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Messa GE, Fontenot CJ, Deville PE, Hunt JP, Marr AB, Schoen JE, Stuke LE, Greiffenstein PP, Smith AA. Chest Tube Size Selection: Evaluating Provider Practices, Treatment Efficacy, and Complications in Management of Thoracic Trauma. Am Surg 2024:31348241241735. [PMID: 38557288 DOI: 10.1177/00031348241241735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
BACKGROUND The standard for managing traumatic pneumothorax (PTX), hemothorax (HTX), and hemopneumothorax (HPTX) has historically been large-bore (LB) chest tubes (>20-Fr). Previous studies have shown equal efficacy of small-bore (SB) chest tubes (≤19-Fr) in draining PTX and HTX/HPTX. This study aimed to evaluate provider practice patterns, treatment efficacy, and complications related to the selection of chest tube sizes for patients with thoracic trauma. METHODS A retrospective chart review was performed on adult patients who underwent tube thoracostomy for traumatic PTX, HTX, or HPTX at a Level 1 Trauma Center from January 2016 to December 2021. Comparison was made between SB and LB thoracostomy tubes. The primary outcome was indication for chest tube placement based on injury pattern. Secondary outcomes included retained hemothorax, insertion-related complications, and duration of chest tube placement. Univariate and multivariate analyses were performed. RESULTS Three hundred and forty-one patients were included and 297 (87.1%) received LB tubes. No significant differences were found between the groups concerning tube failure and insertion-related complications. LB tubes were more frequently placed in patients with penetrating MOI, higher average ISS, and higher average thoracic AIS. Patients who received LB chest tubes experienced a higher incidence of retained HTX. DISCUSSION In patients with thoracic trauma, both SB and LB chest tubes may be used for treatment. SB tubes are typically placed in nonemergent situations, and there is apparent provider bias for LB tubes. A future randomized clinical trial is needed to provide additional data on the usage of SB tubes in emergent situations.
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Affiliation(s)
- Genevieve E Messa
- Department of Surgery, Louisiana State University Health New Orleans, School of Medicine, New Orleans, LA, USA
| | - Cameron J Fontenot
- Department of Surgery, Louisiana State University Health New Orleans, School of Medicine, New Orleans, LA, USA
| | - Paige E Deville
- Department of Surgery, Louisiana State University Health New Orleans, School of Medicine, New Orleans, LA, USA
| | - John P Hunt
- Department of Surgery, Louisiana State University Health New Orleans, School of Medicine, New Orleans, LA, USA
- Trauma and Critical Care, University Medical Center New Orleans, New Orleans, LA, USA
| | - Alan B Marr
- Department of Surgery, Louisiana State University Health New Orleans, School of Medicine, New Orleans, LA, USA
- Trauma and Critical Care, University Medical Center New Orleans, New Orleans, LA, USA
| | - Jonathan E Schoen
- Department of Surgery, Louisiana State University Health New Orleans, School of Medicine, New Orleans, LA, USA
- Trauma and Critical Care, University Medical Center New Orleans, New Orleans, LA, USA
| | - Lance E Stuke
- Department of Surgery, Louisiana State University Health New Orleans, School of Medicine, New Orleans, LA, USA
- Trauma and Critical Care, University Medical Center New Orleans, New Orleans, LA, USA
| | - Patrick P Greiffenstein
- Department of Surgery, Louisiana State University Health New Orleans, School of Medicine, New Orleans, LA, USA
- Trauma and Critical Care, University Medical Center New Orleans, New Orleans, LA, USA
| | - Alison A Smith
- Department of Surgery, Louisiana State University Health New Orleans, School of Medicine, New Orleans, LA, USA
- Trauma and Critical Care, University Medical Center New Orleans, New Orleans, LA, USA
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Beeton G, Ngatuvai M, Breeding T, Andrade R, Zagales R, Khan A, Santos R, Elkbuli A. Outcomes of Pigtail Catheter Placement versus Chest Tube Placement in Adult Thoracic Trauma Patients: A Systematic Review and Meta-Analysis. Am Surg 2023:31348231157809. [PMID: 36802811 DOI: 10.1177/00031348231157809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
