Thoracostomy tube function not trajectory dictates reintervention

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• 作者：Nathan W. Kugler ; MD<sup>asup><sup> ; sup><sup>nkugler@mcw.edu" class="auth_mail" title="E-mail the corresponding authorsup><sup> ; sup><sup>nwkugler@me.com" class="auth_mail" title="E-mail the corresponding authorsup> ; Thomas W. Carver ; MD<sup>asup> ; Paul Knechtges ; MD<sup>bsup> ; David Milia ; MD<sup>asup> ; Lawrence Goodman ; MD<sup>bsup> ; Jasmeet S. Paul ; MD<sup>asup>
• 关键词：Chest tube ; Thoracostomy tube ; Trauma ; Thoracic trauma ; