Chest Tube Management

Retained Blood Syndrome is a potentially serious complication following cardiac surgery, where blood is left behind in the chest cavity or heart, leading to symptoms and potential cardiac dysfunction. Maintaining chest tube patency following cardiac surgery is essential for effective postoperative care. It ensures proper drainage, prevents complications, and supports the patient's overall recovery by optimizing cardiac and respiratory function.

Retained Blood Syndrome (RBS) following cardiac surgery can occur when blood accumulates in the chest cavity after cardiac surgery. Maintaining chest tube patency following cardiac surgery is essential for effective postoperative care. It ensures proper drainage, prevents complications, and supports the patient's overall recovery by optimizing cardiac and respiratory function.

RBS can lead to various complications if not promptly diagnosed and managed. These complications can have a significant impact on the patient's health and recovery:

Hemodynamic Instability:

• The presence of retained blood can impede the heart's ability to pump effectively, leading to hemodynamic instability. This can result in low blood pressure, reduced cardiac output, and inadequate oxygen delivery to vital organs. Severe hemodynamic instability can be life-threatening.

Cardiac Tamponade:

• In cases where the accumulated blood compresses the heart chambers and limits their ability to fill properly, it can lead to cardiac tamponade. This condition involves increased pressure on the heart, which can impair its function. Cardiac tamponade is a medical emergency and requires immediate intervention, often involving the drainage of the accumulated blood from the pericardial sac.

Increased Risk of Infection:

• The presence of blood in the chest cavity or around the heart can provide an ideal environment for the growth of bacteria. This increases the risk of infection, which can lead to conditions like mediastinitis (infection of the mediastinum) or pleuritis (inflammation of the pleura, the membrane around the lungs).

Atrial Fibrillation:

• Retained blood causes an inflammatory cascade that can increase the risk of post-operative atrial fibrillation.

Prolonged Hospital Stay:

• Patients with RBS often require extended hospitalization to address the complications and monitor their recovery. Prolonged hospital stays can lead to increased healthcare costs and discomfort for the patient.

Additional Surgical Procedures:

• The treatment of RBS may require re-exploration surgery to remove the retained blood.

Read a recent review on modern chest tube management in JTCVS Open for more information.

____________________________________________________________________________________________________________________________

This summary was written with assistance from artificial intelligence. All text was reviewed, edited, and supplemented by the listed editor(s). Reference: OpenAI. (2023). ChatGPT (Sept 25 version) [Large language model]. https://chat.openai.com/chat

ERAS Cardiac VTC Disclaimer:

The VTC, and all included content, is intended to inform ERAS Cardiac Members in a multitude of topics related to enhanced recovery. The information included has been provided by other enhanced recovery experts and should be used for educational purposes only. It is not intended to describe, recommend, or suggest any specific medical practice or intervention, nor should it be considered as formal medical advice or consultation. The ERAS Cardiac Society cannot guarantee that the information on the VTC is accurate or complete in every respect. Therefore, ERAS Cardiac Society is not responsible for any errors or omissions in the content, or medical results that occur with the application of the information obtained while using the VTC. All healthcare professionals should continue to use sound clinical judgment and prescribe therapies based on the best medical knowledge at their disposal.

All the material presented on the VTC is the intellectual property of the ERAS Cardiac Society, its contributors, and its sponsors. Unless explicitly stated, the information, images, audio, video, and other content may not be reproduced (in whole or in part) in any way without the written permission of the ERAS Cardiac Society.

If you have any questions or comments about the ERAS Cardiac VTC, please email: VTC@erascardiac.org