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Lu HY, Lin MY, Tsai PS, Chiu HY, Fang SC. Effectiveness of Cold Therapy for Pain and Anxiety Associated with Chest Tube Removal: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Pain Manag Nurs 2024; 25:34-45. [PMID: 37268491 DOI: 10.1016/j.pmn.2023.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 04/19/2023] [Accepted: 04/29/2023] [Indexed: 06/04/2023]
Abstract
OBJECTIVES To assess the effectiveness of cold therapy for pain and anxiety associated with chest tube removal. DESIGN A Systematic review and meta-analysis of randomized controlled trials. DATA SOURCES Articles were searched from Cochrane Library, PubMed, Embase, CINAHL, ProQuest, Airiti Library, China National Knowledge Infrastructure, and the National Digital Library of Theses and Dissertations in Taiwan. REVIEW/ANALYSIS METHODS Eight electronic databases were searched from inception to August 20, 2022. The Cochrane Risk of Bias 2.0 tool was used to assess the quality of the included studies. Using a random-effects model, we calculated Hedges' g and its associated confidence interval to evaluate the effects of cold therapy. Cochrane's Q test and an I2 test were used to detect heterogeneity, and moderator and meta-regression analyses were conducted to explore possible sources of heterogeneity. Publication bias was assessed using a funnel plot, Egger's test, and trim-and-fill analysis. RESULTS We examined 24 trials involving 1,821 patients. Cold therapy significantly reduced pain during and after chest tube removal as well as anxiety after chest tube removal (Hedges' g: -1.28, -1.27, and -1.80, respectively). Additionally, the effect size of cold therapy for reducing anxiety after chest tube removal was significantly and positively associated with that of cold therapy for reducing pain after chest tube removal. CONCLUSIONS Cold therapy can reduce pain and anxiety associated with chest tube removal.
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Affiliation(s)
- Hsin-Yi Lu
- Department of Nursing, Tri-Service General Hospital, National Defence Medical Center, Taipei, Taiwan; School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Mei-Yu Lin
- Department of Nursing, Tzu Chi University of Science and Technology, Hualian, Taiwan
| | - Pei-Shan Tsai
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan; Department of Nursing and Center for Nursing and Healthcare Research in Clinical Practice Application, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; Research Center of Sleep Medicine, Taipei Medical University Hospital, Taipei, Taiwan.
| | - Hsiao-Yean Chiu
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan; Research Center of Sleep Medicine, Taipei Medical University Hospital, Taipei, Taiwan
| | - Su-Chen Fang
- Department of Nursing, Mackay Medical College, New Taipei City, Taiwan
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Simsek Yaban Z, Álvarez-García C, Bozdemir H. The effect of cold application on pain during the chest tube removal: A meta-analysis. Turk Gogus Kalp Damar Cerrahisi Derg 2023; 31:398-407. [PMID: 37664777 PMCID: PMC10472463 DOI: 10.5606/tgkdc.dergisi.2023.23846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 10/31/2022] [Indexed: 09/05/2023]
Abstract
Background In this meta-analysis, we aimed to investigate the effect of cold application on chest tube removal-related pain compared to conventional analgesic care. Methods A systematic review and meta-analysis were conducted (PROSPERO, 2021: CRD42020179867). We searched studies in PubMed, Ovid-LWW, Scopus, Taylor & Francis, Science Direct, EBSCO, Google Scholar, Medline Complete, Cochrane Library and ULAKBIM databases and grey literature for this study. We included the articles published from January 2009 to December 2019. We limited the language to Turkish and English and the design to randomized-controlled trials. All studies were reviewed by two independent researchers. Meta-analysis was performed using the Comprehensive Meta-Analysis version 3.3 software. Heterogeneity was investigated by meta-regression. Results A total of 2,462 records were identified, of which 16 studies were included in a random model meta-analysis. The cold application was used in combination with a pharmacological agent in six studies and alone in 13 studies. All patients were older than 16 years and they had at least one chest tube. Cold application was found to be effective in relieving pain during chest tube removal (d=-1.265). Conclusion The use of a non-pharmacological method such as cold application is helpful to reduce pain or reduce painkiller doses during chest tube removal. Its use is recommended, as it is effective, easy to use, and cost-effective without any side effects.
