Tube Thoracostomy: A Structured Review of Case Reports and a Standardized Format for Reporting Complications

Aho, Johnathon M.; Ruparel, Raaj K.; Rowse, Phillip G.; Brahmbhatt, Rushin D.; Jenkins, Donald H.; Rivera, Mariela

doi:10.1007/s00268-015-3158-6

Cited by 24 publications

(46 citation statements)

References 210 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Using our previously developed standardized methodology (Appendix) 10 , we were able to uniformly identify and report this data and correlate with angle of insertion as measured on radiographs. To our knowledge, this is the first association found betweenTT angle of insertion,elevated BMI >30 and complications.…”

Section: Discussionmentioning

confidence: 99%

“…Post-procedural chestanteroposterior (AP) or posteroanterior (PA) radiographs were reviewed (by author MH)to determine the angle of TT from skin structuresto thoracic wall and measured relative to the thoracic wall (Figure 2). A previously validated complication classification method (Appendix 1) 10 was utilized to categorize complications. Primary endpoints were TT complications, which were grouped into major categories including: insertional, positional, removal, infective/immunologicor equipment failure (Appendix 1).…”

Section: Methodsmentioning

confidence: 99%

“…Complication categories 10 included: Insertional – Placement of TT into an intra or extrathoracic location with injury to a structure within 24 hours of placement. Injuries include, but not limited to, the lung parenchyma, esophagus, liver, great vessels, subcutaneous space etc.…”

Section: Methodsmentioning

confidence: 99%

“…This may lead tosubsequent injury from this force during placement on underlying structures, kinking of the TT leading to obstruction, or a TT position leading to poor drainage. We recently have developed a TT complication classification method which is robust, validated, successfully categorizes, and classifies complications of TT 10 .…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Tube thoracostomy

Hernandez

Laan²,

Zimmerman³

et al. 2016

Journal of Trauma and Acute Care Surgery

Self Cite

View full text Add to dashboard Cite

Introduction Tube thoracostomy (TT), considered a routine procedure, has significant complications. Current recommendations for placement rely on surface anatomy. There is no information to guide operators regarding angle of insertion relative to chest wall. We aim to determine if angle of insertion is associated with complications of TT. Methods We performed a retrospective review of adult trauma patients who necessitated TT at a level I trauma center over a 2 year period (January 2012 – December 2013). TT performed intraoperatively or using radiological guidance were excluded. Thoracic anteroposterior (AP) or posteroanterior (PA) radiographs were reviewed to determine the angle of insertion of TT relative to the thoracic wall. A previously validated classification method was utilized to categorize complications. Descriptive and univariate statistics were used to compare angle of insertion and complicated vs uncomplicated TT. Results Review identified 154 patients who underwent a total of 246 TT placed for emergent trauma. All patients had a post-procedural chest x-ray. We identified 90 complications (37%) over the study period. 144 of the TT’s reviewed had an angle of insertion less than 45 degrees of which there were 27 complications (19%). 102 of the TT’s had an angle greater than 45 degrees and 63 complications (62%), P<0.0001. Conclusions Tube thoracostomy insertion is inherently dangerous. Placement of TT using a higher angle of insertion greater than 45 degrees is associated with increased complications. Further prospective studies quantifying TT angle of insertion on outcomes are needed. Level of Evidence Level IV therapeutic study.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Tube thoracostomy

Hernandez

Laan²,

Zimmerman³

et al. 2016

Journal of Trauma and Acute Care Surgery

Self Cite

View full text Add to dashboard Cite

show abstract

“…Laterality for standard of care vs visual placement was assigned randomly and the procedure was repeated a total of five times on each side. For both the experimental and standard of care group a thoracoscope without insufflation was used to assess (1) intrathoracic TT placement, (2) location of TT position, (3) development complications based on a defined list of complication types (15). The TT operator was blinded to the thoracoscopic view during placement and was only allowed to utilize the TTVT for visually placed TT or open technique for standard of care.…”

Section: Methodsmentioning

confidence: 99%

Visually guided tube thoracostomy insertion comparison to standard of care in a large animal model

