Search

Background: Novice nurses often find endotracheal suctioning signs unfamiliar. The Endotracheal Suction Assessment Tool© (ESAT©) aids pediatric nurses in suctioning but lacks an adult equivalent. A valid and reliable ESAT© for assessing intensive care unit patients' suction needs across different populations is necessary., Aim: To test the validity and reliability of the ESAT© in adult ICU patients., Methods: This methodological study assessed suction needs in patients at a tertiary adult ICU of a university hospital. Two independent observers used the ESAT© to determine suction needs. Data from 106 suction procedures were collected using a patient characteristics form, the ESAT©, and a suction monitoring form. The ESAT© includes eight respiratory and ventilation parameters and seven clinical consideration parameters. Hemodynamic and respiratory parameters were measured before, and one and five minutes after suction. Linguistic validity, content validity, and pilot testing were conducted. Interobserver agreement was evaluated, and psychometric evaluation was done using content validity index (CVI) and intraclass correlation coefficient (ICC). Data were analyzed with paired samples t-test and ANOVA., Results: Item CVI ranged from 0.80 to 1.00, and scale CVI was 0.96. Inter-item correlation and ICC for inter-rater reliability were both 0.933 (95 % CI = 0.903-0.954, p < 0.001 for ICC). Cohen's Kappa coefficients ranged from 0.690 to 1.000 (p < 0.001), indicating high consistency between raters for all tool items. All scale items showed near-perfect agreement except SpO2, which showed substantial agreement., Conclusion: The S-CVI was good, indicating near-perfect agreement among raters. ESAT© is highly reliable and valid for determining suction needs in adult intensive care patients., Implications for Practice: The ESAT© aids autonomous decision-making for suctioning needs. Originally for novice pediatric nurses, the ESAT© was adapted for adult intensive care nurses. The ESAT© is valid and reliable for adult intensive care patients., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Objective: The objective of this study was to determine the incidence of endotracheal tube (ETT) suction-related adverse events (AEs) and to examine associations between AEs and patient and suction characteristics. Secondary objectives were to describe ETT suction practices in an Australian paediatric intensive care unit (PICU)., Methods: A prospective, observational study was undertaken in a mixed cardiac and general PICU. Children were eligible for inclusion if they were intubated and mechanically ventilated. Data on patient and suction variables (indication for ETT suction, number of suction episodes per mechanical ventilation episode, indication for normal saline instillation [NSI] and NSI dose) including potential predictive variables (age, Paediatric Index of Mortality 3 [PIM3], NSI, positive end-expiratory pressure, and hyperoxygenation) were collected. The main outcome variable was a composite measure of any AE., Main Results: A total of 955 suction episodes were recorded in 100 children. AEs occurred in 211 (22%) ETT suctions. Suction-related AEs were not associated with age, diagnostic category, or index of mortality score. Desaturation was the most common AE (180 suctions; 19%), with 69% of desaturation events requiring clinician intervention. Univariate logistic regression showed the odds of desaturation decreased as the internal diameter of the ETT increased (odds ratio [OR]: 0.59; 95% confidence interval [CI]: 0.37-0.95; p = 0.028). Multivariable modelling revealed NSI was significantly associated with an increased risk of desaturation (adjusted OR [aOR]: 3.23; 95% CI: 1.99-5.40; p < 0.001) and the occurrence of an AE (aOR: 2.76; 95% CI: 1.74-4.37; p < 0.001). Presuction increases in fraction of inspired oxygen (FiO 2 ) was significantly associated with an increased risk of experiencing an AE (aOR: 2.0; 95% CI: 1.27-3.15; p = 0.003)., Conclusions: ETT suction-related AEs are common and associated with NSI and the requirement for pre-suction increases in FiO 2 . Clinical trial data are needed to identify high-risk patient groups and to develop interventions which optimise practice and reduce the occurrence of ETT suction-related AEs., (Copyright © 2019 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. All rights reserved.)

Objectives: To evaluate the association of the Neonatal Resuscitation Program, Seventh Edition changes on term infants born with meconium-stained amniotic fluid (MSAF)., Study Design: We evaluated the effect of no longer routinely intubating nonvigorous term infants born with MSAF in 14 322 infants seen by the resuscitation team from January 1, 2014 to June 30, 2017 in a large, urban, academic hospital., Results: Delivery room intubations of term infants with MSAF fell from 19% to 3% after the change in guidelines ( P = <.0001). The rate of all other delivery room intubations also decreased by 3%. After the implementation of the Seventh Edition guidelines, 1-minute Apgar scores were significantly more likely to be >3 ( P = .009) and significantly less likely to be <7 ( P = .011). The need for continued respiratory support after the first day of life also decreased. Admission rates to the NICU, length of stay, and the need for respiratory support on admission were unchanged., Conclusions: Implementation of the Neonatal Resuscitation Program, Seventh Edition recommendations against routine suctioning nonvigorous infants born with MSAF was temporally associated with an improvement in 1-minute Apgar scores and decreased the need for respiratory support after the first day of life. There was also a significant decrease in total intubations performed in the delivery room. This has long-term implications on intubation experience among frontline providers., Competing Interests: POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose., (Copyright © 2020 by the American Academy of Pediatrics.)

Background: Postpartum mothers express and store breast milk using a hospital-grade pump and manufacturer-specific kit (flanges, bottles, tubing, valves, and membranes). After hospital discharge, mothers may attempt to interchange kits from different manufacturers. The objective of this study is to determine whether pump performance is affected by the use of a different manufacturer's kit. Materials and Methods: Suction pressure was tested using kits and six pumps from three manufacturers (Ameda, Medela, and Spectra). Pump settings (speed and vacuum strength) simulated maximum, minimum, and commonly used median settings. Suction pressure (mmHg) was measured using an analog gauge and repeated six times for each pump-kit combination. Measurements were compared using repeated measures analysis of covariance (ANCOVA) to determine whether kit was an independent predictor of suction pressure. Results: The kit type was a significant independent predictor ( p  < 0.05) of suction pressure for all at medium vacuum strength and many at maximum and minimum vacuum strengths. Upon further analysis interchanging kits resulted in both significantly increased and decreased suction pressures compared to the manufacturer-specific kit. Conclusion: Breast pump kits generate variable suction pressures when interchanged between pumps from different manufacturers. Interchanging combinations of kits and breast pumps could potentially lead to low milk expression due to ineffective suction pressure or increased discomfort from excessive pressure. The results of this study emphasize the importance of maternal education regarding the use of manufacturer-specific kits and breast pumps.

