BACKGROUND: Tube thoracostomy is a common procedure used in the management of thoracic trauma. Traditional teaching suggests that chest tubes should be directed in specific locations to improve function. Common examples include anterior and superior placement for pneumothorax, inferior and posterior placement for hemothorax, and avoidance of the pulmonary fissure. The purpose of this study was to examine the effect of specific chest tube position on subsequent chest tube function. METHODS: A retrospective review of all patients undergoing tube thoracostomy for trauma from January 1, 2010, to September 30, 2012, was performed. Only patients undergoing computed tomography scans following chest tube insertion were included so that positioning could be accurately determined. Rib space insertion level and positioning of the tube relative to the lung parenchyma were recorded. The duration of chest tube drainage and the need for secondary interventions were determined and compared for tubes in different rib spaces and locations. For purposes of comparison, tubes placed above the sixth rib space were considered "high," and those at or below it were considered "low." RESULTS: A total of 291 patients met criteria for inclusion. Forty-eight patients (16.5%) required secondary intervention. Neither high chest tube placement nor chest tube location relative to lung parenchyma was associated with an increased need for secondary interventions. On multivariate analysis, only chest Abbreviated Injury Scale (AIS) scores, mechanism, and volume of hemothorax were found to be significant risk factors for the need for secondary interventions. CONCLUSION: Chest tube location does not influence the need for secondary interventions as long as the tube resides in the pleural space. The severity of chest injury is the most important factor influencing outcome in patients undergoing tube thoracostomy for trauma. Tube thoracostomy technique should focus on safe insertion within the pleural space and not on achieving a specific tube location. LEVEL OF EVIDENCE: Therapeutic study, level IV.
BACKGROUND: Tube thoracostomy is a common procedure used in the management of thoracic trauma. Traditional teaching suggests that chest tubes should be directed in specific locations to improve function. Common examples include anterior and superior placement for pneumothorax, inferior and posterior placement for hemothorax, and avoidance of the pulmonary fissure. The purpose of this study was to examine the effect of specific chest tube position on subsequent chest tube function. METHODS: A retrospective review of all patients undergoing tube thoracostomy for trauma from January 1, 2010, to September 30, 2012, was performed. Only patients undergoing computed tomography scans following chest tube insertion were included so that positioning could be accurately determined. Rib space insertion level and positioning of the tube relative to the lung parenchyma were recorded. The duration of chest tube drainage and the need for secondary interventions were determined and compared for tubes in different rib spaces and locations. For purposes of comparison, tubes placed above the sixth rib space were considered "high," and those at or below it were considered "low." RESULTS: A total of 291 patients met criteria for inclusion. Forty-eight patients (16.5%) required secondary intervention. Neither high chest tube placement nor chest tube location relative to lung parenchyma was associated with an increased need for secondary interventions. On multivariate analysis, only chest Abbreviated Injury Scale (AIS) scores, mechanism, and volume of hemothorax were found to be significant risk factors for the need for secondary interventions. CONCLUSION: Chest tube location does not influence the need for secondary interventions as long as the tube resides in the pleural space. The severity of chest injury is the most important factor influencing outcome in patients undergoing tube thoracostomy for trauma. Tube thoracostomy technique should focus on safe insertion within the pleural space and not on achieving a specific tube location. LEVEL OF EVIDENCE: Therapeutic study, level IV.
Authors: Manuel F Struck; Sebastian Ewens; Johannes K M Fakler; Gunther Hempel; André Beilicke; Michael Bernhard; Patrick Stumpp; Christoph Josten; Sebastian N Stehr; Hermann Wrigge; Sebastian Krämer Journal: Eur J Trauma Emerg Surg Date: 2018-05-31 Impact factor: 3.693
Authors: Matthew C Hernandez; Moustafah El Khatib; Larry Prokop; Martin D Zielinski; Johnathon M Aho Journal: J Trauma Acute Care Surg Date: 2018-08 Impact factor: 3.313
Authors: Emmanouil I Kapetanakis; Nikolaos L Korodimos; Thrasyvoulos P Michos; Periklis I Tomos Journal: Interact Cardiovasc Thorac Surg Date: 2022-06-15
Authors: Matthew C Hernandez; Danuel V Laan; Stacey L Zimmerman; Nimesh D Naik; Henry J Schiller; Johnathon M Aho Journal: J Trauma Acute Care Surg Date: 2016-08 Impact factor: 3.313
Authors: A Orlando; J Cordero; M M Carrick; A H Tanner; K Banton; R Vogel; M Lieser; D Acuna; D Bar-Or Journal: Scand J Trauma Resusc Emerg Med Date: 2020-06-22 Impact factor: 2.953
Authors: Jessica Mckee; Ian Mckee; Melanie Bouclin; Chad G Ball; Paul McBeth; Derek J Roberts; Ian Atkinson; Dennis Filips; Andrew W Kirkpatrick Journal: Turk J Emerg Med Date: 2018-03-09