Clinical consequences of chest tube malposition in trauma resuscitation: single-center experience

Struck, Matthias; Ewens, Sebastian; Fakler, Johannes K. M.; Hempel, Gunther; Beilicke, André; Bernhard, Michaël; Stumpp, Patrick; Josten, Christoph; Stehr, Sebastian; Wrigge, Hermann; Krämer, Sebastian

doi:10.1007/s00068-018-0966-z

Cited by 16 publications

(6 citation statements)

References 15 publications

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“…Regarding patients who received chest tube replacement after CT due to functionality issues or malposition, these patients presented with poorer P/F ratios and higher TTS scores than patients receiving chest tube placement after CT only or before CT only, whereas the 30-day mortality rates were comparable. This is in line with a previous study from our center, in which major trauma patients with malposition of chest tubes on initial CT did not show worse outcomes compared to patients with correctly positioned tubes [33].…”

Section: Discussionsupporting

confidence: 92%

Chest Tube Placement in Mechanically Ventilated Trauma Patients: Differences between Computed Tomography-Based Indication and Clinical Decision

Struck

Kleber

Ewens

et al. 2022

JCM

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The rate of occult pneumothorax in intubated and mechanically ventilated trauma patients until initial computed tomography (CT) remains undetermined. The primary aims of this study were to analyze initial chest CTs with respect to the thoracic pathology of trauma, the clinical injury severity, and chest tube placement (CTP) before and after CT. In a single-center retrospective analysis of 616 intubated and mechanically ventilated adult patients admitted directly from the scene to the emergency department (ED), 224 underwent CTP (36%). Of these, 142 patients (62%) underwent CTP before CT, of which, 125 (88%) had significant chest injury on CT. Seventeen patients had minor or absent chest injuries, most of which were associated with transient or unrecognized tracheal tube malposition. After CT, CTP was performed in another 82 patients, of which, 56 (68.3%) had relevant pneumothorax and 26 had minor findings on CT. Sixty patients who had already undergone CTP before CT received another CTP after CT, of which, 15 (25%) had relevant pneumothorax and 45 (75%) had functionality issues or malposition requiring replacement. Nine patients showed small pneumothorax on CT, and did not undergo CTP (including four patients with CTP before CT). The physiological variables were unspecific, and the trauma scores were dependent on the CT findings for identifying patients at risk for CTP. In conclusion, the clinical decisions for CTP before CT are associated with relevant false-negative and false-positive cases. Clinical assessment and CT imaging, together, are important indicators for CTP decisions that cannot be achieved by using clinical assessment or CT alone.

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Section: Discussionsupporting

confidence: 92%

Chest Tube Placement in Mechanically Ventilated Trauma Patients: Differences between Computed Tomography-Based Indication and Clinical Decision

Struck

Kleber

Ewens

et al. 2022

JCM

Self Cite

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“…Manuel F et al documented chest tube malposition in 42% of patients who had emergency admission after trauma and needed chest tubes. In his study Manuel found that chest tubes were in the pleural space in 58% of the cases; while malposition were intrafissural positions in (27%), intraparenchymal positions in (11%) and extra pleural positions in (4%) [ 21 , 22 ]. In his study Kun-Eng Lim et al documented 28 chest tube malposition among the 76 chest tubes that were placed in 54 patients.…”

Section: Discussionmentioning

confidence: 99%

“…In his study Kun-Eng Lim et al documented 28 chest tube malposition among the 76 chest tubes that were placed in 54 patients. Among the 28 malposition, 23 tubes were in the intrathoracic location (20 intraparenchymal; 3 intrafissural) and 5 tubes were in the extra thoracic location (4 in mediastinum; 1 in chest wall) [ 22 , 23 ]. Tube clotting, especially in smaller tubes, is a common cause of non-functioning drainage [ 23 , 24 ].…”

Section: Discussionmentioning

confidence: 99%

Limitation of tube thoracostomy in treating pneumothorax in COVID-19 infected patients. A retrospective cohort study

Ani¹,

AbuZayda²,

Ahmed³

et al. 2022

Annals of Medicine &Amp; Surgery

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“…Malposition occurs in approximately 30% of the cases during chest tube insertion. The intrafissural position is the most frequent tube location, followed by the intraparenchymal and extrapleural positions (3,4). As mentioned earlier, tension pneumothorax or massive hemothorax was suspected as no breathing sounds were heard on both sides; therefore, bilateral tube thoracostomy was performed.…”

Section: Discussionmentioning

confidence: 96%

A possible cause of chest tube malposition

Kim

2023

Trauma Image Proced

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Tube thoracostomy is one of the essential skills for physicians. However, tube malposition is a common issue, and little is known about the reasons for malposition or the underlying mechanism. This report presents a case of tube malposition with an identifiable cause. A patient with traumatic cardiac arrest and severe chest injury was transported. Bilateral thoracostomy was performed because of tension pneumothorax, and 400 mL of blood was drained from the left tube. However, while securing the tube, it was pushed out by 3–4 cm before complete fixation. The tube was advanced back in further without retrying the tube placement. However, postmortem chest X-ray imaging revealed the malposition of the left tube. The only reason for malposition in this patient was the advancement of the pulled-out tube without replacement. To reduce the rate of tube malposition, it is necessary to reinsert the tube rather than advancing the pulled-out tube.

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Clinical consequences of chest tube malposition in trauma resuscitation: single-center experience

Cited by 16 publications

References 15 publications

Chest Tube Placement in Mechanically Ventilated Trauma Patients: Differences between Computed Tomography-Based Indication and Clinical Decision

Chest Tube Placement in Mechanically Ventilated Trauma Patients: Differences between Computed Tomography-Based Indication and Clinical Decision

Limitation of tube thoracostomy in treating pneumothorax in COVID-19 infected patients. A retrospective cohort study

A possible cause of chest tube malposition

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