{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2023,11,10]],"date-time":"2023-11-10T15:32:53Z","timestamp":1699630373386},"reference-count":19,"publisher":"Oxford University Press (OUP)","issue":"Supplement_1","license":[{"start":{"date-parts":[[2021,1,1]],"date-time":"2021-01-01T00:00:00Z","timestamp":1609459200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"name":"Defense Health Agency Small Business Innovation Research","award":["W81XWH17C0209"],"award-info":[{"award-number":["W81XWH17C0209"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,1,25]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n               <jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>With blunt and penetrating trauma to the chest, warfighters and civilians frequently suffer from punctured lung (pneumothorax) and\/or bleeding into the pleural space (hemothorax). Optimal management of this condition requires the rapid placement of a chest tube to evacuate as much of the blood and air as possible. Incomplete drainage of blood leading to retained hemothorax may be the result of the final tube tip position not being in contact with the blood collections. To address this problem, we sought to develop a \u201csteerable\u201d chest tube that could be accurately placed or repositioned into a specific desired position in the pleural space to assure optimal drainage. An integrated infusion cannula was added for the instillation of anticoagulants to maintain tube patency, thrombolytics for clot lysis, and analgesics for pain control if required.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Materials and Methods<\/jats:title>\n                  <jats:p>A triple-lumen tube was designed to provide a channel for a pull-wire which was wound around an axle integrated into a small proximal handle and controlled by a ratcheted thumbwheel. Tension on the wire creates an arc on the tube that allows for positioning. In vitro testing focused on the relationship between the tension on the pull-wire and the resultant arc. Two adult cadavers and two anesthetized pigs were used to study the feasibility of accurate tube placement. After a brief training session, providers were asked to place tubes inferiorly along the diaphragm where blood was anticipated to accumulate or at the apex of the lung for pneumothorax. Success was determined with fluoroscopic images and was judged as a tube tip lying in the targeted position.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>The design was prototyped with an extruded polyvinyl chloride multilumen tube and a 3D printed tensioning handle. In vitro studies showed that one turn of the thumbwheel created 70\u00b0 to 90\u00b0 of arc of the tube. Cadaver and animal studies showed consistent success in the desired placement of the tube at or near the lateral diaphragm or in the apex. Attempts were also successful by surgical residents with minimal training.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Initial preliminary studies on a novel steerable chest tube have demonstrated the ability to appropriately position the tube in a desired location. The addition of an extendable cannula will allow for safe clot lysis or maintained tube patency. Additional studies are planned to confirm the benefit of this device in preventing retained hemothorax.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/milmed\/usaa295","type":"journal-article","created":{"date-parts":[[2021,1,26]],"date-time":"2021-01-26T01:50:16Z","timestamp":1611625816000},"page":"324-330","source":"Crossref","is-referenced-by-count":1,"title":["Optimal Initial Positioning of Chest Tubes to Prevent Retained Hemothorax Using a Novel Steerable Chest Tube With Extendable Infusion Cannula"],"prefix":"10.1093","volume":"186","author":[{"suffix":"MD, FACS","given":"John B","family":"Fortune","sequence":"first","affiliation":[{"name":"Department of Surgery, University of Vermont Larner School of Medicine, Burlington, VT 05401, USA"},{"name":"Sim*Vivo, LLC, Naples, FL 34110, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"suffix":"MD","given":"Serena","family":"Murphy","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of Vermont Larner School of Medicine, Burlington, VT 05401, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"suffix":"RN, MPH","given":"Kimberley","family":"Tiller","sequence":"additional","affiliation":[{"name":"Sim*Vivo, LLC, Naples, FL 34110, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2021,1,25]]},"reference":[{"key":"2021012913540539900_R1","doi-asserted-by":"crossref","first-page":"1032","DOI":"10.1016\/j.athoracsur.2010.01.014","article-title":"Wartime thoracic injury: perspectives in modern warfare","volume":"89","author":"Propper","year":"2010","journal-title":"Ann Thorac Surg"},{"key":"2021012913540539900_R2","article-title":"Joint Trauma System Clinical Practice Guideline (JTS CPG): Wartime Thoracic Injury (CPG ID:74)","author":"Bowen","year":"2018"},{"issue":"6","key":"2021012913540539900_R3","doi-asserted-by":"crossref","first-page":"960","DOI":"10.1016\/j.amjsurg.2013.08.052","article-title":"Evaluation of chest tube administration of tissue plasminogen activator to treat retained hemothorax","volume":"207","author":"Stiles","year":"2014","journal-title":"Am J Surg"},{"issue":"1","key":"2021012913540539900_R4","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1097\/TA.0b013e318242e368","article-title":"Management of post-traumatic retained hemothorax: a prospective, observational, multicenter AAST study","volume":"72","author":"DuBose","year":"2012","journal-title":"J Trauma Acute Care