Systematic review and meta-analysis of tube thoracostomy following traumatic chest injury; suction versus water seal

Abstract

PurposeTube thoracostomy is frequently used in thoracic trauma patients. However, there is no consensus on whether low pressure suction or water seal is the optimal method of tube management. Against this background, we performed a systematic review of studies comparing suction and water seal management of chest tubes placed for traumatic chest injuries in adults. Evaluated outcomes are duration of chest tube treatment, length of stay in hospital, incidence of persistent air leak, clotted hemothorax, and the need for (re-)interventions.MethodsA systematic literature search according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines was performed. Included studies were evaluated according to the Cochrane Collaboration’s tool for assessing the risk of bias, and according to Grading of Recommendations Assessment, Development and Evaluation (GRADE) guidelines for assessing the quality of evidence.ResultsAfter assessment of 120 identified studies, three RCT’s (randomized controlled trials) were included in this review and meta-analysis. A favorable effect of suction was found for duration of chest tube treatment [MD (mean difference) − 3.38 days, P = 0.005], length of stay in hospital (MD −3.90 days, P = 0.0003), and the incidence of persistent air leak [OR (odds ratio) 0.27, P = 0.001]. No significant difference was found for the incidence of clotted hemothorax and (re-)interventions. The quality of evidence according to GRADE was low, except for persistent air leak (moderate).ConclusionsSuction seems to have a positive effect on duration of chest tube treatment, length of stay in hospital and persistent air leakage in chest trauma. However, available data was limited and the quality of evidence was (very) low to moderate according to GRADE.

It is Time to Replace Large Drains with Small Ones After Fixation of Rib Fractures: A Prospective Observational Study

“…Therefore, adequate drainage is critical to preventing fluid accumulation after thoracic surgical procedures. Tube thoracostomy combined with closed low-pressure suction is necessary during chest surgery, especially for chest trauma, to prevent the collapse of lung parenchyma [ 5 ]. Traditionally, large-bore chest tubes have been used after chest surgery.…”

“…Following surgery, suitable drainage for eliminating any residual hemothorax or pneumothorax is required. Adequate drainage combined with low-pressure suction is critical to maintaining full expansion of the lung parenchyma [ 4 , 5 ].…”

Improved outcomes utilizing a novel pectin-based pleural sealant following acute lung injury

“…Penetrating and blunt trauma to the chest occurs in 60% of polytrauma patients and accounts for approximately 25% of mortality in the US. (20,21) Air leaks related to parenchymal injuries account for roughly one fifth of these injuries with the majority of these patients being successfully managed with chest tube drainage. ( 22) However, up to 20% of these patients may develop persistent air leaks.…”

Chest drain and thoracotomy for chest trauma

“…Outcomes in terms of duration, complications and failures were similar between the two group, with a significant lower pain in patients who were treated with a pig tail. Nevertheless, data regarding pain assessment comparing small and large bore chest drains are inconsistent and several studies did not show any significant difference (22,(26)(27)(28).…”