INTRODUCTION A debate currently exists regarding the efficacy of pigtail catheters vs chest tubes in the management of thoracic trauma. This meta-analysis aims to compare the outcomes of pigtail catheters vs chest tubes in adult trauma patients with thoracic injuries. METHODS This systematic review and meta-analysis were conducted using PRISMA guidelines and registered with PROSPERO. PubMed, Google Scholar, Embase, Ebsco, and ProQuest electronic databases were queried for studies comparing the use of pigtail catheters vs chest tubes in adult trauma patients from database inception to August 15th, 2022. The primary outcome was the failure rate of drainage tubes, defined as requiring a second tube placement or VATS, unresolved pneumothorax, hemothorax, or hemopneumothorax requiring additional intervention. Secondary outcomes were initial drainage output, ICU-LOS, and ventilator days. RESULTS A total of 7 studies satisfied eligibility criteria and were assessed in the meta-analysis. The pigtail group had higher initial output volumes vs the chest tube group, with a mean difference of 114.7 mL [95% CI (70.6 mL, 158.8 mL)]. Patients in the chest tube group also had a higher risk of requiring VATS vs the pigtail group, with a relative risk of 2.77 [95% CI (1.50, 5.11)]. CONCLUSIONS In trauma patients, pigtail catheters rather than chest tubes are associated with higher initial output volume, reduced risk of VATS, and shorter tube duration. Considering the similar rates of failure, ventilator days, and ICU length-of-stay, pigtail catheters should be considered in the management of traumatic thoracic injuries. STUDY TYPE Systematic Review and meta-analysis.
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Affiliation(s)
- George Beeton
- 12376University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Micah Ngatuvai
- Dr Kiran C. Patel College of Allopathic Medicine, 2814NOVA Southeastern University, Fort Lauderdale, FL, USA
| | - Tessa Breeding
- Dr Kiran C. Patel College of Allopathic Medicine, 2814NOVA Southeastern University, Fort Lauderdale, FL, USA
| | - Ryan Andrade
- 390414A.T. Still University School of Osteopathic Medicine, Mesa, AZ, USA
| | - Ruth Zagales
- 5450Florida International University, Miami, FL, USA
| | - Areeba Khan
- Department of Mathematics, 2814NOVA Southeastern University, Fort Lauderdale, FL, USA
| | - Radleigh Santos
- Department of Mathematics, 2814NOVA Southeastern University, Fort Lauderdale, FL, USA
| | - Adel Elkbuli
- Department of Surgery, Division of Trauma and Surgical Critical Care, 25105Orlando Regional Medical Center, Orlando, FL, USA.,Department of Surgical Education, 25105Orlando Regional Medical Center, Orlando, FL, USA
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Terada T, Nishimura T, Uchida K, Hagawa N, Esaki M, Mizobata Y. How emergency physicians choose chest tube size for traumatic pneumothorax or hemothorax: a comparison between 28Fr and smaller tube. NAGOYA JOURNAL OF MEDICAL SCIENCE 2021; 82:59-68. [PMID: 32273633 PMCID: PMC7103871 DOI: 10.18999/nagjms.82.1.59] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Most traumatic pneumothoraxes and hemothoraxes can be managed non-operatively by means of chest tube thoracostomy. This study aimed to investigate how emergency physicians choose chest tube size and whether chest tube size affects patient outcome. We reviewed medical charts of patients who underwent chest tube insertion for chest trauma within 24 hours of admission in this retrospective, single-institution study. Patient characteristics, inserted tube size, risk of additional tube, and complications were evaluated. Eighty-six chest tubes were placed in 64 patients. Sixty-seven tubes were placed initially, and 19 additionally, which was significantly smaller than the initial tube. Initial tube size was 28 Fr in 38 and <28 Fr in 28 patients. Indications were pneumothorax (n=24), hemothorax (n=7), and hemopneumothorax (n=36). Initial tube size was not related to sex, BMI, BSA, indication, ISS, RTS, chest AIS, or respiratory status. An additional tube was placed in the same thoracic cavity for residual pneumothorax (n=13), hemothorax (n=1), hemopneumothorax (n=1), and inappropriate extrapleural placement (n=3). Risk of additional tube placement was not significantly different depending on tube size. No additional tube was placed for tube occlusion or surgical intervention for residual clotted hemothorax. Emergency physicians did not choose tube size depending on patient sex, body size, or situation. Even with a <28 Fr tube placed in chest trauma patients, the risk of residual hemo/pneumothorax and tube occlusion did not increase, and drainage was effective.