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Affiliation(s)
- Zuleyha Simsek Yaban
- Department of Surgical Nursing, Kocaeli University Faculty of Health Sciences, Kocaeli, Türkiye
| | | | - Havva Bozdemir
- Department of Nursing, Kocaeli University Medico-Social Center, Kocaeli, Türkiye
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Soydan D, Uğraş GA. Effect of different cold application materials on pain during chest tube removal: three-arm randomized controlled clinical trial. Afr Health Sci 2021; 21:1273-1281. [PMID: 35222592 PMCID: PMC8843275 DOI: 10.4314/ahs.v21i3.38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Chest tube causes severe pain during removal because it attaches to the endothelium in the chest cavity. Objectives This study aimed to determine the effectiveness of cold application with ice pack and gel pad in the control of pain experienced during chest tube removal. Methods The sample of prospective, parallel three-arm (1:1:1), randomized controlled clinical trial consisted of 180 patients in two experimental groups (ice pack/gel pad) and one control group. The primary outcome was effect of cold application materials on severity of pain during chest removal. Secondary outcomes were duration of cold application and analgesic requirements of the patients. Results The study found that the cold application using either of the materials reduced the severity of pain and the need for analgesics after the removal of chest tube compared to the control group (p<0.05). But cold application with ice pack allowed the skin to drop to the temperature effective in pain control in a shorter time than gel pad application (p<0.05). Conclusions Despite entirely covering the area around the chest tube, the gel pad was more disadvantageous than ice pack in pain control due to the longer duration of cold application.
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Kanamori LM, Guner Y, Gibbs D, Schomberg J. Are routine chest X-rays following chest tube removal necessary in asymptomatic pediatric patients? Pediatr Surg Int 2021; 37:631-637. [PMID: 33385243 DOI: 10.1007/s00383-020-04809-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/05/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE The purpose of this study was to determine if routine chest X-rays (CXRs) performed after chest tube (CT) removal in pediatric patients provide additional benefit for clinical management compared to observation of symptoms alone. METHODS A single-center retrospective study was conducted of inpatients, 18 years or younger, who had a CT managed by the pediatric surgery team between July 2017 and May 2019. The study compared two groups: (1) patients who received a post-pull CXR and (2) those who did not. The primary outcome of the study was the need for intervention after CT removal. RESULTS 102 patients had 116 CTs and met inclusion criteria; 79 post-pull CXRs were performed; the remaining 37 CT pulls did not have a follow-up CXR. No patients required CT replacement or surgery in the absence of symptoms. Three patients exhibited clinical symptoms that would have prompted intervention regardless of post-pull CXR results. One patient had an intervention guided by post-pull CXR results alone. Meanwhile, another patient had delayed onset of symptoms and intervention. No patients required an intervention in the group that did not have a post-pull CXR. CONCLUSION Chest X-ray after CT removal had a very low yield for changing clinical management of asymptomatic patients. Clinical symptoms predict the need for an intervention.
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Affiliation(s)
- Lauren M Kanamori
- Division of Pediatric General, Thoracic and Trauma Surgery, CHOC Children's Hospital of Orange County, 505 South Main Street, Suite 225, Orange, CA, 92868, USA.
| | - Yigit Guner
- Division of Pediatric General, Thoracic and Trauma Surgery, CHOC Children's Hospital of Orange County, University of California, Irvine Medical Center, Department of Surgery, 505 South Main Street, Suite 225, Orange, CA, 92868, USA
| | - David Gibbs
- Division of Pediatric General, Thoracic and Trauma Surgery, CHOC Children's Hospital of Orange County, University of California, Irvine Medical Center, Department of Surgery, 505 South Main Street, Suite 225, Orange, CA, 92868, USA
| | - John Schomberg
- Department of Clinical Education and Professional Development, CHOC Children's Hospital of Orange County, 1201 W. La Veta Avenue, Orange, CA, 92868, USA
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Marulli G, Comacchio GM, Nosotti M, Rosso L, Mendogni P, Natale G, Andriolo L, Imbriglio G, Larocca V, Brascia D, Rea F. Multicenter randomized study on the comparison between electronic and traditional chest drainage systems. Trials 2019; 20:730. [PMID: 31842974 PMCID: PMC6915964 DOI: 10.1186/s13063-019-3811-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 10/22/2019] [Indexed: 11/13/2022] Open
Abstract
