Ever seen a pt live after 5 chest tubes?

  1. 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.
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    About Darkfield

    Joined: Jul '10; Posts: 50; Likes: 49
    from NY , US
    Specialty: 4 year(s) of experience


  3. by   flo136
    Hi. I am betting he may make it, and have not seen 5 in at the same time but 4.
    But the ventilation issues are huge, an absolute nightmare to wrecked lungs.
    Some smart tricky ventilations modes and positions may just be what gets him through. I'd say its not over yet.
  4. by   detroitdano
    Most I've ever seen is 3, 2 on one side, 1 on the other. Guess my ICU is boring lol.
  5. by   meandragonbrett
    I've had 8 chest tubes in one patient in the past.
  6. by   GreyGull
    In the days of Super PEEP in the treatment of ARDS, we started with 2 on each side with 6 - 8 being the norm. Some patients lived.
  7. by   Penelope_Pitstop
    I've seen a patient with four chest tubes live. In fact, he didn't need to be moved to ICU or even stepdown...stayed on a regular floor the entire time.

    I can't for the life of me remember what caused his original ptx. I do know that it was the first time I ever saw subq emphysema, though.
  8. by   meandragonbrett
    Quote from GreyGull
    In the days of Super PEEP in the treatment of ARDS, we started with 2 on each side with 6 - 8 being the norm. Some patients lived.
    Hahahah. Some of us are still using Super PEEP. Some of my colleagues cannot believe my stories from my trauma hospital when it comes to vent management.
  9. by   MomRN0913
    I had a patient with 4 chest tubes. She just kept blowing up. Subq emphysema like I had never seen before. SO much to the fact that her boobs would blow up to DD's. If the suction stopped on the chest tube for 3 sec, she would blow up again it was something else. I grew to love this patient, intubated with 4 chest tubes she was funny as hell. grew close to her son who would find me wherever I was even if I wasn't taking care of her.

    She died of a mucous plug of all things. I was devastated. Not on my time.

    Has an alcoholic who aspirated while he was drinking beer and eating a bucket of fried chicken. he lived even after going through his bout of ARDS. Trached, but lived.
  10. by   umcRN
    no experience with what you're talking about but I have seen an 8lb newborn with 5 chest tubes and getting multiple needle aspirates for days on end for collapsed lungs make it, go home and visit us later looking wonderful
  11. by   flo136
    How is the patient going? Any updates on his condition?
  12. by   ghillbert
    Never saw a study showing that # chest tubes corresponds to survival... what and how much is being drained determines that, but it doesn't grade the severity of illness.
  13. by   sunnycalifRN
    We had a guy with 7 and he made it out of the hospital. He looked like a Borg!
  14. by   Darkfield
    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.