Surg"},{"issue":"3","key":"2021012913540539900_R5","doi-asserted-by":"publisher","DOI":"10.4172\/2167-1222.1000326","article-title":"Modern management of traumatic hemothorax","volume":"5","author":"Mahoozi","year":"2016","journal-title":"J Trauma Treat"},{"issue":"10","key":"2021012913540539900_R6","doi-asserted-by":"crossref","first-page":"1367","DOI":"10.1097\/00005373-198910000-00013","article-title":"Complications following blunt and penetrating injuries in 216 victims of chest trauma requiring tube thoracostomy","volume":"29","author":"Helling","year":"1989","journal-title":"J Trauma"},{"issue":"5","key":"2021012913540539900_R7","doi-asserted-by":"crossref","first-page":"255","DOI":"10.1155\/2008\/918951","article-title":"Residual hemothorax after chest tube placement correlates with increased risk of empyema following traumatic injury","volume":"15","author":"Karmy-Jones","year":"2008","journal-title":"Can Respir J"},{"issue":"6","key":"2021012913540539900_R8","doi-asserted-by":"crossref","first-page":"647","DOI":"10.1001\/archsurg.1997.01430300089018","article-title":"Posttraumatic empyema: risk factor analysis","volume":"132","author":"Aguilar","year":"1997","journal-title":"Arch Surg"},{"issue":"6","key":"2021012913540539900_R9","doi-asserted-by":"crossref","first-page":"401","DOI":"10.1016\/j.clinimag.2005.06.032","article-title":"Diagnosis of malpositioned chest tubes after emergency tube thoracostomy: is computed tomography more accurate than chest radiograph?","volume":"29","author":"Lim","year":"2005","journal-title":"Clin Imaging"},{"issue":"1","key":"2021012913540539900_R10","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1016\/j.injury.2011.06.420","article-title":"Complications following thoracic trauma managed with tube thoracostomy","volume":"43","author":"Menger","year":"2012","journal-title":"Injury"},{"issue":"supp 34","key":"2021012913540539900_R11","article-title":"CT scan assessment of malpositioned chest tube in the intensive care unit patient: A-605","volume":"22","author":"Remerand","year":"2005","journal-title":"Eur J Anaesth"},{"key":"2021012913540539900_R12","doi-asserted-by":"crossref","first-page":"633","DOI":"10.1016\/S0954-6111(98)90509-1","article-title":"Curved chest tube for drainage of malignant pleural effusion","volume":"92","author":"Ishikawa","year":"1998","journal-title":"Respir Med"},{"issue":"6","key":"2021012913540539900_R13","doi-asserted-by":"crossref","first-page":"1029","DOI":"10.1093\/ejcts\/ezt140","article-title":"Incidence of chest tube clogging after cardiac surgery: a single-centre prospective observational study","volume":"44","author":"Karimov","year":"2013","journal-title":"Eur J Cardiothorac Surg"},{"issue":"3","key":"2021012913540539900_R14","doi-asserted-by":"crossref","first-page":"832","DOI":"10.1016\/j.jtcvs.2015.10.015","article-title":"Active clearance of chest drainage catheters reduces retained blood","volume":"151","author":"Sirch","year":"2016","journal-title":"J Thorac Cardiovasc Surg"},{"issue":"9","key":"2021012913540539900_R15","doi-asserted-by":"crossref","first-page":"1749","DOI":"10.1016\/j.injury.2015.02.028","article-title":"VATS versus intrapleural streptokinase: a prospective, randomized, controlled clinical trial for optimum treatment of post-traumatic residual hemothorax","volume":"46","author":"Kumar","year":"2015","journal-title":"Injury"},{"issue":"6","key":"2021012913540539900_R16","first-page":"999","article-title":"Intrapleural tissue plasminogen activator and deoxyribonuclease therapy for pleural infection","volume":"7","author":"Piccolo","year":"2015","journal-title":"J Thorac Dis"},{"issue":"4","key":"2021012913540539900_R17","doi-asserted-by":"crossref","first-page":"805","DOI":"10.1016\/j.chest.2019.01.007","article-title":"Lytic therapy for retained traumatic hemothorax: a systematic review and meta-analysis","volume":"155","author":"Hendriksen","year":"2019","journal-title":"Chest"},{"issue":"5","key":"2021012913540539900_R18","doi-asserted-by":"crossref","first-page":"936","DOI":"10.1097\/TA.0000000000001209","article-title":"Pain management for blunt thoracic trauma: a joint practice management guideline from the Eastern Association for the Surgery of Trauma and Trauma Anesthesiology Society","volume":"81","author":"Galvagno","year":"2016","journal-title":"J Trauma Acute Care Surg"},{"issue":"1","key":"2021012913540539900_R19","doi-asserted-by":"crossref","first-page":"14","DOI":"10.17925\/USRPD.2016.01.01.14","article-title":"Evaluation of a steerable tube thoracostomy system compatible with a flexible bronchoscope","volume":"1","author":"Pastis","year":"2016","journal-title":"US Respiratory Pulmonary Diseases"}],"container-title":["Military Medicine"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/milmed\/article-pdf\/186\/Supplement_1\/324\/36145069\/usaa295.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/milmed\/article-pdf\/186\/Supplement_1\/324\/36145069\/usaa295.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,1,29]],"date-time":"2021-01-29T13:54:32Z","timestamp":1611928472000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/milmed\/article\/186\/Supplement_1\/324\/6119418"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,1,1]]},"references-count":19,"journal-issue":{"issue":"Supplement_1","published-online":{"date-parts":[[2021,1,25]]},"published-print":{"date-parts":[[2021,1,25]]}},"URL":"https:\/\/doi.org\/10.1093\/milmed\/usaa295","relation":{},"ISSN":["0026-4075","1930-613X"],"issn-type":[{"value":"0026-4075","type":"print"},{"value":"1930-613X","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2021,1,1]]},"published":{"date-parts":[[2021,1,1]]}}}