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Affiliation(s)
- Takafumi Terada
- JA Aichi Koseiren Toyota Kosei Hospital, Department of Cardiac Surgery, Aichi, Japan
| | - Tetsuro Nishimura
- Department of Traumatology and Critical Care Medicine, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Kenichiro Uchida
- Department of Traumatology and Critical Care Medicine, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Naohiro Hagawa
- Department of Traumatology and Critical Care Medicine, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Maiko Esaki
- Department of Traumatology and Critical Care Medicine, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Yasumitsu Mizobata
- Department of Traumatology and Critical Care Medicine, Graduate School of Medicine, Osaka City University, Osaka, Japan
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Bauman ZM, Kulvatunyou N, Joseph B, Gries L, O'Keeffe T, Tang AL, Rhee P. Randomized Clinical Trial of 14-French (14F) Pigtail Catheters versus 28-32F Chest Tubes in the Management of Patients with Traumatic Hemothorax and Hemopneumothorax. World J Surg 2021; 45:880-886. [PMID: 33415448 PMCID: PMC7790482 DOI: 10.1007/s00268-020-05852-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/23/2020] [Indexed: 12/01/2022]
Abstract
Introduction Traditional management of traumatic hemothorax/hemopneumothorax (HTX/HPTX) has been insertion of large-bore 32–40 French (Fr) chest tubes (CTs). Retrospective studies have shown 14Fr percutaneous pigtail catheters (PCs) are equally effective as CTs. Our aim was to compare effectiveness between PCs and CTs by performing the first randomized controlled trial (RCT). We hypothesize PCs work equally as well as CTs in management of traumatic HTX/HPTX. Methods Prospective RCT comparing 14Fr PCs to 28–32Fr CTs for management of traumatic HTX/HPTX from 07/2015 to 01/2018. We excluded patients requiring emergency tube placement or who refused. Primary outcome was failure rate defined as retained HTX or recurrent PTX requiring additional intervention. Secondary outcomes included initial output (IO), tube days and insertion perception experience (IPE) score on a scale of 1–5 (1 = tolerable experience, 5 = worst experience). Unpaired Student’s t-test, chi-square and Wilcoxon rank-sum test were utilized with significance set at P < 0.05. Results Forty-three patients were enrolled. Baseline characteristics between PC patients (N = 20) and CT patients (N = 23) were similar. Failure rates (10% PCs vs. 17% CTs, P = 0.49) between cohorts were similar. IO (median, 650 milliliters[ml]; interquartile range[IR], 375–1087; for PCs vs. 400 ml; IR, 240–700; for CTs, P = 0.06), and tube duration was similar, but PC patients reported lower IPE scores (median, 1, “I can tolerate it”; IR, 1–2) than CT patients (median, 3, “It was a bad experience”; IR, 3–4, P = 0.001). Conclusion In patients with traumatic HTX/HPTX, 14Fr PCs were equally as effective as 28–32Fr CTs with no significant difference in failure rates. PC patients, however, reported a better insertion experience. www.ClinicalTrials.gov Registration ID: NCT02553434
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Affiliation(s)
- Zachary M Bauman
- Division of Acute Care Surgery, Department of Surgery, University of Nebraska, Omaha, NE, USA
| | - Narong Kulvatunyou
- Division of Acute Care Surgery, Department of Surgery, University of Arizona, 1501 N. Campbell Ave., Room 5411, PO Box 245063, Tucson, AZ, 85724-5063, USA.
