Pre-hospital and in-hospital thoracostomy: indications and complications (original) (raw)
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Thoracostomy tubes: A comprehensive review of complications and related topics
International Journal of Critical Illness and Injury Science, 2014
Tube thoracostomy (TT) placement belongs among the most commonly performed procedures. Despite many benefits of TT drainage, potential for significant morbidity and mortality exists. Abdominal or thoracic injury, fistula formation and vascular trauma are among the most serious, but more common complications such as recurrent pneumothorax, insertion site infection and nonfunctioning or malpositioned TT also represent a significant source of morbidity and treatment cost. Awareness of potential complications and familiarity with associated preventive, diagnostic and treatment strategies are fundamental to satisfactory patient outcomes. This review focuses on chest tube complications and related topics, with emphasis on prevention and problem-oriented approaches to diagnosis and treatment. The authors hope that this manuscript will serve as a valuable foundation for those who wish to become adept at the management of chest tubes.
Tube Thoracostomy: Complications and Its Management
Pulmonary Medicine, 2012
Background. Tube thoracostomy is widely used throughout the medical, surgical, and critical care specialities. It is generally used to drain pleural collections either as elective or emergency. Complications resulting from tube thoracostomy can occasionally be life threatening.Aim. To present an update on the complications and management of complications of tube thoracostomy.Methods. A review of the publications obtained from Medline search, medical libraries, and Google on tube thoracostomy and its complications was done.Results. Tube thoracostomy is a common surgical procedure which can be performed by either the blunt dissection technique or the trocar technique. Complication rates are increased by the trocar technique. These complications have been broadly classified as either technical or infective. Technical causes include tube malposition, blocked drain, chest drain dislodgement, reexpansion pulmonary edema, subcutaneous emphysema, nerve injuries, cardiac and vascular injurie...
Tube thoracostomy; chest tube implantation and follow up
Journal of thoracic disease, 2014
Pneumothorax is an urgent medical situation that requires urgent treatment. We can divide this entity based on the etiology to primary and secondary. Chest tube implantation can be performed either in the upper chest wall or lower. Both thoracic surgeons and pulmonary physicians can place a chest tube with minimal invasive techniques. In our current work, we will demonstrate chest tube implantation to locations, methodology and tools.
Analysis of Tube Thoracostomy Performed by Pulmonologists at a Teaching Hospital
Chest, 1997
To evaluate all tube thoracostomies (TTs) done by pulmonary/critical care fellows and attending physicians in the Medical University of South Carolina's health-care system documenting patient demographics, indication for placement, size and characteristics of the tube, and associated problems. Design: Prospective. Setting: University health-care system, including a university hospital, a Veterans Affairs hospital, and a county hospital. Patients: All adult patients requiring consultation by a member of the pulmonary/critical care staff for a tube thoracostomy. Results: One hundred twenty-six tube thoracostomies were performed over a 24-month period in 91 patients. The most common initial indication for a TT was pneumothorax (69/103, 67%). Overall mortality in the patient population was 35% (32/91). Early problems (<24 hours following placement) occurred in 3% (4/126); late problems (>24 h after placement) occurred in 8% (10/126). Problems occurred in 36% (4/ll) of small-bore tube placements vs 9% (10/ll5) of standard TT placements (p=0.02). Conclusions: Tube thoracostomy can be safely performed by pulmonologists with relatively few associated problems.
OSMANGAZİ JOURNAL OF MEDICINE, 2021
Traumatic hemothorax/pneumothorax; is a pathological condition seen in blunt and sharp thoracic traumas and can generally be treated by tube thoracostomy. While patients are being followed up with tube thoracotomy, analgesics support, and respiratory exercise support; emergency thoracotomy is usually not required. Early thoracoscopy is a method that has come to the fore in recent years. This thoracoscopy is known to have therapeutic and diagnostic benefits. In our study; the files of 40 patients who underwent tube thoracostomy after traumatic hemothorax/pneumothorax were reviewed retrospectively. Twenty of these patients, whose radiological and clinical improvement could not be achieved after tube thoracostomy, underwent thoracoscopy with sedo-analgesia on the first day after the procedure. The remaining 20 patients were followed up without any additional procedures. Patients' age, gender, trauma type, tube thoracostomy indication, presence of additional trauma, length of chest tube stay, length of hospital stay, WBC, RDW, %Neu, pO2, pCO2, SO2, presence of tube malposition, and complications were recorded from patient files. Demographic data of the two groups were similar. While tube withdrawal time was 4.7±1.5 days in the thoracoscopy group, it was 6.9±1.9 days in the control group. This difference was statistically significant (p < 0.001). The mean hospital stay was 7.1±2.0 days in the first group, while it was 9.3±3.3 days in the control group. This difference was statistically significant (p=0.014). In both groups, there was a 1 (5%) patient who developed a need for thoracotomy. Thoracoscopy with sedo-analgesia in early period is a safe method for patients who have undergone tube thoracostomy due to trauma. This method reduces the duration of chest tube removal and hospital stay of patients. The need for thoracotomy after follow-up was similar in both groups.
