAL), and ClinicalTrials. gov without any limit on the publication year. The references of the included studies are manually screened to identify potentially eligible studies. Results A total of 375 studies were retrieved through the search and 18 studies were included in the review. Incidence of pneumothorax remains less than 10% across adult cardiac, and pediatric cardiac and thoracic surgical populations. The incidence may be as high as 50% in adult thoracic surgical patients. However, the reintervention rate remains less than 2% across the populations. Development of respiratory and cardiovascular symptoms can adequately guide for a chest X‐ray following the drain removal. As an alternative, bedside ultrasound can be used to detect pneumothorax in the thorax after the removal of a chest drain without the need for ionizing radiation. Conclusion A routine chest X‐ray following chest drain removal in adult and pediatric patients undergoing cardiac and thoracic surgery is not necessary. It can be omitted without compromising patient safety. Obtaining a chest X‐ray should be clinically guided. Alternatively, bedside ultrasound can be used for the same purpose without the need for radiation exposure.</abstract><cop>United States</cop><pub>John Wiley and Sons Inc</pub><pmid>36335600</pmid><doi>10.1111/jocs.17114</doi><tpages>6</tpages><orcidid>https://orcid.org/0000-0002-2741-0339</orcidid><oa>free_for_read</oa></addata></record>
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subjects Adult
cardiac surgery
chest drain
chest tube
chest X‐ray
Child
Heart
Humans
Pneumothorax
Radiography, Thoracic
Regular Issue Papers
Review
Thoracic Surgery
Thoracic Surgical Procedures - methods
X-Rays
title Efficacy of chest X‐rays after drain removal in adult and pediatric patients undergoing cardiac and thoracic surgery: A systematic review
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