Systematic ReviewResearchWorkflow

Meta-analysis of 404 chest trauma patients finds post-thoracostomy suction reduces chest tube duration by 3 days and hospital stay by 4 days versus water seal

The American journal of emergency medicine (PubMed)Jul 27, 2026

AI-summarized from the linked source. Educational brief, not medical advice.

Brief summary

An updated systematic review and meta-analysis of five randomized controlled trials comprising 404 chest trauma patients demonstrated that applying suction following tube thoracostomy significantly shortened chest tube duration by 2.95 days and hospital stay by 3.98 days compared with water seal.

What NurseJet pulled from the source

Optimal drainage management following tube thoracostomy for traumatic pneumothorax and hemothorax remains a subject of ongoing clinical debate between continuous suction and passive water seal systems. In this updated systematic review and meta-analysis searching PubMed, Embase, Web of Science, and Cochrane CENTRAL through May 2026, researchers pooled data from five randomized controlled trials encompassing 404 trauma patients. Compared to water seal management, suction significantly reduced chest tube duration (mean difference [MD]: -2.95 days, 95% CI: -4.58 to -1.31; p = 0.0004) and hospital length of stay (MD: -3.98 days, 95% CI: -5.70 to -2.27; p < 0.00001). Furthermore, suction significantly increased the likelihood of achieving full lung expansion (OR: 4.86, 95% CI: 1.70–13.88; p = 0.003). Minimal clinically important difference (MCID) analysis confirmed meaningful benefits across all three parameters. Rates of recurrent pneumothorax, re-intervention, and retained or clotted hemothorax did not differ significantly between groups.

Why this matters for nurses

Surgical and medical-surgical nurses care daily for trauma patients with chest drainage systems. Tube thoracostomy carries substantial pain, impairs pulmonary mechanics, and limits ambulation. Demonstrating that proactive suction management promotes faster pleural re-expansion and significantly reduces both tube duration and hospital stay provides bedside nurses and trauma teams with evidence to question prolonged passive water seal strategies in traumatic injury.

Bedside takeaway

A meta-analysis of 5 RCTs and 404 trauma patients found suction after tube thoracostomy reduced chest tube duration by 2.95 days and hospital stay by 3.98 days compared to water seal.

Key takeaways

Meta-analysis synthesized 5 randomized controlled trials comprising 404 patients with traumatic chest injuries.
Continuous suction shortened chest tube indwelling duration by nearly three days (MD -2.95 days, p = 0.0004).
Hospital length of stay was significantly reduced by approximately four days with suction (MD -3.98 days, p < 0.00001).
Patients on suction were nearly five times more likely to achieve full lung expansion (OR 4.86, p = 0.003).
No significant differences were identified in recurrent pneumothorax, clotted hemothorax, or re-intervention rates.

Practice implications

Monitor chest drainage systems actively according to provider orders; when suction is prescribed, maintain prescribed negative pressure (-20 cm H2O), assess air leak chambers and drainage volumes regularly, and facilitate early incentive spirometry to optimize lung expansion.

Limitations & cautions

All included trials exhibited high risk of bias due to lack of clinician and outcome assessor blinding, which could influence subjective removal decisions; small sample size (404 patients across 5 trials) limited statistical power to assess complications such as clotted hemothorax.
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The American journal of emergency medicine (PubMed)

The American journal of emergency medicine (PubMed). Comparative effectiveness of suction versus water seal following tube thoracostomy in traumatic pneumothorax and hemothorax: An updated systematic review and meta-analysis.

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https://pubmed.ncbi.nlm.nih.gov/42537523/

Professional education only

This summary does not replace clinical judgment, facility policy, provider orders, or official guidelines. Verify practice changes against the original source and local protocol.

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Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer (PubMed)Oct 29, 2026Research Article

A randomized controlled trial of 90 patients recovering from gastric or colorectal cancer surgery found that individualized, clinician-supervised nutritional guidance generated with AI assistance significantly increased 30-day caloric adequacy from 40.0% to 66.7% and protein adequacy from 35.6% to 62.2% while reducing GI symptoms.

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Postoperative nutritional deficits and gastrointestinal symptoms frequently plague patients following surgical resection for gastrointestinal malignancies, yet hospital discharge advice often remains generic and difficult to operationalize at home. In this single-center, parallel-group randomized controlled trial, 90 patients undergoing laparoscopic gastric or colorectal cancer surgery were randomized 1:1 to receive either clinician-reviewed AI-facilitated individualized nutritional guidance (utilizing DeepSeek v3.2 with ABC-structured prompting) or standard discharge dietary advice. At 30 days post-discharge, the intervention cohort achieved significantly greater energy intake adequacy (>=90% of caloric target: 66.7% vs 40.0%, odds ratio [OR] 3.0, 95% CI: 1.3–7.1; p = 0.01) and protein adequacy (62.2% vs 35.6%, OR 2.9, 95% CI: 1.2–6.8; p = 0.01). Patients receiving individualized guidance reported significant improvements in postoperative fatigue, nausea, vomiting, appetite loss, and overall gastrointestinal symptom burden (Gastrointestinal Symptom Rating Scale [GSRS] score 2.1 vs 2.5, p = 0.03). Clinician preparation time fell from 12.5 minutes to 8.2 minutes per patient (p < 0.001), while 30-day complication rates and weight trajectory did not differ.