| | - Bellal Joseph
- Division of Acute Care Surgery, Department of Surgery, University of Arizona, 1501 N. Campbell Ave., Room 5411, PO Box 245063, Tucson, AZ, 85724-5063, USA
| | - Lynn Gries
- Division of Acute Care Surgery, Department of Surgery, University of Arizona, 1501 N. Campbell Ave., Room 5411, PO Box 245063, Tucson, AZ, 85724-5063, USA
| | - Terence O'Keeffe
- Division of Acute Care Surgery, Department of Surgery, University of Arizona, 1501 N. Campbell Ave., Room 5411, PO Box 245063, Tucson, AZ, 85724-5063, USA
| | - Andrew L Tang
- Division of Acute Care Surgery, Department of Surgery, University of Arizona, 1501 N. Campbell Ave., Room 5411, PO Box 245063, Tucson, AZ, 85724-5063, USA
| | - Peter Rhee
- Department of Surgery, New York Medical College, Valhalla, NY, USA
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Yoshioka Y, Ishikura H. Chest Trauma Management with Small-Bore Chest Tube. J Emerg Trauma Shock 2020; 13:318-319. [PMID: 33897153 PMCID: PMC8047954 DOI: 10.4103/jets.jets_57_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 04/21/2020] [Accepted: 04/21/2020] [Indexed: 11/04/2022] Open
Affiliation(s)
- Yuki Yoshioka
- Department of Emergency and Critical Care Medicine, Tokushima Red Cross Hospital, Komatsushima, Tokushima 773-8502, Japan
| | - Hisashi Ishikura
- Department of Thoracic Surgery, Tokushima Red Cross Hospital, Komatsushima, Tokushima 773-8502, Japan
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Puetz J, Segon A, Umpierrez A. Two-Year Experience of 14 French Pigtail Catheters Placed by Procedure-Focused Hospitalists. J Hosp Med 2020; 15:526-530. [PMID: 32195653 DOI: 10.12788/jhm.3383] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 01/13/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND Recent studies show small-bore chest tubes, commonly 14 French pigtail catheters (PCs), are noninferior to large-bore chest tubes for treating various conditions, and they are associated with better patient comfort. The Medical College of Wisconsin implemented a bedside procedure service (BPS) that has been trained in the placement of PCs as an adjunct to its interventional radiology department. METHODS The data regarding consults for PC placement was collected by the BPS over a 2-year period. Primary outcomes reviewed were insertion-related complications (IRCs), unsuccessful attempts (UAs), and adverse outcomes (AOs) because the authors believe these represent the safety and effectiveness of the group. It was determined which services consulted the BPS for PC placement, the indications for consults, and a brief review of declined PC consults. RESULTS Of the 124 accepted consults, the service had 3 IRCs (2.4%), 2 UAs (1.6%), and 3 AOs (2.4%). A total of 18 consults were declined. The BPS was consulted by 12 services with 8 primary reasons for PC placement. CONCLUSIONS At high-volume, tertiary care centers, and with the support of cardiothoracic surgical and interventional radiology services, procedure-focused hospitalists can safely serve as an adjunct service for PC placement in selected hospitalized patients.
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Affiliation(s)
- Joseph Puetz
- General Internal Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Ankur Segon
- General Internal Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Adrian Umpierrez
- General Internal Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
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Fang M, Liu G, Luo G, Wu T. Does pigtail catheters relieve pneumothorax?: A PRISMA-compliant systematic review and meta-analysis. Medicine (Baltimore) 2018; 97:e13255. [PMID: 30461628 PMCID: PMC6392921 DOI: 10.1097/md.0000000000013255] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 10/22/2018] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Pigtail catheter drainage has been usually applied for the treatment of pleural effusion and pneumothorax. Our aim was to investigate the application and efficacy of pigtail catheters for pneumothorax. METHODS We carried out a meta-analysis of retro- or pro-spective studies addressing the effect of pigtail catheters for pneumothorax. We presented success rates of pigtail catheter drainage as primary outcomes, and considered the duration of drainage, and complication rates as secondary outcomes. Pooled data were available using the fixed or random effects model. Heterogeneity, sensitivity, and subgroup analyses were performed. RESULTS The meta-analysis was based on 16 articles with a total of 1067 patients. Our analyses showed that pooled success rates were 0.77 (0.71-0.82), )furthermore, duration of drainage was 5.61 (3.99-7.23), and complication rates 0.18 (0.09-0.27). Subgroup results according to causes of pneumothorax and patient characteristics were robust and all consistent with overall outcomes. CONCLUSION These suggested that pigtail catheter insertion within radiological guidance may provide a safe and effective way for the treatment of pneumothorax. More large-scale and prospective studies were required to determine these findings.
