BACKGROUND: Recurrent pneumothorax is the most significant complication after discontinuation of thoracostomy tubes. The primary objective of the present study was to determine which method of tube removal, at the end of inspiration or at the end of expiration, is associated with a lesser risk of developing a recurrent pneumothorax. A secondary objective was to identify potential risk factors for developing recurrence. METHODS: A prospective study of 102 chest tubes in 69 trauma patients (1.5 tubes per patient) randomly assigned to removal at the end of inspiration (n = 52) or the end of expiration (n = 50). RESULTS:Recurrent pneumothorax or enlargement of a small but stable pneumothorax was observed after the removal of four chest tubes in the end-inspiration group (8%) and after discontinuation of three chest tubes (6%) in the end-expiration group (p = 1.0). Of those, only two tubes in the end-inspiration group and 1 tube in the end-expiration group required repeat closed thoracostomy. Multiple factors were analyzed that did not adversely affect outcome. These included patient age, Injury Severity Score, Revised Trauma Score, mechanism of injury, hemothorax, thoracotomy, thoracostomy, previous lung disease, chest tube duration, the presence of more than one thoracostomy tube in the same hemithorax, or a small (but stable) pneumothorax at the time of tube removal. CONCLUSIONS: Discontinuation of chest tubes at the end of inspiration or at the end of expiration has a similar rate of post-removal pneumothorax. Both methods are equally safe.
RCT Entities:
BACKGROUND: Recurrent pneumothorax is the most significant complication after discontinuation of thoracostomy tubes. The primary objective of the present study was to determine which method of tube removal, at the end of inspiration or at the end of expiration, is associated with a lesser risk of developing a recurrent pneumothorax. A secondary objective was to identify potential risk factors for developing recurrence. METHODS: A prospective study of 102 chest tubes in 69 traumapatients (1.5 tubes per patient) randomly assigned to removal at the end of inspiration (n = 52) or the end of expiration (n = 50). RESULTS: Recurrent pneumothorax or enlargement of a small but stable pneumothorax was observed after the removal of four chest tubes in the end-inspiration group (8%) and after discontinuation of three chest tubes (6%) in the end-expiration group (p = 1.0). Of those, only two tubes in the end-inspiration group and 1 tube in the end-expiration group required repeat closed thoracostomy. Multiple factors were analyzed that did not adversely affect outcome. These included patient age, Injury Severity Score, Revised Trauma Score, mechanism of injury, hemothorax, thoracotomy, thoracostomy, previous lung disease, chest tube duration, the presence of more than one thoracostomy tube in the same hemithorax, or a small (but stable) pneumothorax at the time of tube removal. CONCLUSIONS: Discontinuation of chest tubes at the end of inspiration or at the end of expiration has a similar rate of post-removal pneumothorax. Both methods are equally safe.
Authors: Daniel G French; Michael Dilena; Simon LaPlante; Farid Shamji; Sudhir Sundaresan; James Villeneuve; Andrew Seely; Donna Maziak; Sebastien Gilbert Journal: J Thorac Dis Date: 2016-02 Impact factor: 2.895
Authors: Michael Kwiatt; Abigail Tarbox; Mark J Seamon; Mamta Swaroop; James Cipolla; Charles Allen; Stacinoel Hallenbeck; H Tracy Davido; David E Lindsey; Vijay A Doraiswamy; Sagar Galwankar; David Tulman; Nicholas Latchana; Thomas J Papadimos; Charles H Cook; Stanislaw P Stawicki Journal: Int J Crit Illn Inj Sci Date: 2014-04
Authors: Mersadies Martin; Cory T Schall; Cheryl Anderson; Nicole Kopari; Alan T Davis; Penny Stevens; Pam Haan; John P Kepros; Benjamin D Mosher Journal: Springerplus Date: 2013-12-01