Thomas W Clements1, Marco Sirois2, Neil Parry3, Derek J Roberts4, Vincent Trottier5, Sandro Rizoli6, Chad G Ball7, Zhengwen Jimmy Xiao8, Andrew W Kirkpatrick9. 1. Department of Surgery, Foothills Medical Center, University of Calgary, Calgary, Alberta, Canada. Electronic address: twclemen@ucalgary.ca. 2. Department of Thoracic Surgery, Sherbrooke University, Sherbrooke, Quebec, Canada. Electronic address: marco.sirois@usherbrooke.ca. 3. Department of Surgery, London Health Sciences Centre, London, Ontario, Canada. Electronic address: Neil.Parry@lhsc.on.ca. 4. Division of Vascular and Endovascular Surgery, University of Ottawa, Ottawa, Ontario, Canada. Electronic address: derek.roberts01@gmail.com. 5. Centre Hospitalier Affile Universitaire De Quebec, Hopital de l'Enfant-Jesus, Quebec City, Quebec, Canada. Electronic address: vincent.trottier@fmed.ulaval.ca. 6. Hamad General Hospital, Doha, Qatar. Electronic address: SRizoli@hamad.qa. 7. Department of Surgery, Foothills Medical Center, University of Calgary, Calgary, Alberta, Canada; The Trauma Program, Foothills Medical Centre, Calgary, Alberta, Canada. Electronic address: ball.chad@gmail.com. 8. The Trauma Program, Foothills Medical Centre, Calgary, Alberta, Canada. Electronic address: jimmy.xiao@albertahealthservices.ca. 9. Department of Surgery, Foothills Medical Center, University of Calgary, Calgary, Alberta, Canada; The Trauma Program, Foothills Medical Centre, Calgary, Alberta, Canada; Department of Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada; Canadian Forces Medical Services, Ottawa, Ontario, Canada. Electronic address: Andrew.kirkpatrick@albertahealthservices.ca.
Abstract
INTRODUCTION:Patients with occult pneumothorax (OPTX) requiring positive-pressure ventilation (PPV) face uncertain risks of tension pneumothorax or chest drainage complications. METHODS:Adults with traumatic OPTXs requiring PPV were randomized to drainage/observation, with the primary outcome of composite "respiratory distress" (RD)). RESULTS:Seventy-five (75) patients were randomized to observation, 67 to drainage. RD occurred in 38% observed and 25% drained (p = 0.14; Power = 0.38), with no mortality differences. One-quarter of observed patients failed, reaching 40% when ventilated >5 days. Twenty-three percent randomized to drainage had complications or ineffectual drains. CONCLUSION:RD was not significantly different with observation. Thus, OPTXs may be cautiously observed in stable patients undergoing short-term PPV when prompt "rescue drainage" is immediately available. As 40% of patients undergoing prolonged (≥5 days) ventilation (PPPV) require drainage, we suggest consideration of chest drainage performed with expert guidance to reduce risk of chest tube complications. LEVEL OF EVIDENCE: Therapeutic study, level II.
RCT Entities:
INTRODUCTION:Patients with occult pneumothorax (OPTX) requiring positive-pressure ventilation (PPV) face uncertain risks of tension pneumothorax or chest drainage complications. METHODS: Adults with traumatic OPTXs requiring PPV were randomized to drainage/observation, with the primary outcome of composite "respiratory distress" (RD)). RESULTS: Seventy-five (75) patients were randomized to observation, 67 to drainage. RD occurred in 38% observed and 25% drained (p = 0.14; Power = 0.38), with no mortality differences. One-quarter of observed patients failed, reaching 40% when ventilated >5 days. Twenty-three percent randomized to drainage had complications or ineffectual drains. CONCLUSION: RD was not significantly different with observation. Thus, OPTXs may be cautiously observed in stable patients undergoing short-term PPV when prompt "rescue drainage" is immediately available. As 40% of patients undergoing prolonged (≥5 days) ventilation (PPPV) require drainage, we suggest consideration of chest drainage performed with expert guidance to reduce risk of chest tube complications. LEVEL OF EVIDENCE: Therapeutic study, level II.