Airway suctioning is an important health care intervention that can be associated with serious adverse effects. Given the risks involved with suctioning, it is important to ensure the clinical competence of health care professionals who perform it. A scoping review was conducted to identify the nature and extent of research related to the assessment of airway-suctioning competence for health care professionals working with adults. This included an examination of the assessment context, the type of suctioning and health care professionals being assessed, and the methods used to assess competence. Four scientific electronic databases (MEDLINE, EMBASE, CINAHL, and the Cochrane Library) were searched from inception to March 9, 2018. A gray literature search was also performed. Two reviewers independently screened articles and resources for inclusion, and data were extracted using a form created by the authors. Seventy full text articles and resources were screened for eligibility, with 36 included in the review. Endotracheal suctioning was the most common type, and intensive or critical care units were the primary setting of interest (28 of 36, 78%). Competence or a component of competence for nurses, nursing students, nursing assistants, or nurse technicians was specifically addressed in 97% (35 of 36) of the included articles and resources; 4 of 36 (11%) also included physical therapists, 1 of 36 (3%) included respiratory therapists, and 1 of 36 (3%) was aimed toward all clinicians who perform suctioning. Nine (25%) used questionnaire-based assessments, 11 (31%) used checklists, audit forms, or other observational tools, and 16 (44%) used both. Directed content analysis revealed 3 major themes: consistency across overarching evaluation frameworks, inconsistency across detailed components, and inconsistency in the evaluation or reporting of assessment tool measurement properties. Additional gaps in the literature included limited consideration of health care professionals beyond nursing, limited consideration of settings beyond intensive and critical care, a lack of tools to assess nasotracheal and orotracheal suctioning, and limited detail regarding assessment tool development., (Copyright © 2019 by Daedalus Enterprises.)

Background: In 2015, the Neonatal Resuscitation Program (NRP) guidelines were updated to recommend that nonvigorous infants delivered through meconium-stained amniotic fluid (MSAF) do not require routine intubation and tracheal suction., Objective: Explore the implications of 2015 NRP guidelines on delivery room management and outcome of infants born through MSAF., Design: Retrospective cohort study., Settings: King Abdul-Aziz University Hospital (KAUH)., Patients and Methods: All term ( greater than or equal 37 weeks) infants born in KAUH through MSAF between January 1, 2016, and December 31, 2017, were included. Patients were divided into two groups according to the date of birth: period 1 (January 1, 2016, to December 31, 2016), before the implementation of the new NRP guidelines; period 2 (January 1, 2017, to December 31, 2017), after the implementation., Main Outcome Measures: Outcomes of infants born through MSAF., Sample Size: 420 infants., Results: A majority of infants (n=261) were born in period 1 and 159 after in period 2. No differences were found in the booking status of mothers, cesarean section rate, and number of deliveries attended by physicians between the 2 cohorts. Infants in both cohorts were of similar gestational age, birth weight, and gender. A nonsignificant lower rate of intubation at birth (2.3% vs 0.6%), admission to neonatal intensive care unit (3.8% vs 3.1%), and meconium aspiration syndrome (1.5% vs 0.6%) were found in period 2 compared with period 1. Only 1 infant died in period 1., Conclusion: After the implementation of 2015 NRP guidelines, fewer infants were intubated at birth for MSAF. No difference was observed in the rate of associated morbidities and mortality., Limitations: A single-center retrospective study of misclassification bias because some of the medical staff started practicing the new guidelines before the official implementation., Conflict of Interest: None.

Importance: Mucus plugging after tracheostomy is a preventable cause of respiratory distress. Implementation of standardized tracheostomy care guidelines may reduce the occurrence of fatal respiratory compromise., Objective: To determine the effect of implementing and reinforcing a standardized tracheostomy care protocol on the occurrence of acute life-threatening respiratory events., Design, Setting, and Participants: Retrospective cohort study of adult patients who received a tracheostomy between May 2014 and August 2016 at a tertiary care center., Main Outcomes and Measures: Patient demographics, tracheostomy indication, rapid response for mucus plugging and other acute events, duration of hospital stay, and levels of care that the patients received were recorded through examination of clinical logs. Statistical analysis was conducted between patients before protocol implementation and patients after protocol implementation in terms of rapid-response use, and intragroup comparison of the mean length of stay in various hospital units was also analyzed., Results: A total of 247 patients (89 women [36%]; mean [SD] age, 58.5 [12.3] years), 117 preprotocol and 130 postprotocol, met inclusion criteria. Of the 130 patients in the postprotocol cohort, 123 (93%) were on the new tracheostomy care protocol. Preprotocol rapid-response rate was 21 of 117 patients (17.9%) and postprotocol response rate was 12 of 130 patients (9.2%) for a difference of 8.7% (95% CI, 0.2%-18.0%). In terms of mucus plugging, preprotocol rate was 8 of 117 patients (6.8%) and the postprotocol rate was 1 of 130 patients (0.8%) for a difference of 6.0% (95% CI, 1.3%-12.2%). Intragroup difference of the mean time spent (days) in various care units between patients in the no rapid-response group vs rapid-response group demonstrated clinically meaningful longer stay for rapid responses in both preprotocol and postprotocol groups for the intensive care unit (preprotocol, 2.03; 95% CI, 1.03-3.03 vs postprotocol, 3.02; 95% CI, 1.49-4.45) and step down units (preprotocol, 1.40; 95% CI, 0.77-2.02 vs postprotocol, 2.11; 95% CI, 0.78 to 3.44)., Conclusions and Relevance: Implementation and reinforcement of a standardized tracheostomy care protocol was associated with a reduction in the occurrences of rapid-response calls for life-threatening mucus plugging and is recommended for clinical practice. In addition, length of stay in the intensive care unit and intermediate surgical care unit was increased in a clinically meaningful way for patients who experienced a rapid-response event.