Key takeaways

Randomized trial evaluated 90 patients following laparoscopic gastric or colorectal cancer surgery.
Individualized, clinician-reviewed discharge guidance increased caloric adequacy to 66.7% vs 40.0% with standard care (p = 0.01).
Protein intake adequacy improved substantially from 35.6% to 62.2% (p = 0.01).
Patient-reported symptoms of nausea, vomiting, fatigue, and appetite loss were significantly mitigated at 30 days post-discharge.
Clinician drafting time decreased by 34% (8.2 vs 12.5 minutes), demonstrating operational efficiency without compromising clinical oversight.

Why this matters on shift

Surgical oncology nurses coordinate complex discharge plans for patients with altered gastrointestinal anatomy. Malnutrition and debilitating symptoms like nausea and early satiety commonly trigger avoidable rehospitalizations. Demonstrating that personalized, quantified meal guidance significantly boosts nutritional adherence and suppresses symptom distress provides bedside and clinic nurses with an actionable model for enhancing discharge education through supervised digital tools.

Bedside takeaway

An RCT of 90 post-op gastrointestinal cancer patients showed clinician-reviewed individualized discharge nutrition plans boosted 30-day caloric adequacy from 40% to 66.7%.

Nursing implications

Prior to discharge following gastrointestinal resections, provide patients with specific, quantified daily protein and caloric targets tailored to their surgical anatomy and food preferences, emphasizing small, nutrient-dense meals and ongoing symptom monitoring.

Limitations & cautions

Single-center design in 90 surgical patients; intervention evaluated a combined bundle of structured prompts, individualization, and clinician review, preventing isolation of the AI component alone; no significant differences were seen in 30-day complications or weight preservation.
AI-summarized from the linked source. Review the original article before applying to practice.

Citations · exact source links

Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer (PubMed). AI-facilitated individualized nutritional guidance with ABC-structured prompts improves short-term dietary intake adequacy and patient-reported symptoms after gastrointestinal cancer surgery: a randomized controlled trial.

Open original sourceFull brief

AI-summarized from the linked source. Review the original article before applying to practice.

European journal of emergency medicine : official journal of the European Society for Emergency Medicine (PubMed)Oct 27, 2026Systematic Review

A systematic review of 11 studies covering 10,115 emergency department patients with chest pain found that commercial point-of-care high-sensitivity cardiac troponin assays achieve 96.3% to 100% sensitivity and 98.1% to 100% negative predictive value for ruling out acute myocardial infarction upon arrival.

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Systematic ReviewResearchWorkflowAI summary · original source linked below

High-sensitivity cardiac troponin (hs-cTn) assays have transformed emergency chest pain triage, but standard central laboratory processing often incurs turnaround delays exceeding an hour. This systematic review evaluated 11 studies (including both derivation and validation cohorts) comprising 10,115 adult ED patients presenting with chest pain suggestive of acute coronary syndrome to determine the diagnostic accuracy of four commercial point-of-care hs-cTn devices with turnaround times under 20 minutes. Applied as a single-test rule-out upon ED arrival, high sensitivity and negative predictive value (NPV) were documented: Atellica VTLi demonstrated 98.8% to 100% sensitivity for troponin <4 ng/L (NPV 99.8%–100%) and 100% sensitivity for <7 ng/L (NPV 100%); Pathfast showed 96.3% to 100% sensitivity for <3 ng/L (NPV 98.1%–100%); i-STAT achieved 99.8% sensitivity for <5 ng/L (NPV 100%); and TriageTrue achieved 100% sensitivity for <3 ng/L (NPV 100%). Serial testing using the 99th percentile across 0- to 3-hour protocols yielded variable sensitivities (VTLi 64.8%–100%, Pathfast 83%–87%, and TriageTrue 79.8%), demonstrating that POC assays are most reliable when utilized for rapid arrival rule-out at low thresholds.

Key takeaways

Systematic review analyzed 11 derivation and validation studies encompassing 10,115 emergency chest pain patients.
Point-of-care hs-cTn devices provided rapid turnaround times (<20 minutes) suitable for bedside emergency testing.
Single-test arrival rule-out achieved 96.3% to 100% sensitivity and 98.1% to 100% negative predictive value across four commercial devices.
Serial protocols at the 99th percentile exhibited broader sensitivity variability (64.8% to 100%), favoring arrival threshold pathways.
Integration into clinical decision protocols can expedite low-risk rule-out while central laboratory confirmation remains prudent for ambiguous presentations.

Why this matters on shift

Emergency nurses triage hundreds of potential acute coronary syndrome presentations where rapid risk stratification prevents bed overcrowding and expedites definitive interventions. Understanding that verified bedside hs-cTn devices deliver lab-comparable rule-out accuracy in under 20 minutes allows triage nurses and rapid-assessment teams to accelerate clinical decision-making, shorten emergency stays, and safely reassure low-risk individuals.

