CXR after thoracocentesis

from Light pleural disease
Aleman et al. reported that only 5 of 488 patients without symptoms after thoracentesis developed a pneumothorax and that only 1 of these 5 patients required a chest tube. Gervais et al. reported that the incidence of iatrogenic pneumothorax was approximately 1% in nonintubated patients undergoing ultrasound-guided thoracentesis and concluded that routine postprocedure chest radiographs are not indicated in spontaneously breathing patients who undergo thoracentesis.
สรุปหากผู้ป่วยไม่มีsymptom, 1%เท่านั้นที่develop PTX หลังทำ thoracentesis ดังนั้นไม่ต้องroutine CXR เลือกทำเฉพาะรายที่ขณะtap drawได้ลม หรือผู้ป่วยมี symptomเท่านั้น

Percutaneous tracheostomy

Percutaneous Versus Surgical Tracheostomy: A Randomized Controlled
Study With Long-Term Follow-Up
Crit Care Med. 2006;34(8):2145-2152.

Abstract
Objective: To compare the safety, availability, and long-term sequelae of percutaneous vs. surgical tracheostomy.

Design: Prospective, randomized, controlled study.
Setting: Combined medical/surgical intensive care unit in a tertiary referral hospital.

Patients: Two hundred critically ill mechanically ventilated patients who required tracheostomy.

Interventions: Tracheostomy by either percutaneous tracheostomy or surgical tracheostomy performed in the
intensive care unit.

Measurements and Main Results: The primary outcome measure was the aggregate incidence of predefined
moderate or severe complications. The secondary outcome measures were the incidence of each of the components
of the primary outcome. Long-term follow-up included clinical assessment, flow volume loops, and bronchoscopy.
Both groups were well matched for age, gender, admission Acute Physiology and Chronic Health Evaluation II score,
period of endotracheal intubation, reason for intubation, and admission diagnosis. There was no statistical difference
between groups for the primary outcome. Bleeding requiring surgical intervention occurred in three percutaneous
tracheostomy patients and in no surgical tracheostomy patient (p = .2). Postoperative infection (p = .044) and
cosmetic sequelae (p = .08) were more common in surgical tracheostomy patients. There was a shorter delay from
randomization to percutaneous tracheostomy vs. surgical tracheostomy (p = .006). Long-term follow-up revealed no
complications in either group.

Conclusions: Both percutaneous tracheostomies and surgical tracheostomies can be safely performed at the
bedside by experienced, skilled practitioners.