Aims and Objectives: To establish criterion-related construct validity and test-retest reliability for the Endotracheal Suction Assessment Tool© (ESAT©)., Background: Endotracheal tube suction performed in children can significantly affect clinical stability. Previously identified clinical indicators for endotracheal tube suction were used as criteria when designing the ESAT©. Content validity was reported previously. The final stages of psychometric testing are presented., Design: Observational testing was used to measure construct validity and determine whether the ESAT© could guide "inexperienced" paediatric intensive care nurses' decision-making regarding endotracheal tube suction. Test-retest reliability of the ESAT© was performed at two time points., Methods: The researchers and paediatric intensive care nurse "experts" developed 10 hypothetical clinical scenarios with predetermined endotracheal tube suction outcomes. "Experienced" (n = 12) and "inexperienced" (n = 14) paediatric intensive care nurses were presented with the scenarios and the ESAT© guiding decision-making about whether to perform endotracheal tube suction for each scenario. Outcomes were compared with those predetermined by the "experts" (n = 9). Test-retest reliability of the ESAT© was measured at two consecutive time points (4 weeks apart) with "experienced" and "inexperienced" paediatric intensive care nurses using the same scenarios and tool to guide decision-making., Results: No differences were observed between endotracheal tube suction decisions made by "experts" (n = 9), "inexperienced" (n = 14) and "experienced" (n = 12) nurses confirming the tool's construct validity. No differences were observed between groups for endotracheal tube suction decisions at T1 and T2., Conclusion: Criterion-related construct validity and test-retest reliability of the ESAT© were demonstrated. Further testing is recommended to confirm reliability in the clinical setting with the "inexperienced" nurse to guide decision-making related to endotracheal tube suction., Relevance to Clinical Practice: The ESAT© is the first validated tool to systematically guide endotracheal nursing practice for the "inexperienced" nurse., (© 2018 John Wiley & Sons Ltd.)

Objective: The purpose of this study was to evaluate the effect of late applied negative pressure on postoperative drain output after primary total hip arthroplasty (THA)., Patients and Methods: 100 patients (100 hips) were treated by closed suction drainage applying negative pressure immediately after THA (group I). The remaining 100 patients (100 hips) were treated by the same drainage system, but the negative pressure was not applied in the first 24 h after THA and then negative pressure was applied (group II)., Results: The mean total drain output was different between the two groups (group I: 597 ± 200.1 mL, group II: 403 ± 204.1 mL; p < 0.05). Reported drain output from immediate postoperative to postoperative day one was 369 ± 125.5 ml in group I and 221 ± 141.3 ml in group II (p < 0.05). The change of hemoglobin from immediate postoperative to 24 h after THA was lower in group II (group I: 1.5 ± 0.62 g/dL, group II: 1.1 ± 0.73 g/dL; p = 0.004). The mean unit number of blood transfusions was 1.0 (range, 0.0-5.0) in group I and 0.3 (range, 0.0-2.0) in group II (p < 0.05). There was no difference in Harris hip score between the two groups at postoperative 1 year or last follow-up (p = 0.073)., Conclusion: The minor change in drain system management can reduce postoperative blood loss after primary THA and the need for transfusion., Level of Evidence: Level III, Therapeutic study., (Copyright © 2017 Turkish Association of Orthopaedics and Traumatology. Production and hosting by Elsevier B.V. All rights reserved.)

Objectives: This study was conducted to determine intensive care nurses' knowledge and practice levels regarding open system endotracheal suctioning and to investigate if there is a relationship between nurses' demographic characteristics and their knowledge and practice., Research Methodology/design: The study was conducted as a cross-sectional and non-participant structured observational design. Data were collected using a 45-item structured and self-administered questionnaire and a 31-item observational checklist. The study sample included 72 nurses., Setting: Three adult intensive care units in a teaching hospital., Results: The nurses' mean scores of knowledge and practice were 23.79±3.83 and 12.88±2.53. Their level of knowledge was very good in 59.7%, good in 34.7%, and the level of practice was fair in 79.2% and good in 18.1%. The relationship between the type of unit and the nurses' knowledge scores was statistically significant (p=0.013). The correlation between the nurses' scores of knowledge and practice was not statistically significant (r=0.220; p=0.063)., Conclusion: This study suggests that the knowledge level of most of the nurses was good and their practice level was fair. Intensive care nurses must perform suctioning procedures safely and effectively to ensure delivery of quality of care and eliminate complications., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Background: It has been suggested that an adult 8.0 endotracheal tube (ETT) connected to a neonatal meconium aspirator would improve suctioning during emergent endotracheal intubation compared to the Yankauer suction instrument, the standard tool used by emergency physicians., Objectives: This study was designed to compare the effectiveness of a Yankauer vs. an ETT-meconium aspirator set-up in suctioning liquids of different viscosities., Methods: The Yankauer and ETT-meconium aspirator device underwent a head-to-head timed comparison, suctioning 250 mL of three different fluids, varying in viscosity. The first comparison test used tap water to represent simple oral secretions. The second comparison test used porcine whole blood as a proxy for human blood. The third comparison test used a coarsely blended mixture of a hamburger, French fries, and a soda to simulate emesis from a recently ingested meal. Five separate time trials were conducted for each liquid and for each suction device., Results: The ETT-meconium aspirator device compared to the Yankauer suctioned faster in both the water comparison test (mean = 2.6 s vs. 3.4 s; p < 0.001) and the porcine whole blood comparison test (mean = 2.9 s vs. 4.3 s; p = 0.0015). In the emesis trial, the Yankauer immediately clogged, whereas the ETT-meconium aspirator apparatus managed to suction an average of 90 mL prior to clogging., Conclusion: Compared to the Yankauer, an adult 8.0 ETT connected to a meconium aspirator was superior in suctioning liquids of varying viscosities and should be considered when encountering a difficult airway due to copious secretions, blood, or emesis., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Recent advances in percutaneous coronary intervention and antiplatelet therapy as well as faster door-to-balloon times have markedly improved the therapy of patients with acute myocardial infarction. However, impaired myocardial perfusion despite revascularization of the infarcted vessel remains an ongoing problem with high prognostic relevance. In initial clinical trials thrombus aspiration in addition to conventional percutaneous coronary intervention demonstrated benefits regarding coronary flow and myocardial perfusion and was therefore recommended in practice guidelines. These improvements in surrogate endpoints did not translate into a favorable clinical outcome in recent large-scale multicenter randomized trials investigating the routine use of thrombus aspiration in patients with acute myocardial infarction. Furthermore, an increased risk of stroke after thrombus aspiration raises safety concerns. Therefore, thrombus aspiration has been downgraded in the recent guideline updates. The current article reviews the evidence from clinical trials and the recommendations in practice guidelines regarding thrombus aspiration in acute myocardial infarction.

