Which recumbency does avoid insertional complications during small-bore wire-guided thoracostomy tube placement in cats - a cadaver study

Abstract

Background: Small-bore wire-guided thoracostomy tubes (SBWGTT) are commonly used in cats to manage pleural disease and generally have a low complication rate. Our study aimed to explore the correlation between recumbency of cats, placement method, and the occurrence of insertional complications to identify risk factors during SBWGTT placement. In this experimental cadaveric study, SBWGTT placement using a modified Seldinger technique was conducted in 24 feline cadavers. Cats, euthanized for reasons unrelated to the study, were randomly assigned to pleural effusion (EFF; n=12) and pneumothorax (PNEU; n=12) groups. Each cadaver was intubated and ventilated with a positive end-expiratory pressure (PEEP) of 10 mmHg, and sterile saline or air was instilled into the thorax over a 5 mm thoracoscopic trocar in the fourth intercostal space (ICS). Instillation was stopped when the lateral thoracic wall to lung distance (TWLD) reached 10 to 12 mm, measured with ultrasound in the favorable position. Sternal recumbency was the favorable position for the EFF group, and lateral recumbency for the PNEU group. Following the placement of the first SBWGTT in each group, the cadavers were positioned unfavorably (lateral recumbency for EFF group, sternal recumbency for PNEU group), and a second drain was introduced contralaterally. A bilateral 8^th ICS thoracotomy was then performed to visually assess intrathoracic structures and drain integrity. A binary logistic regression mixed model was conducted to determine interaction between the induced condition and body position. Results: A total of 48 SBWGTTs were placed, with complications observed in 33.3 % (8/24) of cases. Five of these were major complications consisting of lung lacerations. Complications were more common in the unfavorable position, accounting for 75 % of cases, although this result was not statistically significant. The odds of complication rates were > 70 % in the unfavorable position and decreased with an increase in TWLD (< 30 %). Conclusion: Complications associated with SBWGTT placement are influenced by recumbency, although the data did not reach statistical significance. Placing cats in lateral recumbency for pneumothorax treatment and sternal recumbency for pleural effusion treatment may reduce insertional complications.