Background In patients submitted to major pulmonary resection, the postoperative length of stay is mainly influenced by the duration of air leaks and chest tube removal. The measurement of air leaks largely relies on traditional chest drainage systems which are prone to subjective interpretation. Difficulty in differentiating between active air leaks and bubbles due to a pleural space effect may also lead to tentative drain clamping and prolonged time for chest drain removal. New digital systems allow continuous monitoring of air leaks, identifying subtle leakage that may be not visible during daily patient evaluation. Moreover, an objective assessment of air leaks may lead to a reduced interobserver variability and to an optimized timing for chest tube removal. Methods This study is a prospective randomized, interventional, multicenter trial designed to compare an electronic chest drainage system (Drentech™ Palm Evo) with a traditional system (Drentech™ Compact) in a cohort of patients undergoing pulmonary lobectomy through a standard three-port video-assisted thoracic surgery approach for both benign and malignant disease. The study will enroll 382 patients in three Italian centers. The duration of chest drainage and the length of hospital stay will be evaluated in the two groups. Moreover, the study will evaluate whether the use of a digital chest system compared with a traditional system reduces the interobserver variability. Finally, it will evaluate whether the digital drain system may help in distinguishing an active air leak from a pleural space effect, by the digital assessment of intrapleural differential pressure, and in identifying potential predictors of prolonged air leaks. Discussion To date, few studies have been performed to evaluate the clinical impact of digital drainage systems. The proposed prospective randomized trial will provide new knowledge to this research area by investigating and comparing the difference between digital and traditional chest drain systems. In particular, the objectives of this project are to evaluate the feasibility and usefulness of digital chest drainages and to provide new tools to identify patients at higher risk of developing prolonged air leaks. Trial registration ClinicalTrials.gov, NCT03536130. Retrospectively registered on 24 May 2018.
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Affiliation(s)
- Giuseppe Marulli
- Thoracic Surgery Unit, Department of Organ Transplantation and Emergency, University Hospital of Bari, Piazza Giulio Cesare, 11, 70124, Bari, Italy.
| | - Giovanni M Comacchio
- Thoracic Surgery Unit, Department of Cardiologic, Thoracic and Vascular Sciences, University Hospital of Padova, Padova, Italy
| | - Mario Nosotti
- Thoracic Surgery Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Lorenzo Rosso
- Thoracic Surgery Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Paolo Mendogni
- Thoracic Surgery Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Giuseppe Natale
- Thoracic Surgery Unit, Department of Cardiologic, Thoracic and Vascular Sciences, University Hospital of Padova, Padova, Italy
| | | | | | | | - Debora Brascia
- Thoracic Surgery Unit, Department of Organ Transplantation and Emergency, University Hospital of Bari, Piazza Giulio Cesare, 11, 70124, Bari, Italy
| | - Federico Rea
- Thoracic Surgery Unit, Department of Cardiologic, Thoracic and Vascular Sciences, University Hospital of Padova, Padova, Italy
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Olgac G, Cosgun T, Vayvada M, Ozdemir A, Kutlu CA. Low protein content of drainage fluid is a good predictor for earlier chest tube removal after lobectomy. Interact Cardiovasc Thorac Surg 2014; 19:650-5. [PMID: 24994700 DOI: 10.1093/icvts/ivu207] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Owing to the great absorption capability of the pleura for transudates, the protein content of draining pleural fluid may be considered as a more adequate determinant than its daily draining amount in the decision-making for earlier chest tube removal. In an a priori pilot study, we observed that the initially draining protein-rich exudate converts to a transudate quickly in most patients after lobectomies. Thus, chest tubes draining high-volume but low-protein fluids can safely be removed earlier in the absence of an air leak. This randomized study aims to investigate the validity and clinical applicability of this hypothesis as well as its influence on the timing for chest tube removal and earlier discharge after lobectomy. METHODS Seventy-two consecutive patients undergoing straightforward lobectomy were randomized into two groups. Patients with conditions affecting postoperative drainage and with persisting air leaks beyond the third postoperative day were excluded. Drains were removed if the pleural fluid to blood protein ratio (PrRPl/B) was ≤0.5, regardless of its daily draining amount in the study arm (Group S; n = 38), and patients in the control arm (Group C; n = 34) had their tubes removed if daily drainage was ≤250 ml regardless of its protein content. Patients were discharged home immediately or the following morning after removal of the last drain. All