Background: Ventilator-associated pneumonia (VAP) in neonates can be reduced by implementing preventive care practices. Implementation of a group, or bundle, of evidence-based practices that improve processes of care has been shown to be cost-effective and to have better outcomes than implementation of individual single practices., Purpose: The purpose of this article is to describe a safe, effective, and efficient neonatal VAP prevention protocol developed for caregivers in the neonatal intensive care unit (NICU). Improved understanding of VAP causes, effects of care practices, and rationale for interventions can help reduce VAP risk to neonatal patients., Method: In order to improve care practices to affect VAP rates, initial and annual education occurred on improved protocol components after surveying staff practices and auditing documentation compliance., Findings/results: In 2009, a tertiary care level III NICU in the Midwestern United States had 14 VAP cases. Lacking evidence-based VAP prevention practices for neonates, effective adult strategies were modified to meet the complex needs of the ventilated neonate. A protocol was developed over time and resulted in an annual decrease in VAP until rates were zero for 20 consecutive months from October 2012 to May 2014., Implications for Practice: This article describes a VAP prevention protocol developed to address care practices surrounding hand hygiene, intubation, feeding, suctioning, positioning, oral care, and respiratory equipment in the NICU., Implications for Research: Implementation of this VAP prevention protocol in other facilities with appropriate monitoring and tracking would provide broader support for standardization of care. Individual components of this VAP protocol could be studied to strengthen the inclusion of each; however, bundled interventions are often considered stronger when implemented as a whole.

Rationale and key points Tracheal suction involves the removal of pulmonary secretions from the respiratory tract using negative pressure under sterile conditions. Practitioners should be aware of the indications for, and risks associated with, open tracheal suction via an endotracheal tube. ▶ Respiratory assessment of the patient should be carried out to identify when tracheal suction is required. ▶ A suction pressure of 80-120mmHg is recommended, and suction should last no longer than 15 seconds. ▶ Reassurance and support should be given to the patient to minimise any discomfort and distress that might result from tracheal suction. Reflective activity Clinical skills articles can help update your practice and ensure it remains evidence-based. Apply this article to your practice. Reflect on and write a short account of: 1. How you think this article will change your practice when performing open tracheal suction via an endotracheal tube. 2. How you could use this resource to educate your colleagues. Subscribers can upload their reflective accounts at: rcni.com/portfolio .

Evidence-based practices search for the best available scientific evidence to support problem solving and decision making. Because of the complexity and amount of information related to health care, the results of methodologically sound scientific papers must be integrated by performing literature reviews. Although endotracheal suctioning is the most frequently performed invasive procedure in intubated newborns in neonatal intensive care units, few Brazilian studies of good methodological quality have examined this practice, and a national consensus or standardization of this technique is lacking. Therefore, the purpose of this study was to review secondary studies on the subject to establish recommendations for endotracheal suctioning in intubated newborns and promote the adoption of best-practice concepts when conducting this procedure. An integrative literature review was performed, and the recommendations of this study are to only perform endotracheal suctioning in newborns when there are signs of tracheal secretions and to avoid routinely performing the procedure. In addition, endotracheal suctioning should be conducted by at least two people, the suctioning time should be less than 15 seconds, the negative suction pressure should be below 100 mmHg, and hyperoxygenation should not be used on a routine basis. If indicated, oxygenation is recommended with an inspired oxygen fraction value that is 10 to 20% greater than the value of the previous fraction, and it should be performed 30 to 60 seconds before, during and 1 minute after the procedure. Saline instillation should not be performed routinely, and the standards for invasive procedures must be respected.

The routine aspiration of gastric residuals (GR) is considered standard care for critically ill infants in the neonatal intensive care unit (NICU). Unfortunately, scant information exists regarding the risks and benefits associated with this common procedure. This article provides the state of the science regarding what is known about the routine aspiration and evaluation of GRs in the NICU focusing on the following issues: (1) the use of GRs for verification of feeding tube placement, (2) GRs as an indicator of gastric contents, (3) GRs as an indicator of feeding intolerance or necrotizing enterocolitis, (4) the association between GR volume and ventilator-associated pneumonia, (5) whether GRs should be discarded or refed, (6) the definition of an abnormal GR, and (7) the potential risks associated with aspiration and evaluation of GRs. Recommendations for further research and practice guidelines are also provided.

Nurses at a pediatric hospital identified the liberal utilization of deep nasopharyngeal (NP) suction as the primary airway clearance modality in young children with bronchiolitis. This invasive practice lacked supporting evidence and a standardized approach. Nurses created an interdisciplinary team to develop a less invasive airway clearance protocol. Data from 2years, both pre and post protocol implementation, were analyzed. An 11% decrease in deep NP suctioning resulted in improved or unchanged balancing measures and perceptions of quality of care., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Background: Accurately diagnosing and treating childhood hip sepsis is challenging. Adjacent bone and soft-tissue infections are common and can lead to delayed and inappropriate treatment. This study evaluated the effect of early advanced imaging (bone scan, magnetic resonance imaging) in the management of suspected hip sepsis., Methods: A retrospective review of pediatric patients admitted between 2003 and 2009 with suspected hip sepsis was performed. Patients were classified into 2 categories: group I-immediate hip aspiration or group II-advanced imaging performed before intervention., Results: In total, 130 patients (53 in group I and 77 in group II) were included. No significant differences were found between the groups with regard to laboratory values, temperature, number of anesthetics, and length of hospital stay. However, patients in group I were younger than in group II (5.4 vs. 7.3 y, P=0.02) and more patients in group I were unable to bear weight on the affected limb compared with group II (83% vs. 61%, P=0.009). In group I, 36 patients (68%) had a septic hip compared with 35 patients (45%) in group II. In group I, 16 patients (30%) required reoperation versus 13 (17%) patients in group II. Results from the multivariate analysis demonstrated that reoperation was required 2.8 times (95% confidence interval, 1.12-6.78) more often in group I as compared with group II (P=0.03)., Conclusions: Advanced imaging performed before hip aspiration improves diagnostic efficacy and may decrease the need for reoperation., Level of Evidence: III.