Bedside takeaway

A systematic review of 10,115 emergency patients showed point-of-care high-sensitivity troponin assays rule out acute myocardial infarction upon arrival with 96.3% to 100% sensitivity.

Nursing implications

When evaluating acute chest pain using point-of-care hs-cTn platforms, recognize that extremely low arrival concentrations offer high negative predictive value for acute myocardial infarction, but adhere strictly to facility serial draw algorithms and ECG evaluations for indeterminate or evolving symptoms.

Limitations & cautions

Review included both derivation and prospective validation studies evaluated via QUADAS-3; diagnostic accuracy varied considerably when serial testing was evaluated at the 99th percentile rather than arrival rule-out thresholds; devices cannot replace continuous electrocardiographic monitoring or clinical risk scoring.
AI-summarized from the linked source. Review the original article before applying to practice.

Citations · exact source links

European journal of emergency medicine : official journal of the European Society for Emergency Medicine (PubMed). Diagnostic accuracy of high-sensitivity point-of-care troponin assays in emergency department for patients presenting with chest pain: a systematic review.

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AI-summarized from the linked source. Review the original article before applying to practice.

Heart & lung : the journal of critical care (PubMed)Sep 18, 2026Research Article

A randomized controlled trial of 66 adult cardiac surgery patients undergoing median sternotomy found that adding dexmedetomidine to bilateral transversus thoracic muscle plane blocks significantly prolonged time to first rescue analgesia and reduced 24-hour postoperative fentanyl consumption compared to bupivacaine alone.

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Post-sternotomy pain contributes significantly to delayed respiratory recovery, prolonged mechanical ventilation, and hemodynamic instability in cardiac intensive care units. In this randomized controlled trial, 66 adult patients (ASA physical status I–III) scheduled for open cardiac surgery via median sternotomy received bilateral ultrasound-guided transversus thoracic muscle plane blocks (TTPB) following induction of anesthesia. Participants were randomized to three groups: dexamethasone (0.25% bupivacaine plus 8 mg dexamethasone), dexmedetomidine (0.25% bupivacaine plus 1 mcg/kg dexmedetomidine), and control (0.25% bupivacaine alone). The primary outcome was time to first rescue analgesia following extubation. Time to first rescue analgesia was significantly longer in the dexmedetomidine group compared with the dexamethasone and control cohorts (p < 0.001). Total 24-hour postoperative fentanyl consumption was significantly reduced in both the dexmedetomidine and dexamethasone groups compared to controls (p < 0.001), accompanied by consistently lower numerical pain scores. Extubation times and intraoperative fentanyl consumption were comparable across all three arms (p > 0.05).

Key takeaways

Randomized trial evaluated bilateral transversus thoracic muscle plane blocks in 66 cardiac surgery patients.
Dexmedetomidine as an adjuvant significantly lengthened the duration of pain relief prior to first rescue analgesia (p < 0.001).
Both dexmedetomidine and dexamethasone significantly diminished total 24-hour postoperative fentanyl consumption (p < 0.001).
Postoperative pain scores were consistently lower in both adjuvant cohorts compared to plain bupivacaine.
Neither adjuvant delayed postoperative extubation times or altered intraoperative opioid requirements.

Why this matters on shift

Cardiothoracic ICU nurses manage intense acute post-sternotomy pain where excessive opioid use risks respiratory depression, delayed weaning, delirium, and ileus. Regional plane blocks with prolonged action facilitate smooth recovery, deeper spontaneous breaths, earlier incentive spirometry, and reduced systemic opioid exposure without hindering timely extubation in recovering cardiac surgical patients.

Bedside takeaway

In an RCT of 66 cardiac surgery patients, adding dexmedetomidine or dexamethasone to parasternal plane blocks significantly cut 24-hour opioid consumption and improved pain control.

Nursing implications

In postoperative sternotomy patients receiving ultrasound-guided parasternal blocks with adjuvants, anticipate prolonged analgesia; perform routine multimodal pain and sedation assessments, monitor for adjuvant-related bradycardia or hypotension, and encourage early pulmonary toilet as pain remains well controlled.

Limitations & cautions

Single-center trial in 66 patients; limited to elective adult cardiac procedures (ASA I–III); did not evaluate long-term persistent post-sternotomy pain or chronic opioid use after hospital discharge.
AI-summarized from the linked source. Review the original article before applying to practice.

Citations · exact source links

Heart & lung : the journal of critical care (PubMed). Comparison of analgesic efficacy of dexamethasone and dexmedetomidine as an adjuvant to local anaesthetic in transversus thoracic muscle plane block in adult patients undergoing median sternotomy: A randomised controlled trial.

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AI-summarized from the linked source. Review the original article before applying to practice.

Key takeaways

Practice implications

Limitations & cautions

Exact source links

More updates for this clinical area

Randomized trial of 90 gastrointestinal cancer surgery patients finds individualized AI-assisted discharge nutrition boosts protein and caloric adequacy

Systematic review of 10,115 emergency chest pain patients finds point-of-care high-sensitivity troponin reliably rules out acute myocardial infarction on arrival

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