SpringerPlus, 2013
The management and removal of thoracostomy tubes for trauma-related hemothorax and pneumothorax is controversial. General recommendations exist; however, institutional data related to an algorithmic approach has not been well described. The difficulty in establishing an algorithm centers about individualized patients' needs for subsequent management after thoracostomy tube placement. In our institution, we use the same protocol for all trauma patients who receive a thoracostomy tube with minimal complications. To present the clinical outcomes of patients who required a tube thoracostomy for traumatic injury and were managed by an institutional protocol. A retrospective chart review of 313 trauma patients at a single level I trauma institution from January 2008 through June 2012 was conducted. Inclusion criteria were patient age ≥ 18 years, involvement in a trauma, and requirement of a thoracostomy tube. The patients' charts were reviewed for demographic data, injury severity...
SBMU publishing, 2017
Introduction: Tube thoracostomy complications depend on the operator's skill, patients' general condition and the place in which the procedure is done. The present study aimed to compare the quality and complications of tube thoracostomy carried out by emergency medicine residents (EMRs) and surgery residents (SRs). Methods: This cohort study was conducted on 18-60 years old trauma patients in need of tube thoracostomy presenting to two academic emergency departments. Quality of tube placement and its subsequent complications until tube removal were compared between SRs and EMRs using SPSS 20. Results: 72 patients with the mean age of 37.1±14.1 years were studied (86.1% male). 23 (63.8%) cases were complicated in SRs and 22 (61.1%) cases in EMRs group (total= 62.5%). Chest drain dislodgement (22.2% in SRs vs. 22.2% EMRs; p>0.99), drainage failure (19.4% in SRs vs. 16.7% EMRs; p=0.50), and surgical site infection (11.1% in SRs vs. 19.4% EMRs; p=0.25) were among the most common observed complications. The overall odds ratio of complication development was 0.89 (95% CI: 0.35-2.25, p = 0.814) for SRs and 1.12 (95% CI: 0.28-4.53, p = 0.867) for EMRs. Conclusion: The findings of the present study showed no significant difference between SRs and EMRs regarding quality of tube thoracostomy placement and its subsequent complications for trauma patients. The rate of complications were interestingly high (>60%) for both groups.
The American Journal of Surgery, 2019
Objective: This study examined the indications for prehospital needle thoracostomy (pNT), the need for tube thoracostomy (TT) following pNT, and the outcomes of patients who underwent pNT. Methods: This study is a retrospective chart review of patients who underwent pNT prior to trauma center arrival. Patients were identified from the trauma registry and a quality improvement (QI) database from 9/2014e9/2018. Results: 59 patients underwent 63 pNTs during the time period. The indication for pNT was "hypotension" in only 5 patients (7.9%). A CT chest was obtained on 51 NT attempts with the catheter in place. In 48 (94.1%) NT attempts, the catheter was not in the pleural space. 44 (69.4%) TTs were placed on admission date. Conclusion: In patients undergoing pNT, hypotension was rarely the indication. Additionally, CT identified the catheter within the pleural space in only 3 (5.8%) NT attempts. TT placement was performed in 79.3% of NT attempts.
Chest Tube Management Practices by Trauma Surgeons
Journal of Surgical Research, 2019
Background: Chest tube (CT) placement is among the most common procedures performed by trauma surgeons; evidence guiding CT management is limited and tends toward thoracic surgery patients. The study goal was to identify current CT management practices among trauma providers. Materials and methods: We designed a Web-based multiple-choice survey to assess CT management practices of trauma providers who were active, senior, or provisional members (n ¼ 1890) of the Eastern Association for the Surgery of Trauma and distributed via e-mail. Descriptive statistics were used. Results: The response rate was 39% (n ¼ 734). Ninety-one percent of respondents were attending surgeons, the remainder fellows or residents. Regarding experience, 36% of respondents had five or fewer years of practice, 54% 10 y or fewer, and 79% 20 y or fewer. Attendings were more likely than trainees to place pigtail catheters for stable patients with pneumothorax (PTX). Attendings with experience of <5 y were more likely to choose a pigtail than more experienced surgeons for elderly patients with PTX. Respondents preferred standard size CTs for hemothorax and unstable patients with PTX, and larger tubes for unstable patients with hemothorax. Most respondents (53%) perceived the quality of evidence for trauma CT management to be low and cited personal experience and training as the main factors driving their practice. Conclusions: Trauma CT management is variable and nonstandardized, depending mostly on clinician training and personal experience. Few surgeons identify their practice as evidence based. We offer compelling justification for the need for trauma CT management research to determine best practices.