Background: The Penumbra system uses a coaxial separator and continuous extracorporeal suction to remove a clot from a cerebral artery. Forced-suction thrombectomy (FST) involves aspirating clots through the same reperfusion catheter using only a syringe, decreasing the procedure time and supplies needed., Objective: To evaluate multiple combinations of catheters and syringes to determine the optimal pairing for use in FST., Methods: Tests were performed using both the Penumbra system and syringes to aspirate water through Penumbra 0.041 inch (041), 4Max, 0.054 inch (054) and 5Max reperfusion catheters and a shuttle sheath. Dynamic pressure and flow at the catheter tip were calculated from the fill times for each system. Static pressure and force for each aspiration source were determined with a vacuum gauge., Results: All syringes provided significantly higher dynamic pressure at the catheter tip than the Penumbra system (p<0.001). Increasing syringe volume significantly increased static pressure (p<0.001). Both flow and aspiration force significantly increased with catheter size (p<0.001). Cases are presented to demonstrate the clinical value of the laboratory principles., Conclusions: Maximizing static and dynamic pressure when performing FST is achieved by aspirating with a syringe possessing both the largest volume and the largest inlet diameter available. Maximizing aspiration force and flow rate is achieved by using the largest catheter possible.

Background: Little is known about the incidence of and risk factors for adverse effects from endotracheal suctioning. We studied the incidence and risk factors, and evaluated the effect of suctioning practice guidelines., Methods: During a 3-month period, in 79 mechanically ventilated subjects, we recorded the adverse effects in 4,506 suctioning procedures. Then practice guidelines were implemented, and 1 year later, during another 3-month period, in 68 subjects, we recorded the adverse effects in 4,994 suctioning procedures., Results: In the first period, adverse effects occurred frequently: oxygen desaturation in 46.8% of subjects and 6.5% of suctionings, hemorrhagic secretions in 31.6% of subjects and 4% of suctionings, blood pressure change in 24.1% of subjects and 1.6% of suctionings, and heart rate change in 10.1% of subjects and 1.1% of suctionings. After guidelines implementation, all complications, both separately and all together, were reduced. The incidence of all complications together decreased from 59.5% to 42.6% of subjects, and from 12.4% to 4.9% of procedures (both P < .05). PEEP > 5 cm H2O was an independent risk factor for oxygen desaturation. Receiving > 6 suctionings per day was a risk factor for desaturation and hemorrhagic secretions. The use of guidelines was independently associated with fewer complications., Conclusions: Endotracheal suctioning frequently induces adverse effects. Technique, suctioning frequency, and higher PEEP are risk factors for complications. Their incidence can be reduced by the implementation of suctioning guidelines.

Background: Protection of distal embolization by balloon occlusion and thrombus aspiration has not improved microvascular circulation nor decreased myocardial injury during primary percutaneous intervention (PCI) for ST-elevation myocardial infarction (STEMI) in randomized trials. In a prospective randomized trial, we investigated the mechanism of the poor effect of distal protection and thrombus aspiration (DP-TA) in 126 patients with STEMI., Methods: Patients with first-diagnosed STEMI were randomly assigned to DP-TA pretreatment or conventional PCI (c-PCI). Primary endpoint was reduced left ventricular end-diastolic volume (LVEDV) measured by MRI at post-PCI and 6 months after PCI. Secondary end points were infarct ratio (infarct size to entire LV size) by delayed enhancement (DE), area at risk (AAR) ratio (AAR to entire LV size) by T2 high signal, microvascular occlusion index (MVO) ratio (MVO to entire LV size) by DE, and myocardial salvage index (MSI: (AAR--infarct size)*100/AAR) using cardiac magnetic resonance imaging (MRI) within 3 days after PCI., Results: Baseline characteristics of the patients including cardiovascular risk factors and lesion characteristics were similar between the two groups. DT-PA failed to improve LV remodeling at 6 months (LVEDV 140 ± 39 vs 133 ± 37 in c-PCI group, p=0.418). Infarct ratio, AAR ratio and MSI were not statistically different between DP-TA group and c-PCI group. However, MVO ratio was significantly larger in DP-TA group than in c-PCI group (2.4 ± 2.7 vs 1.1 ± 1.9, p=0.045)., Conclusion: DP-TA was potentially hazardous in primary PCI for STEMI by increasing MVO. DP-TA should not be used in STEMI., (Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.)

Background: There has been a major evolution in laryngeal surgery, largely due to an improved understanding of disease pathogenesis and advances in technology, especially the introduction of lasers., Method and Results: Continuous laser plume evacuation during endolaryngeal surgery improves visualisation of the surgical field. Hence, microlaryngoscopes are fitted with smoke evacuation channels on their sides. We have devised a new, simple and efficient suction holder clip for endolaryngeal surgery that has distinct advantages over other suction holders.

Blood donation is an essential step in transfusion medicine that must take into account the donor's welfare, collection effectiveness, and blood product quality. This prospective study enrolled 13 canine blood donors, each subjected to both gravity and suction collection methods, in a randomized order. Clinical parameters, including heart rate (HR), respiratory rate (RR), systolic blood pressure (SBP), and rectal temperature (RT), were evaluated at four time points, including when the donor was on the floor and on the collection table, and before and after blood donation. The number of times the donor and needle required repositioning, the duration of the donation, the noise created by the apparatus, and the presence of a hematoma were evaluated. The weight, index of hemolysis, and hematocrit of each unit of blood were recorded. There was no significant difference between collection methods for either the clinical parameters at each time point or the prevalence of hematoma formation, the frequency of needle repositioning, the hemolysis index, or hematocrit. Collection by suction was noisier (P < 0.0001), faster (P = 0.004), and associated with significantly less donor repositioning (P = 0.007). Suction appears to be a safe and cost-effective method that should be considered to optimize blood donation.

Objective: To evaluate the effectiveness of an educational intervention on healthcare professionals' adherence to the technical recommendations for tracheobronchial aspiration in intensive care unit patients., Methods: A quasi-experimental study was performed to evaluate intensive care unit professionals' adherence to the tracheobronchial aspiration technical recommendations in intensive care unit patients both before and after a theoretical and practical educational intervention. Comparisons were performed using the chi-square test, and the significance level was set to p<0.05., Results: A total of 124 procedures, pre- and post-intervention, were observed. Increased adherence was observed in the following actions: the use of personal protective equipment (p=0.01); precaution when opening the catheter package (p<0.001); the use of a sterile glove on the dominant hand to remove the catheter (p=0.003); the contact of the sterile glove with the catheter only (p<0.001); the execution of circular movements during the catheter removal (p<0.001); wrapping the catheter in the sterile glove at the end of the procedure (p=0.003); the use of distilled water, opened at the start of the procedure, to wash the connection latex (p=0.002); the disposal of the leftover distilled water at the end of the procedure (p<0.001); and the performance of the aspiration technique procedures (p<0.001)., Conclusion: There was a low adherence by health professionals to the preventive measures against hospital infection, indicating the need to implement educational strategies. The educational intervention used was shown to be effective in increasing adherence to the technical recommendations for tracheobronchial aspiration.

