Effectiveness and safety of small-bore tube thoracostomy (≤20 Fr) for chest trauma patients: A retrospective observational study

Abstract

Introduction: Tube thoracostomy is an important treatment for traumatic hemothorax and pneumothorax. The optimal tube diameter remains unclear. To reduce invasiveness, we use small-bore chest tubes (≤20 Fr) for all trauma patients for whom tube thoracostomy is indicated in our emergency department (ED). The aim of this study was to investigate the effectiveness and safety of small-bore tube thoracostomy for traumatic hemothorax or pneumothorax. Method: We conducted a retrospective observational study at a single emergency medical center. This study included adult patients (≥18 years old) who had undergone tube thoracostomy for chest trauma in the ED during the 5 years from October 2013 to September 2018. We used 20 Fr chest tubes or 8 Fr pigtail catheters. The examined outcome was tube-related complications, such as tube obstruction, retained hemothorax, and unresolved pneumothorax. Results: A total of 107 tube thoracostomies were performed in 102 patients. The mean Injury Severity Score of these patients was 17.8 (±9.6), and the mean duration of the tube placement period was 3.9 days (±1.8). Eight patients developed tube-related complications (7.8%) (retained hemothorax: 4 patients (3.9%), unresolved pneumothorax: 4 patients (3.9%)). None of these cases were caused by tube obstruction. Although the drainage itself was effective, they underwent definitive invasive interventions to stop bleeding or air leak. Conclusion:Our study showed that the use of small-bore (≤20 Fr) chest tubes to treat traumatic hemothorax/ pneumothorax achieved the purposes of tube thoracostomy. It might be possible to safely manage chest trauma with small-bore chest tubes.

Management of pneumothorax with 8.3-French Pigtail Catheter: description of the ultrasound-guided technique and case series

“…However, the present-day literature focuses on the less invasive techniques in the management of traumatic or spontaneous pneumothorax [7][8][9][10]. Kulvatunyou et al [11], in a randomized clinical trial, showed that there is no difference in clinical outcomes comparing PC versus CT in patients with traumatic pneumothorax, with benefit in pain relief in patients with PC, with the lesser failure rate.…”

“…The use of less invasive techniques is increasing, such as the utilization of PC in the management of pneumothorax. Multiple studies [7][8][9][10] are now evaluating the advantages and benefits of this approach; Bauman et al [5] show that in terms of failure rates there is no difference between CT and PC, with a better patient's experience, comparable results with Kulvatunyou et al [11].…”

Safety and feasibility of a novel chest tube placement in uniportal video‐assisted thoracoscopic surgery for non‐small cell lung cancer

“…Furthermore, some studies reported that a single chest tube inserted through the incision may not be favorable for the drainage of blood, even if using the conventional 26‐Fr chest tube. 10 Maezawa et al 25 demonstrated that an 8 Fr pigtail catheter may achieve a similar effect in treating traumatic hemothorax when compared to a 20 Fr chest tube. In this study, postoperative persistent bleeding in the chest was not encountered in any patient, and we plan to observe the drainage effect of a 12‐Fr pigtail catheter in case of postoperative bleeding in further studies.…”

Pneumothorax Following Breast Surgery at an Ambulatory Surgery Center

“…The most recent guidelines from the American College of Surgeons Advanced Trauma Life Support (ATLS) recommend using smaller (28-32 Fr) chest tubes to treat pneumothorax [ 8 ]. However, smaller tubes, including pigtail catheters, may be equally effective [ 12 ]. Tension pneumothorax requires immediate decompression.…”