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8
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Bauman ZM, Kulvatunyou N, Joseph B, Jain A, Friese RS, Gries L, O'Keeffe T, Tang AL, Vercruysse G, Rhee P. A Prospective Study of 7-Year Experience Using Percutaneous 14-French Pigtail Catheters for Traumatic Hemothorax/Hemopneumothorax at a Level-1 Trauma Center: Size Still Does Not Matter. World J Surg 2018; 42:107-113. [PMID: 28795207 DOI: 10.1007/s00268-017-4168-3] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The effectiveness of 14-French (14F) pigtail catheters (PCs) compared to 32-40F chest tubes (CTs) in patients with traumatic hemothorax (HTX) and hemopneumothorax (HPTX) is becoming more well known but still lacking. The aim of our study was to analyze our cumulative experience and outcomes with PCs in patients with traumatic HTX/HPTX. We hypothesized that PCs would be as effective as CTs. METHODS Using our PC database, we analyzed all trauma patients who required chest drainage for HTX/HPTX from 2008 to 2014. Primary outcomes of interest, comparing PCs to CTs, included initial drainage output in milliliters (mL), tube insertion-related complications, and failure rate. For our statistical analysis, we used the unpaired Student's t test, Chi-square test, and Wilcoxon rank-sum test. We defined statistical significance as P < 0.05. RESULTS During the 7-year period, 496 trauma patients required chest drainage for traumatic HTX/HPTX: 307 by CTs and 189 by PCs. PC patients were older (52 ± 21 vs. 42 ± 19, P < 0.001), demonstrated a significantly higher occurrence of blunt trauma (86 vs. 55%, P ≤ 0.001), and had tubes placed in a non-emergent fashion (Day 1 [interquartile range (IQR) 1-3 days] for PC placement vs. Day 0 [IQR 0-1 days] for CT placement, P < 0.001). All primary outcomes of interest were similar, except that the initial drainage output for PCs was higher (425 mL [IQR 200-800 mL] vs. 300 mL [IQR 150-500], P < 0.001). Findings for subgroup analysis among emergent and non-emergent PC placement were also similar to CT placement. CONCLUSION PCs had similar outcomes to CTs in terms of failure rate and tube insertion-related complications, and the initial drainage output from PCs was not inferior to that of CTs. The usage of PCs was, however, selective. A future multi-center study is needed to provide additional support and information for PC usage in traumatic HTX/HPTX.
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Affiliation(s)
- Zachary M Bauman
- Division of Trauma, Emergency General Surgery, and Critical Care, Department of Surgery, University of Nebraska, Omaha, NE, USA
| | - Narong Kulvatunyou
- Division of Acute Care Surgery, Department of Surgery, University of Arizona, Tucson, AZ, USA.
- Department of Surgery, Division of Trauma, Section of Trauma, Critical Care, and Emergency General Surgery, University of Arizona, 1501 N. Campbell Ave, Rm. 5411, PO Box 245063, Tucson, AZ, 85727-5063, USA.
