Ever seen a pt live after 5 chest tubes?

Specialties MICU

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Had a guy who aspirated his own vomit when he was drunk, ended up with empyema, loculated fluid collection, all out white out left lung. Five chest tubes. He was in the OR for a trach when I came on the other night, but he came back with 2 jp's draining the abscess around his trachea (pure purulence) and pleuravac draining a pericardial abscess instead. My colleague and I were, somewhat morbidly, betting on his survival. I've had two other pts with five chest tubes who both died. One was virtually brain dead and the other had severe pulmonary co-morbidities. (that's a fancy way of saying bad COPD.) Wondering if you fabulous ICU RN's out there have any bright ideas about this poor man's chances? I'd like to see him make it. I really would.

He went for a trach and came back with a 6th pleuravac, draining the pericardium and two jp's, draining the puss around his treachea instead. Then I was off for a few days. There is a happy thank-you card from his family in the break room, so I'm assuming all went well.

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Specializes in ICU-my whole life!!.
I've had 8 chest tubes in one patient in the past.

Winner! :D:D:yeah::yeah: I think the most I've seen is 4-5 can't recall. But I had pt's with 8-12 wound vacs :eek:

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Specializes in PICU/Pedi.
I've had 8 chest tubes in one patient in the past.

I have spent the last year as a student tech in SI, and will start work there soon as a new grad RN. We see all kinds of trauma patients, heart op patients, etc. I have seen three or four chest tubes at one time in a person, but never seven or eight. I'm just curious - what could a person have going on with them to require that many tubes?

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Specializes in MICU/SICU PCU/Education/Transplant.

It depends on what the underlying issue is with the patients. I don't think that chest tubes dictate patient mortality. I know that when we use high frequency oscillatory ventilation patients end up with multiple chest tubes. I have recently seen a patient with 8 chest tubes. She lived and did well after about 4 months.

Nikkie

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I'm only a pre-medical student myself, but my mentor has seen someone with eight chest tubes recover with no lasting side effects.

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Specializes in ICU.

Chest tubes don't kill. :D

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Specializes in Emergency nursing, critical care nursing..

MY ICU unit had a guy with 5 chest tubes for recurring pneumo's and PNA. He did not make it. Got septic and died.

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Yeah, I had a pregnant ER nurse (26 weeks gestation) with H1N1 develop ARDS and MODS. She had 5 chest tubes. Thought at one point we'd lose both her and baby being she had no stable vital signs whatsoever and the fetus's doc discouraged paralytic use....she was ventilating poorly on PCAC mode with intrinsic RR's in the 60's, on pressors with sbp's in the 90's barely achieving a MAP of 60, HR 160's, fevers of 104+, SAO2's in the upper 80%'s. Different modes of ventilation and high dose multiple sedatives were utilized, but baby showed signs of distress with tachycardia also prompting a panel of experts to meet with hubby to discuss heroic efforts and who to save....it was one of the worst cases I ever dealt with, having to see her struggle as she did so unstable, having a panel of experts anxiously barking orders in a tug-of-war fashion at me to include the hospital legal dept and the CDC but not only did she survive (so did I! LOL), so did baby and when mama stabilized enough she underwent an elective c-section to deliver a strong baby girl (at 34 weeks gestation) who required min. supplemental o2 at birth. Both were discharged home just before christmas of that year. I believe in her case she had a strong will to live. Couple that with youth and the incredible power of protective pregnancy hormones and I was lucky to witness what I would classify as a miracle. I don't know how old your alcoholic pt is, but I've worked in the MICU for 11 years and can tell you that these marinated souls are hard to kill (so to speak). Generally speaking, they will die mostly only when their livers fail....otherwise, as our bluntest intensivist said it "you can't kill a cockroach". Good luck with your fellow....sounds like he could malinger in your ICU a long time.

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Specializes in ICU.

Seen multiple chest tubes, at one time seen four, but the patient had several more throughout his stay. Never give up hope, this guy had a flail chest like I have never seen, completely separated all the ribs from the left side of his sternum (no belt MVA steering wheel to chest). Followed him from ER to ICU. He was with us in ICU for 3 months, actually ran in to him later in a local daquiri bar. I had another patient that kept getting tension pneumothorax on me on nights, we put in three chest tubes emergent, he had the 20 cm of peep, back in the day. He walked back in about 6 months later late at night and said 'I was in that room over there and my lung kept dropping'. Do you know who the nurse was? I said "me and you look totally different". He was MVA with major facial reconstruction. Good to see those success stories. Makes it all worth it. Hope your guy makes it.

Be careful with the "death pools" bad karma there.

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