Manuel F Struck1, Sebastian Ewens2, Johannes K M Fakler3, Gunther Hempel4, André Beilicke5, Michael Bernhard5, Patrick Stumpp2, Christoph Josten3, Sebastian N Stehr4, Hermann Wrigge4, Sebastian Krämer6. 1. Department of Anesthesiology and Intensive Care Medicine, University Hospital Leipzig, Liebigstr. 20, 04103, Leipzig, Germany. manuelstruck@web.de. 2. Department of Diagnostic and Interventional Radiology, University Hospital Leipzig, Liebigstr. 20, 04103, Leipzig, Germany. 3. Department of Orthopedics, Traumatology and Plastic Surgery, University Hospital Leipzig, Liebigstr. 20, 04103, Leipzig, Germany. 4. Department of Anesthesiology and Intensive Care Medicine, University Hospital Leipzig, Liebigstr. 20, 04103, Leipzig, Germany. 5. Emergency Department, University Hospital Leipzig, Liebigstr. 20, 04103, Leipzig, Germany. 6. Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital Leipzig, Liebigstr. 20, 04103, Leipzig, Germany.
Abstract
PURPOSE: Evaluation of trauma patients with chest tube malposition using initial emergency computed tomography (CT) and assessment of outcomes and the need for chest tube replacement. METHODS: Patients with an injury severity score > 15, admitted directly from the scene, and requiring chest tube insertion prior to initial emergency CT were retrospectively reviewed. Injury severity, outcomes, and the positions of chest tubes were analyzed with respect to the need for replacement after CT. RESULTS: One hundred seven chest tubes of 78 patients met the inclusion criteria. Chest tubes were in the pleural space in 58% of cases. Malposition included intrafissural positions (27%), intraparenchymal positions (11%) and extrapleural positions (4%). Injury severity and outcomes were comparable in patients with and without malposition. Replacement due to malfunction was required at similar rates when comparing intrapleural positions with both intrafissural or intraparenchymal positions (11 vs. 23%, p = 0.072). Chest tubes not reaching the target position (e.g., pneumothorax) required replacement more often than targeted tubes (75 vs. 45%, p = 0.027). Out-of-hospital insertions required higher replacement rates than resuscitation room insertions (29 vs. 10%, p = 0.016). Body mass index, chest wall thickness, injury severity, insertion side and intercostal space did not predict the need for replacement. CONCLUSIONS: Patients with malposition of emergency chest tubes according to CT were not associated with worse outcomes compared to patients with correctly positioned tubes. Early emergency chest CT in the initial evaluation of severely injured patients allows precise detection of possible malposition of chest tubes that may require immediate intervention.
PURPOSE: Evaluation of traumapatients with chest tube malposition using initial emergency computed tomography (CT) and assessment of outcomes and the need for chest tube replacement. METHODS:Patients with an injury severity score > 15, admitted directly from the scene, and requiring chest tube insertion prior to initial emergency CT were retrospectively reviewed. Injury severity, outcomes, and the positions of chest tubes were analyzed with respect to the need for replacement after CT. RESULTS: One hundred seven chest tubes of 78 patients met the inclusion criteria. Chest tubes were in the pleural space in 58% of cases. Malposition included intrafissural positions (27%), intraparenchymal positions (11%) and extrapleural positions (4%). Injury severity and outcomes were comparable in patients with and without malposition. Replacement due to malfunction was required at similar rates when comparing intrapleural positions with both intrafissural or intraparenchymal positions (11 vs. 23%, p = 0.072). Chest tubes not reaching the target position (e.g., pneumothorax) required replacement more often than targeted tubes (75 vs. 45%, p = 0.027). Out-of-hospital insertions required higher replacement rates than resuscitation room insertions (29 vs. 10%, p = 0.016). Body mass index, chest wall thickness, injury severity, insertion side and intercostal space did not predict the need for replacement. CONCLUSIONS:Patients with malposition of emergency chest tubes according to CT were not associated with worse outcomes compared to patients with correctly positioned tubes. Early emergency chest CT in the initial evaluation of severely injured patients allows precise detection of possible malposition of chest tubes that may require immediate intervention.
Authors: Richard Menger; Georgianna Telford; Patrick Kim; Meredith R Bergey; Juron Foreman; Babak Sarani; Jose Pascual; Patrick Reilly; Charles W Schwab; Carrie A Sims Journal: Injury Date: 2011-08-11 Impact factor: 2.586
Authors: Stefan Huber-Wagner; Markus Körner; Achim Ehrt; Mike V Kay; Klaus-Jürgen Pfeifer; Wolf Mutschler; Karl-Georg Kanz Journal: Resuscitation Date: 2006-12-01 Impact factor: 5.262
Authors: Kenji Inaba; Thomas Lustenberger; Gustavo Recinos; Crysanthos Georgiou; George C Velmahos; Carlos Brown; Ali Salim; Demetrios Demetriades; Peter Rhee Journal: J Trauma Acute Care Surg Date: 2012-02 Impact factor: 3.313
Authors: Manuel Florian Struck; Christian Kleber; Sebastian Ewens; Sebastian Ebel; Holger Kirsten; Sebastian Krämer; Stefan Schob; Georg Osterhoff; Felix Girrbach; Peter Hilbert-Carius; Benjamin Ondruschka; Gunther Hempel Journal: J Clin Med Date: 2022-07-13 Impact factor: 4.964