Subcutaneous emphysema associated with chest tube drainage

Abstract

Subcutaneous emphysema can be spontaneous or traumatic, but is associated with avoidable causes such as inadequate chest tube drainage, particularly due to poor tube placement, anchorage and blockage, and also with side-port migration into the subcutaneous tissue. It is associated with an increased morbidity and mortality, and may indicate the need for urgent chest tube replacement.

Impact and Predictors of Prolonged Chest Tube Duration in Mechanically Ventilated Patients with Acquired Pneumothorax

“…Subjects with subcutaneous emphysema after thoracostomy (so-called surgical emphysema) had a higher mortality rate, longer chest tube duration, and a higher incidence of chest tube malposition. 6 However, in that study, a much higher percentage of subjects with surgical emphysema were mechanically ventilated, which may have biased the results. In our subjects, surgical emphysema was significantly associated with prolonged chest tube duration in subjects who developed pneumothorax during ventilation.…”

“…Thoracostomy complications have a relatively high incidence (ϳ25-30% 8,9 ) and may worsen outcomes. [3][4][5][6][7][8][9] Subcutaneous emphysema is usually thought to be only a cosmetic issue. 16,20 Jones et al enrolled 134 subjects, and 17 (12.6%) of them were mechanically ventilated.…”

“…1,2 Complications of tube thoracostomy include infection, tube malpositioning, laceration, and hemothorax, all of which may worsen outcome. [3][4][5][6][7][8][9] Several studies have compared the safety and efficacy of different chest tube sizes 3,[10][11][12] and various methods of chest tube removal. 13,14 Chest tube duration would seem to be an important management issue that might impact outcome, but there is a paucity of data on the impact of and risk factors affecting prolonged chest tube duration in patients with pneumothorax.…”

Thoracostomy tubes: A comprehensive review of complications and related topics

“…[112] This clinical finding can usually be attributed to subcutaneous side-port migration, suboptimal initial TT placement, poorly secured tube, and thoracostomy blockage. [112] When unanticipated subcutaneous emphysema is clinically or radiographically noted, management includes TT inspection, followed by tube repositioning or replacement, as applicable/indicated.…”

“…[112] This clinical finding can usually be attributed to subcutaneous side-port migration, suboptimal initial TT placement, poorly secured tube, and thoracostomy blockage. [112] When unanticipated subcutaneous emphysema is clinically or radiographically noted, management includes TT inspection, followed by tube repositioning or replacement, as applicable/indicated. When the subcutaneous air is associated with inadequate drainage despite properly placed chest tube, consideration should be given to placement of additional thoracostomy drainage, investigation of a more serious complication (i.e., bronchopleural fistula) up to and including operative therapy as indicated.…”