| | - Bellal Joseph
- Division of Acute Care Surgery, Department of Surgery, University of Arizona, Tucson, AZ, USA
| | - Arpana Jain
- Division of Acute Care Surgery, Department of Surgery, University of Arizona, Tucson, AZ, USA
| | - Randall S Friese
- Division of Acute Care Surgery, Department of Surgery, University of Arizona, Tucson, AZ, USA
| | - Lynn Gries
- Division of Acute Care Surgery, Department of Surgery, University of Arizona, Tucson, AZ, USA
| | - Terence O'Keeffe
- Division of Acute Care Surgery, Department of Surgery, University of Arizona, Tucson, AZ, USA
| | - Andy L Tang
- Division of Acute Care Surgery, Department of Surgery, University of Arizona, Tucson, AZ, USA
| | - Gary Vercruysse
- Division of Acute Care Surgery, Department of Surgery, University of Arizona, Tucson, AZ, USA
| | - Peter Rhee
- Grady Memorial Hospital, Atlanta, GA, USA
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Small tube thoracostomy (20-22 Fr) in emergent management of chest trauma. Injury 2017; 48:1884-1887. [PMID: 28673640 DOI: 10.1016/j.injury.2017.06.021] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Revised: 06/16/2017] [Accepted: 06/21/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND The optimal tube size for an emergent thoracostomy for traumatic pneumothorax or hemothorax is unknown. Both small catheter tube thoracostomy and large-bore chest tube thoracostomy have been shown to work for the nonemergent management of patients with traumatic pneumothorax or hemothorax. This study was conducted to compare the efficacy of a small chest tube with that of a large tube in emergent thoracostomy due to chest trauma. Our hypothesis was that there would be no difference in clinical outcomes including tube-related complications, the need for additional tube placement, and thoracotomy, with the replacement of large tubes with small tubes. METHODS A retrospective review of all patients with chest trauma requiring tube thoracostomy within the first 2h from arrival at our emergency department over a 7-year period was conducted. Charts were reviewed for demographic data and outcomes including complications and initial drainage output. Small chest tubes (20-22 Fr) were compared with a large tube (28 Fr). Our primary outcome was tube-related complications. Secondary outcomes included additional invasive procedures, such as additional tube insertion and thoracotomy. RESULTS There were 124 tube thoracostomies (small: 68, large: 56) performed in 116 patients. There were no significant differences between the small- and large-tube groups with regard to age, gender, injury mechanism, systolic blood pressure, heart rate, and injury severity score. Both groups were similar in the posterior direction of tube insertion, initial drainage output, and the duration of tube insertion. There was no significant difference in the primary outcomes of tube-related complications, including empyema (small: 1/68 vs. large: 1/56; p=1.000) or retained hemothorax (small: 2/68 vs. large: 2/56; p=1.000). Secondary outcomes, including the need for additional tube placement (small: 2/68 vs. large: 4/56; p=0.408) or thoracotomy (small: 2/68 vs. large: 1/56; p=1.000), were also similar. CONCLUSION For patients with chest trauma, emergent insertion of 20-22 Fr chest tubes has no difference in the efficacy of drainage, rate of complications, and need for additional invasive procedures compared with a large tube (28 Fr).
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Riber SS, Riber LPS, Olesen WH, Licht PB. The influence of chest tube size and position in primary spontaneous pneumothorax. J Thorac Dis 2017; 9:327-332. [PMID: 28275481 DOI: 10.21037/jtd.2017.02.18] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Optimal chest tube position in the pleural cavity is largely unexplored for the treatment of primary spontaneous pneumothorax (PSP). We investigated whether type, size and position of chest tubes influenced duration of treatment for PSP. METHODS A retrospective follow-up study of all patients admitted with PSP over a 5-year period. Traumatic, iatrogenic and secondary pneumothoraxes were excluded. Gender, age, smoking habits, type and size of chest tube used (pigtail catheter or surgical chest tube) were recorded from the patients' charts. All chest X-rays upon admittance and immediately following chest tube placement were retrieved and re-evaluated for size of pneumothorax (categorized into five groups) and location of the chest tube tip (categorized as upper, middle or lower third of the pleural cavity). All data were analysed in a Cox proportional hazards regression model. RESULTS We identified 134 patients with PSP. Baseline characteristics were similar for patients treated with surgical chest tubes and pigtail catheters. Chest tube duration was not significantly influenced by position of the chest tube tip, but was significantly longer in females (P<0.01), patients <30 years (P=0.01), larger pneumothoraxes (P<0.01), use of surgical chest tubes (P=0.03) and a history of previous pneumothorax (P=0.04). CONCLUSIONS Contrary to common belief and guidelines recommendation the position of a chest tube in the pleural cavity did not significantly influence chest tube duration, but it was significantly longer in patients who were treated with a surgical chest tube.