The primary objective of this study was to evaluate the safety of early warfarin resumption following burr hole drainage for warfarin-associated subdural hemorrhage (SDH). This prospective, single-arm, single-center trial was conducted from February 2008 to April 2010. Inclusion criteria were premorbid warfarin therapy, subacute or chronic SDH requiring burr hole drainage, and an International Normalized Ratio (INR) of >1.5 at presentation. Three days after surgery, warfarin was re-administered to reach the target INR range of 1.7-2.5. Patients were followed by regular INR monitoring and serial brain CT scans, which were performed at 1 week, and at 1, 3, and 6 months after surgery. The primary outcome was recurrent SDH incidence. Twenty patients were enrolled and CT scans performed at 1 week revealed no new intracranial hemorrhage in any patient. Subsequent scans were performed at 1 month on 19 patients, and recurrent SDH was observed in three. However, this recurrence rate (15.8%; 95% CI 0,34) did not exceed that of ordinary SDHs, and all recurrent SDHs were successfully managed by repeated burr hole drainage. The other 16 patients completed their 6-month follow-ups uneventfully. SDH recurrence was found to be associated with older age (≥ 75 years), and a thicker SDH (≥ 25 mm), but not with post-operative anticoagulation status. None of the study subjects experienced a thromboembolic event during the study period. Restarting warfarin therapy does not need to be withheld for more than 3 days after burr hole drainage, particularly in patients with a high thromboembolic risk.

Objective: The literature regarding surgical treatment of brain abscess was reviewed from 1990 to (and including) 2008 to supplement a previous literature review from 1930 to 1990., Methods: The Ovid Medline database 1950-2009 with the year range limited to 1990-2009 was used to identify all articles relating to brain abscess. The results were compared with a previously published review from 1930-1990 by the senior author., Results: The original finding was confirmed that the high mortality from aspiration in the pre-computer tomography era decreased dramatically after computer tomographic scanning became available. In the present review, the mean mortality for aspiration post-1990 was 6.6% for publications with more than five patients. With surgical excision by craniotomy, the mean mortality in the same period was 12.7%., Conclusions: The present review suggests that aspiration may be the first surgical choice in patients with supratentorial parenchymal brain abscesses., (Copyright © 2011 Elsevier Inc. All rights reserved.)

Traditionally, patients with symptomatic sterile pancreatic necrosis or infected necrosis have been managed by open surgical debridement and removal of necrotic tissue. Within the last decade, however, reports of endoscopic pancreatic necrosectomy, an alternative minimally invasive approach, have demonstrated high success rates and low mortality rates. This report describes the indications, technique, and study outcome data of the procedure. While our experience with this technique has recently increased, better selection criteria are needed to identify patients who are most suitable for endoscopic therapy.

This four-phase mixed method study developed an evidence based "Endotracheal Suction Assessment Tool" (ESAT) as a guide for nurses undertaking "endotracheal tube" (ETT) suction within "Paediatric Intensive Care" (PIC). Phase 1 involved a comprehensive literature review to determine the most commonly used criteria for assessing the need for ETT suction. In Phase 2 an "Endotracheal Suction Questionnaire" (ESQ) was developed to survey experienced PIC nurses in Australia and New Zealand regarding their ETT suction decision making process and validity testing of the ESQ. In Phase 3, the ESQ was administered to target group (n=104). In Phase 4, the empirical evidence generated from this study, based upon the criteria rated by nurses in this study as being most clinically important and essential during the decision making process, determined the ESAT design. Analyses of quantitative results showed a positive correlation between the perceived frequency of use of a criterion and the appropriateness of the assessment. Where a criterion was used less frequently as a clinical indicator for the requirement for ETT suction, participants had a lower regard for this when rating the criterion as a specific single indicator to perform suction. Findings from qualitative data identified six criteria not previously documented within the literature. Further testing and validation of the tool within the PIC setting will determine the clinical viability of the ESAT., (Crown Copyright © 2011. Published by Elsevier Ltd. All rights reserved.)

Background: Lipoplasty and its associated complications are well researched and documented. In most articles, the focus has been on the major life-threatening complications of liposuction. Most of these major complications are related to conditions other than surgical trauma per se, namely anaesthesia, hypothermia, long duration of surgery and fluid overload. With the exception of pneumothorax and abdominal perforation, surgical trauma does not cause major complications. Although most surgical complications are classified as minor, they present as major events for patients and the treating physician. All efforts to prevent even minor complications to enhance patient satisfaction are needed. This article presents a review of only the surgical-trauma-related complications of lipoplasty and discusses their management and preventive strategy., Methods: A review of 200 consecutive cases of lipoplasty, performed between July 2006 and December 2007, including large-volume liposuctions (LVLs) and combined liposuction abdominoplasties, was undertaken. Complications relating only to the surgical trauma of liposuction were analysed., Results: Complications such as hyperpigmentation of access points, postoperative fluid collection, asymmetry, irregularity, external genital swelling and haematoma were noted. Postoperative fluid collection and haematoma required active intervention. Drainage of fluid collection using a liposuction cannula was effective and prevented recurrence and the need for repeated aspirations. Major surgical complications such as pneumothorax and abdominal wall perforations could be avoided by following simple rules., Conclusions: Major complications related to surgery can be avoided by following well-known safety guidelines. To enhance patient satisfaction, minor complications related to surgical trauma need to be addressed aggressively. This article discusses methods to lower the incidence of most surgical complications., (Copyright 2009 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.)

An electronic literature search for articles published between January 1990 and October 2009 was conducted by using MEDLINE, CINAHL, and Cochrane Library databases. The update of this clinical practice guideline is the result of reviewing a total of 114 clinical trials, 62 reviews and 6 meta-analyses on endotracheal suctioning. The following recommendations are made following the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) criteria: (1) It is recommended that endotracheal suctioning should be performed only when secretions are present, and not routinely; (2) It is suggested that pre-oxygenation be considered if the patient has a clinically important reduction in oxygen saturation with suctioning; (3) Performing suctioning without disconnecting the patient from the ventilator is suggested; (4) Use of shallow suction is suggested instead of deep suction, based on evidence from infant and pediatric studies; (5) It is suggested that routine use of normal saline instillation prior to endotracheal suction should not be performed; (6) The use of closed suction is suggested for adults with high F(I)O2, or PEEP, or at risk for lung de-recruitment, and for neonates; (7) Endotracheal suctioning without disconnection (closed system) is suggested in neonates; (8) Avoidance of disconnection and use of lung recruitment maneuvers are suggested if suctioning-induced lung de-recruitment occurs in patients with ; (9) It is suggested that a suction catheter is used that occludes less than 50% the lumen of the endotracheal tube in children and adults, and less than 70% in infants; (10) It is suggested that the duration of the suctioning event be limited to less than 15 seconds.