cases were followed up regarding the development of symptomatic pleural effusions and hospital readmissions for a redrainage procedure. RESULTS Demographic and clinical characteristics as well as the pattern of decrease in PrRPl/B were the same between groups. The mean PrRPl/B was 0.65 and 0.67 (95% CI = 0.60-0.69 and 0.62-0.72) on the first postoperative day, and it remarkably dropped down to 0.39 and 0.33 (95% CI = 0.33-0.45 and 0.27-0.39) on the second day in Groups S and C, respectively, and remained below 0.5 on the third day (repeated-measures of ANOVA design, post hoc 'within-group' comparison of the first postoperative day versus second and third days; P < 0.002). Eleven of 38 (29%) and 16 of 27 (59%) patients' chest tubes were, respectively, removed on the first and second postoperative days in Group S, but only two of 34 (6%) and ten of 32 (31%) patients, respectively, had their chest tubes removed in Group C (two-tailed Fisher's exact test, P = 0.02 and 0.005 for the first and the second postoperative days, respectively). On the third postoperative day, daily drainage remained ≥250 ml in 22 (65%) patients, among whom, 17 (77%) would have their chest tubes removed on the PrRPl/B value in Group C. However, drains could not be removed due to the high protein content of draining fluid despite the acceptable volume of daily drainage in only three (27%) of 11 cases in Group S (McNemar's paired proportions test, P = 0.009). The mean chest tube removal time (2.1 ± 0.9 vs 2.9 ± 1.0 days; P < 0.001) and the median hospital stay [3 days (IQR: 1-3) vs 4 days (IQR: 2-4), P < 0.003] were significantly shorter in Group S. None of the patients required a redrainage procedure due to a persistent and symptomatic pleural effusion. CONCLUSIONS Regardless of the daily drainage, chest tubes can safely be removed earlier than anticipated in most patients after lobectomy if the protein content of the draining fluid is low.
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Affiliation(s)
- Guven Olgac
- Department of Thoracic Surgery, Sureyyapasa Chest Diseases and Thoracic Surgery Teaching and Research Hospital, Istanbul, Turkey
| | - Tugba Cosgun
- Department of Thoracic Surgery, Sureyyapasa Chest Diseases and Thoracic Surgery Teaching and Research Hospital, Istanbul, Turkey
| | - Mustafa Vayvada
- Department of Thoracic Surgery, Sureyyapasa Chest Diseases and Thoracic Surgery Teaching and Research Hospital, Istanbul, Turkey
| | - Atilla Ozdemir
- Department of Thoracic Surgery, Sureyyapasa Chest Diseases and Thoracic Surgery Teaching and Research Hospital, Istanbul, Turkey
| | - Cemal Asim Kutlu
- Department of Thoracic Surgery, Sureyyapasa Chest Diseases and Thoracic Surgery Teaching and Research Hospital, Istanbul, Turkey
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Gorji HM, Nesami BM, Ayyasi M, Ghafari R, Yazdani J. Comparison of Ice Packs Application and Relaxation Therapy in Pain Reduction during Chest Tube Removal Following Cardiac Surgery. N Am J Med Sci 2014; 6:19-24. [PMID: 24678472 PMCID: PMC3938868 DOI: 10.4103/1947-2714.125857] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Background: Usually the chest tube removal (CTR) has been described as one of the worst experiences by patients in the intensive care unit. Aim: This study aimed to compare the effects of cold therapy and relaxation on pain of CTR among the patients undergoes coronary artery bypass graft surgery. Materials and Methods: This single-blinded clinical trial was done on 80 post-cardiac surgery patients in the heart hospital of Sari-Iran. The patients were assigned to three randomized groups that included cold therapy, relaxation, and control groups. Data analysis was done by T-test, Chi-square, generalized estimating equations and repeated measures analysis variance tests. Results: The groups had no significant differences in pain intensity before CTR (P = 0.84), but immediately after CTR there was a significant difference between the treatment (cold application and relaxation groups) and control groups (P = 0.001). There was no significant difference between relaxation and cold therapy groups. Conclusion: Regarding the relaxation and cold application methods showed relatively equal effects on reducing the pain owing to CTR. Thus, the use of relaxation because of economics, without side effects, easy to use and effective is recommended by the authors to the practitioners.
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Affiliation(s)
- Heidari Ma Gorji
- Department of Nursing and Midwifery, Mazandaran University of Medical Science, Sari, Iran
| | - Bagheri M Nesami
- Department of Nursing and Midwifery, Mazandaran University of Medical Science, Sari, Iran
| | - M Ayyasi
- Department of Nursing and Midwifery, Mazandaran University of Medical Science, Sari, Iran
| | - R Ghafari
- Department of Heart Surgery, Mazandaran University of Medical Science, Sari, Iran
| | - J Yazdani
- Department of Biostatistics, Mazandaran University of Medical Science, Sari, Iran
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