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Affiliation(s)
- Sara S Riber
- Department of Cardiothoracic Surgery, Odense University Hospital, Odense, Denmark
| | - Lars P S Riber
- Department of Cardiothoracic Surgery, Odense University Hospital, Odense, Denmark
| | - Winnie H Olesen
- Department of Cardiothoracic Surgery, Odense University Hospital, Odense, Denmark
| | - Peter B Licht
- Department of Cardiothoracic Surgery, Odense University Hospital, Odense, Denmark
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Hussein RM, Elshahat HM, Shaker A, Hashem AZA. Study of pigtail catheter and chest tube in management of secondary spontaneous pneumothorax. EGYPTIAN JOURNAL OF CHEST DISEASES AND TUBERCULOSIS 2017. [DOI: 10.1016/j.ejcdt.2016.08.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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A pilot study of chest tube versus pigtail catheter drainage of acute hemothorax in swine. J Trauma Acute Care Surg 2016; 79:1038-43; discussion 1043. [PMID: 26317812 DOI: 10.1097/ta.0000000000000693] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Evacuation of traumatic hemothorax (HTx) is typically accomplished with large-bore (28-40 Fr) chest tubes, often resulting in patient discomfort. Management of HTx with smaller (14 Fr) pigtail catheters has not been widely adopted because of concerns about tube occlusion and blood evacuation rates. We compared pigtail catheters with chest tubes for the drainage of acute HTx in a swine model. METHODS Six Yorkshire cross-bred swine (44-54 kg) were anesthetized, instrumented, and mechanically ventilated. A 32 Fr chest tube was placed in one randomly assigned hemithorax; a 14 Fr pigtail catheter was placed in the other. Each was connected to a chest drainage system at -20 cm H2O suction and clamped. Over 15 minutes, 1,500 mL of arterial blood was withdrawn via femoral artery catheters. Seven hundred fifty milliliters of the withdrawn blood was instilled into each pleural space, and fluid resuscitation with colloid was initiated. The chest drains were then unclamped. Output from each drain was measured every minute for 5 minutes and then every 5 minutes for 40 minutes. The swine were euthanized, and thoracotomies were performed to quantify the volume of blood remaining in each pleural space and to examine the position of each tube. RESULTS Blood drainage was more rapid from the chest tube during the first 3 minutes compared with the pigtail catheter (348 ± 109 mL/min vs. 176 ± 53 mL/min), but this difference was not statistically significant (p = 0.19). Thereafter, the rates of drainage between the two tubes were not substantially different. The chest tube drained a higher total percentage of the blood from the chest (87.3% vs. 70.3%), but this difference did not reach statistical significance (p = 0.21). CONCLUSION We found no statistically significant difference in the volume of blood drained by a 14 Fr pigtail catheter compared with a 32 Fr chest tube.
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14
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Vinson DR, Ballard DW, Hance LG, Stevenson MD, Clague VA, Rauchwerger AS, Reed ME, Mark DG. Pneumothorax is a rare complication of thoracic central venous catheterization in community EDs. Am J Emerg Med 2015; 33:60-6. [DOI: 10.1016/j.ajem.2014.10.020] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Revised: 10/08/2014] [Accepted: 10/09/2014] [Indexed: 10/24/2022] Open
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Sebastian R, Ghanem O, Diroma F, Milner SM, Gerold KB, Price LA. Percutaneous pigtail catheter in the treatment of pneumothorax in major burns: the best alternative? Case report and review of literature. Burns 2014; 41:e24-7. [PMID: 25363602 DOI: 10.1016/j.burns.2014.08.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Accepted: 08/26/2014] [Indexed: 11/19/2022]
Abstract
Multiple factors place burn patients at a high risk of pneumothorax development. Currently, no specific recommendations for the management of pneumothorax in large total body surface area (TBSA) burn patients exist. We present a case of a major burn patient who developed pneumothorax after central line insertion. After the traditional large bore (24 Fr) chest tube failed to resolve the pneumothorax, the pneumothorax was ultimately managed by a percutaneous placed pigtail catheter thoracostomy placement and resulted in its complete resolution. We will review the current recommendations of pneumothorax treatment and will highlight on the use of pigtail catheters in pneumothorax management in burn patients.