Background: Not all closed drainage suction bulbs are equivalent, and there may be a discrepancy between purported and observed clinical efficacy. We evaluated four popular bulb suction apparati to directly compare their maximum attainable suction, maximum volume collected, and negative pressure maintained relative to volume collected., Methods: Employing a developed-calibrated digital collection system, the relative function of the Surgidyne 100cc (SD100), Jackson-Pratt 100cc (JP100), Jackson-Pratt 400cc (JP400), and HemoVac 400cc (HV400) drains were compared. For these analyses, three separate drains of each type (JP100 utilized 6 drains) were tested in triplicate (alpha =0.05)., Results: The SD100 bulbs achieved the greatest negative pressure (-167.4 mmHg) while the HV400s the least (-80.5mm Hg). Only the SD100s pulled at or above purported volume. All other types obtained volumes significantly less than their described volumes: for each bulb type, the obtained volumes were statistically different. Of note, 66.7% (4 of 6) of JP100 bulbs collected only half the purported volume., Conclusions: The use of the SD100 bulb demonstrated superior maximum attainable suction, maintained suction to a higher volume; they were the only bulbs tested that collected volumes at or above those purported. The HV400 bulbs demonstrated the lowest suction and volume collected. Nevertheless, when used clinically, all such drain bulbs must be emptied long before achieving maximum volume to maintain reliable suction.

The endotracheal tube (ETT) is the most common artificial airway used in NICUs. Suctioning of the ETT is imperative to maintain patency and prevent complications. An extensive review of the literature revealed a lack of standardized criteria or guidelines for suctioning the ETT of neonates and infants in the NICU. The purpose of this article is to report the implementation of an evidence-based guideline that can be utilized in NICU care.

Aim: This paper is a report of a study to determine whether individualized performance feedback improved nurses' and physiotherapists' knowledge and practice of tracheal suctioning., Background: Nurses' knowledge and practice of tracheal suctioning is often deficient. Whilst teaching has been shown to improve suctioning knowledge and practice, this is not sustained over time., Method: Ninety-five qualified healthcare professionals (nurses and physiotherapists) in two acute hospitals were randomly allocated to receive either individualized performance feedback or no additional feedback after a standardized lecture and practical demonstration of tracheal suctioning. Randomization was stratified by profession, seniority and site. Data were collected in 2005 in a clinical setting involving patients and a simulation setting. The outcome measures were knowledge and practice of tracheal suctioning, assessed by self-completion questionnaire and structured observation., Results: In both settings, intervention groups performed statistically significantly better in terms of knowledge (P = 0.014) and practice (P = 0.037) at final follow-up. Those who received performance feedback had statistically significantly higher knowledge (P = 0.004) and practice (P < 0.01) scores than the control group. For practice, there was also a relationship between professions (P < 0.01), with physiotherapists performing better than nurses overall, and an interaction between group and setting (P < 0.01), with performance feedback showing a stronger positive effect in the simulation setting., Conclusion: Retention of knowledge and tracheal suctioning practice is improved when training is followed up by tailored feedback on performance. Further research would shed light on how long such improvements are sustained, and whether the improvements seen in a simulated setting can be generalized to clinical settings.

Background and Objective: Mechanical characteristics of breast pumps have been shown to influence milk extraction and hormone release in laboratory settings. However, few studies evaluate impact of differences in pump design on long-term breastfeeding success. This study evaluated the impact of a novel pump design on milk extraction, milk fat content, maternal hormone response, maternal satisfaction, long-term milk production, and duration of breastfeeding following return to the workforce., Design and Methods: Healthy women intending to return to work or school and to breastfeed exclusively for

Objective: Many mothers of very low birthweight infants are breast pump-dependent for weeks or months and need a breast pump that is efficient, effective, comfortable, and convenient., Study Design: This multisite, blinded, randomized clinical trial compared the efficiency, efficacy, comfort, and convenience of the Symphony breast pump (Medela, McHenry, IL) (SBP) to the Classic breast pump (Medela) (CBP) and also compared these same outcome measures for single- and multiphase suction patterns used in the SBP. All 100 mothers initiated lactation with the CBP and were randomized to single- and multiphase suction patterns in the SBP when daily milk output was at least 350 mL/day. Protocol I included 35 mothers who compared each of three suction patterns in the SBP on two separate occasions (six observations) in the neonatal intensive care unit and used the CBP for all other pumpings. Protocol II included 65 mothers who compared single- and multiphase patterns in the SBP for 7 days and then returned to the CBP for 5 days., Results: The onset of milk ejection was quicker (P < 0.05) for the single- versus multiphase patterns in the SBP, suggesting that mothers had become conditioned to the unphysiolologic single-phase pattern in the CBP. However, all other measures of efficiency and efficacy were not significantly different, including milk output at 5-minute intervals. When asked to compare the SBP and the CBP, mothers in Protocol 1 rated the SBP as significantly more efficient, effective, comfortable, and convenient than the CBP (P < 0.05), regardless of the suction pattern in the SBP. Similarly, mothers in Protocol II rated the SBP significantly (P < 0.05) more comfortable than the CBP, regardless of the specific pattern in the SBP., Conclusions: These findings suggest that the SBP was as efficient and effective as the CBP but was significantly more comfortable to use for pump-dependent mothers of very low birthweight infants.