Hernandez

Vogelsang

Anderson

et al. 2017

Injury

Self Cite

View full text Add to dashboard Cite

Introduction Tube thoracostomy (TT) is a lifesaving procedure for a variety of thoracic pathologies. The most commonly utilized method for placement involves open dissection and blind insertion. Image guided placement is commonly utilized but is limited by an inability to see distal placement location. Unfortunately, TT is not without complications. We aim to demonstrate the feasibility of a disposable device to allow for visually directed TT placement compared to the standard of care in a large animal model. Methods Three swine were sequentially orotracheally intubated and anesthetized. TT was conducted utilizing a novel visualization device, tube thoracostomy visual trocar (TTVT) and standard of care (open technique). Position of the TT in the chest cavity were recorded using direct thoracoscopic inspection and radiographic imaging with the operator blinded to results. Complications were evaluated using a validated complication grading system. Standard descriptive statistical analyses were performed. Results Thirty TT were placed, 15 using TTVT technique, 15 using standard of care open technique. All of the TT placed using TTVT were without complication and in optimal position. Conversely, 27% of TT placed using standard of care open technique resulted in complications. Necropsy revealed no injury to intrathoracic organs. Conclusion Visual directed TT placement using TTVT is feasible and non-inferior to the standard of care in a large animal model. This improvement in instrumentation has the potential to greatly improve the safety of TT. Further study in humans is required.

show abstract

Comprehensive Review of Chest Tube Management

et al. 2022

View full text Add to dashboard Cite

horacostomy tube, otherwise known as chest tube, insertion can be traced back to the fifth century BCE when Hippocrates described using a hollow tin tube to drain what was likely an empyema. 1 In 1889, valved tubes with air-tight seals were first reported to prevent outside atmospheric pressure from collapsing the lung on inspiration. 2 In 1922, chest tubes were first documented in the postoperative care of patients undergoing modern thoracic surgery. 3 They were used throughout World War II to restore lung function after traumatic thoracotomies, were used during the Korean War, and later became the standard of care for drainage of the pleural space for trauma during the Vietnam War. 4 Chest tubes and their management continue to evolve and are modified to fit modern needs, including clinical conditions associated with the COVID-19 pandemic. IndicationsThe potential space between the visceral pleura that envelops the lungs and the parietal pleura covering the chest wall, diaphragm, and mediastinum is the pleural cavity, which contains lubricating pleural fluid secreted by the parietal pleural capillaries. Air and abnormal fluid can accumulate in this space, causing mass effect and disruptions in the normal negative intrathoracic pressure.When air fills the pleural cavity, it is called a pneumothorax, which is further categorized according to its etiology as primary spontaneous, secondary spontaneous, or traumatic. [5][6][7] Chest tubes are used to evacuate air in the pleural cavity and reestablish the negative in-trathoracic pressure, allowing the lung to reexpand and restore physiologic ventilation and cardiac function. [6][7][8][9] A tension pneumothorax develops when air enters on inspiration and is unable to escape on expiration. This leads to effective mass effect on intrathoracic structures, such as the lung itself; mediastinal structures, such as the venae cavae; and cardiac chambers, resulting in hemodynamic compromise from restricted venous return and cardiac output. This is a medical emergency and should initially be managed with immediate needle thoracentesis to decompress trapped and expanding pleural air before the placement of a formal chest tube.Chest tubes are also used to evacuate excessive fluid from the pleural cavity, which is known as a pleural effusion. When there is pus in the pleural cavity, then it is considered an empyema. There are several ways to evacuate fluid from the pleural cavity and chest tubes are only one of the many options. A Cochrane review from 2017 10 compared the surgical option of video-assisted thoracic surgery (VATS) with chest tube drainage of pleural empyema and found no difference in mortality or complications between the groups, but early VATS reduced the hospital length of stay. VATS has been considered the first-line treatment for retained hemothorax and empyemas with other modalities, such as intrapleural lytic therapy, reserved for poor operative candidates or as a second line treatment. 11 However, a meta-analysis by Hendriksen et al 11 found that treating ret...

show abstract

Tube Thoracostomy: A Structured Review of Case Reports and a Standardized Format for Reporting Complications

Abstract: Our classification method provides further clarity and systematic standardization for reporting TT complications.

Cited by 24 publications

References 210 publications

Tube thoracostomy

Tube thoracostomy

Visually guided tube thoracostomy insertion comparison to standard of care in a large animal model

Comprehensive Review of Chest Tube Management

Contact Info

Product

Resources

About