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Affiliation(s)
- Raul Sebastian
- Johns Hopkins University School of Medicine, Johns Hopkins Burn Center, Baltimore, MD 21224, USA
| | - Omar Ghanem
- Union Memorial Hospital, Medstar, Baltimore, MD 21218, USA
| | - Frank Diroma
- Johns Hopkins University School of Medicine, Johns Hopkins Burn Center, Baltimore, MD 21224, USA
| | - Stephen M Milner
- Johns Hopkins University School of Medicine, Johns Hopkins Burn Center, Baltimore, MD 21224, USA
| | - Kevin B Gerold
- Johns Hopkins University School of Medicine, Johns Hopkins Burn Center, Baltimore, MD 21224, USA
| | - Leigh A Price
- Johns Hopkins University School of Medicine, Johns Hopkins Burn Center, Baltimore, MD 21224, USA.
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14 French pigtail catheters placed by surgeons to drain blood on trauma patients: is 14-Fr too small? J Trauma Acute Care Surg 2013. [PMID: 23188235 DOI: 10.1097/ta.0b013e318271c1c7] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Small 14F pigtail catheters (PCs) have been shown to drain air quite well in patients with traumatic pneumothorax (PTX). But their effectiveness in draining blood in patients with traumatic hemothorax (HTX) or hemopneumothorax (HPTX) is unknown. We hypothesized that 14F PCs can drain blood as well as large-bore 32F to 40F chest tubes. We herein report our early case series experience with PCs in the management of traumatic HTX and HPTX. METHODS We prospectively collected data on all bedside-inserted PCs in patients with traumatic HTX or HPTX during a 30-month period (July 2009 through December 2011) at our Level I trauma center. We then compared our PC prospective data with our trauma registry-derived retrospective chest tube data (January 2008 through December 2010) at our center. Our primary outcome of interest was the initial drainage output. Our secondary outcomes were tube duration, insertion-related complications, and failure rate. For our statistical analysis, we used the unpaired Student's t-test, χ test, and Wilcoxon rank-sum test; we defined significance by a value of p < 0.05. RESULTS A total of 36 patients received PCs, and 191 received chest tubes. Our PC group had a higher rate of blunt mechanism injuries than our chest tube group did (83 vs. 62%; p = 0.01). The mean initial output was similar between our PC group (560 ± 81 mL) and our chest tube group (426 ± 37 mL) (p = 0.13). In the PC group, the tube was inserted later (median, Day 1; interquartile range, Days 0-3) than the tube inserted in our chest tube group (median, Day 0; interquartile range, Days 0-0) (p < 0.001). Tube duration, rate of insertion-related complications, and failure rate were all similar. CONCLUSION In our early experience, 14F PCs seemed to drain blood as well as large-bore chest tubes based on initial drainage output and other outcomes studied. In this early phase, we were being selective in inserting PCs in only stable blunt trauma patients, and PCs were inserted at a later day from the time of the initial evaluation. In the future, we will need a larger sample size and possibly a well-designed prospective study. LEVEL OF EVIDENCE Therapeutic study, level V.
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Emergencies in pleural diseases. Rev Clin Esp 2013. [DOI: 10.1016/j.rceng.2013.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Porcel JM, García-Gil D. Emergencies in pleural diseases. Rev Clin Esp 2012; 213:242-50. [PMID: 23261842 DOI: 10.1016/j.rce.2012.11.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2012] [Revised: 08/16/2012] [Accepted: 11/04/2012] [Indexed: 11/26/2022]
Abstract
A parapneumonic effusion should be drained if it is large (≥ 1/2 of the hemithorax), loculated, frank pus is obtained, if the fluid is non-purulent fluid but has a low pH (< 7.20) or if the culture is positive. Instillation of fibrinolytics and DNase thorough the chest catheter in locutated effusions and empyemas is currently recommended. Management of spontaneous pneumothorax is fundamentally influenced by the patient's symptoms. Insertion of a chest catheter is mandatory if there is significant dyspnea, hemodynamic instability or large pneumothoraces (≥ 2 cm). Pleural ultrasonography confirms the presence of air or fluid in the pleural space and serves to guide any pleural procedure (e.g., thoracentesis, chest tubes). The use of small-bore 12F catheters inserted via the percutaneous Seldinger technique under ultrasonography guidance is a safe and effective procedure in complicated parapneumonic effusions/empyema and most pneumothoraces.
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Affiliation(s)
- J M Porcel
- Unidad de Patología Pleural, Servicio de Medicina Interna, Hospital Universitario Arnau de Vilanova, Lleida, Spain.
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