Conservative Management of Residual Pneumothorax Following Tube Thoracostomy Removal in Trauma Patients

Abstract

Introduction: Residual pneumothorax (rPTX) after tube thoracostomy (TT) is not an uncommon occurrence (10-20%) in any active trauma center. Many different practice patterns exist on how to deal with this clinical conundrum. These differing strategies can include more invasive procedures and increased length of stay (LOS). We hypothesize that the vast majority of these patients can be safely managed with observation and most can be discharged home without complete resolution. Materials and methods: A retrospective study was conducted on trauma patients managed in a level I center over a 2-year period. A "post-pull" chest X-ray was obtained on all TT patients after removal. All patient with rPTX were included for analysis. Results: A total of 412 patients required chest tubes. Since 98 patients were deceased, we excluded them from the study. A total of 314 patients were studied. Forty-two percent of the patients were male, with median age 40. Sixty-one percent of the patients were blunt trauma victims and 39% were penetrating trauma victims. The indications for chest TT were pneumothorax, hemothorax, and hemopneumothorax. A total of 163 had post-pull pneumo and discharged home with residual pathology prior to discharge. Five of these patients were readmitted (3%), and only one required repeat TT, roughly 0.6%. Conclusion:The vast majority of "post-pull" rPTX patients can be managed conservatively and can be safely discharged even without complete resolution.