Study Design: This study retrospectively reviewed spine surgical procedures complicated by wound infection and managed by a protocol including the use of vacuum-assisted wound closure (VAC)., Objective: To define factors influencing the number of debridements needed before the final wound closure by applying VAC for patients with postoperative spinal wound infections., Summary of Background Data: VAC has been suggested as a safe and probably effective method for the treatment of spinal wound infections. The risk factors for infection resistance and need for debridement revisions after VAC placement are unknown., Methods: Seventy-three consecutive patients with 79 wound infections after undergoing spine surgery were studied (6 of them had recurrence of infection). All patients were taken to the operating room for irrigation and debridement under general anesthesia followed by placement of the VAC with subsequent delayed closure of the wound. Linear regression and t test were used to identify if the following variables were risk factors for the resistance of infection to VAC treatment: timing of clinical appearance of infection, depth of infection (deep or superficial), presence of instrumentation, positive culture for methicillin-resistant Staphylococcus aureus (MRSA) or more than 1 microorganism, age of the patient, and presence of other comorbidities., Results: There were 34 males and 39 females with an average age of 58.4 years (21 to 82). Once the VAC was initiated, there was an average of 1.4 procedures until and including closure of the wound. The wound was closed an average of 7 days (range 5 to 14) after the placement of the initial VAC on the wound. The average follow-up was 14 months (range 12 to 28). All of the patients but 2 achieved a clean, closed wound without removal of instrumentation at a minimum follow-up of 1 year. Sixty patients had implants (instrumentation or allograft) within the site of wound infection. Thirteen patients had a decompression with exposed dura. Sixty-four infections (81%) presented with a draining wound within the first 6 weeks postoperatively. Sixty-nine infections (87.3%) were deep below the fascia. There was no statistical significance (P>0.05) of all tested risk factors for the resistance of infection to treatment with the VAC system. The parameter more related to repeat VAC procedures was the culture of MRSA or multiple bacteria., Conclusions: VAC therapy may be an effective adjunct in closing spinal wounds even after the repeat procedures. The MRSA or multibacterial infections seem to be most likely to need repeat debridements and VAC treatment before final wound closure.

Purpose: To compare three phacoemulsification machines for measurement accuracy and postocclusion surge (POS) in human cadaver eyes., Design: In vitro comparisons of machine accuracy and POS., Methods: Tip vacuum and flow were compared with machine indicated vacuum and flow. All machines were placed in two human cadaver eyes and POS was determined., Results: Vacuum (% of actual) was 101.9% +/- 1.7% for Infiniti (Alcon, Fort Worth, Texas, USA), 93.2% +/- 3.9% for Stellaris (Bausch & Lomb, Rochester, New York, USA), and 107.8% +/- 4.6% for Signature (Advanced Medical Optics, Santa, Ana, California, USA; P < .0001). At 60 ml/minute flow, actual flow and unoccluded flow vacuum (UFV) was 55.8 +/- 0.4 ml/minute and 197.7 +/- 0.7 mm Hg for Infiniti, 53.5 +/- 0.0 ml/minute and 179.8 +/- 0.9 mm Hg for Stellaris, and 58.5 +/- 0.0 ml/minute and 115.1 +/- 2.3 mm Hg for Signature (P < .0001). POS in an 32-year-old eye was 0.33 +/- 0.05 mm for Infiniti, 0.16 +/- 0.06 mm for Stellaris, and 0.13 +/- 0.04 mm for Signature at 550 mm Hg, 60 cm bottle height, 45 ml/minute flow with 19-gauge tips (P < .0001 for Infiniti vs Stellaris and Signature). POS in an 81-year-old eye was 1.51 +/- 0.22 mm for Infiniti, 0.83 +/- 0.06 mm for Stellaris, 0.67 +/- 0.01 mm for Signature at 400 mm Hg vacuum, 70 cm bottle height, 40 ml/minute flow with 19-gauge tips (P < .0001)., Conclusions: Machine-indicated accuracy, POS, and UFV were statistically significantly different. Signature had the lowest POS and vacuum to maintain flow. Regarding POS, Stellaris was close to Signature; regarding vacuum to maintain flow, Infiniti and Stellaris were similar. Minimizing POS and vacuum to maintain flow potentially are important in avoiding ocular damage and surgical complications.

Aim and Objectives: The purpose of this study was to investigate open system endotracheal suctioning (ETS) practices of critical care nurses. Specific objectives were to examine nurses' practices prior to, during and post-ETS and to compare nurses' ETS practices with current research recommendations., Background: ETS is a potentially harmful procedure that, if performed inappropriately or incorrectly, might result in life-threatening complications for patients. The literature suggests that critical care nurses vary in their suctioning practices; however, the evidence is predominantly based on retrospective studies that fail to address how ETS is practiced on a daily basis., Design and Method: In March 2005, a structured observational study was conducted using a piloted 20-item observational schedule on two adult intensive-care units to determine how critical care nurses (n = 45) perform ETS in their daily practice and to establish whether the current best practice recommendations for ETS are being adhered to., Results: The findings indicate that participants varied in their ETS practices; did not adhere to best practice suctioning recommendations; and consequently provided lower-quality ETS treatment than expected. Significant discrepancies were observed in the participants' respiratory assessment techniques, hyperoxygenation and infection control practices, patient reassurance and the level of negative pressure used to clear secretions., Conclusion: The findings suggest that critical care nurses do not adhere to best practice recommendations when performing ETS. The results of this study offer an Irish/European perspective on critical care nurses' daily suctioning practices., Relevance to Clinical Practice: As a matter of urgency, institutional policies and guidelines, which are based on current best practice recommendations, need to be developed and/or reviewed and teaching interventions developed to improve nurses' ETS practices, particularly in regard to auscultation skills, hyperoxygenation practices, suctioning pressures and infection control measures.

Cisterna chyli is prone to injury in any retroperitoneal surgery. However, retroperitoneal chylous leakage is a rare complication after anterior spinal surgery. To the best of our knowledge, only ten cases have been reported in the English literature. We present a case of a 49-year-old man who had lumbar metastasis and associated radiculopathy. He had transient retroperitoneal chylous leakage after anterior tumor decompression, interbody bony fusion, and instrumental fixation from L2 to L4. The leakage stopped spontaneously after we temporarily clamped the drain tube. Intraperitoneal ascites accumulation developed thereafter due to nutritional loss and impaired hepatic reserves. We gathered ten reported cases of chylous leak after anterior thoracolumbar or lumbar spinal surgery, and categorized all these cases into two groups, depending on the integrity of diaphragm. Six patients received anterior spinal surgery without diaphragm splitting. Postoperative chylous leak stopped after conservative treatment. Another five cases received diaphragm splitting in the interim of anterior spinal surgery. Chylous leakage stopped spontaneously in four patients. The remaining one had a chylothorax secondary to postop chyloretroperitoneum. It was resolved only after surgical intervention. In view of these cases, all the chylous leakage could be spontaneously closed without complications, except for one who had a secondary chylothorax and required thoracic duct ligation and chemopleurodesis. We conclude that intraoperative diaphragm splitting or incision does not increase the risk of secondary chylothorax if it was closed tightly at the end of the surgery and the chest tube drainage properly done.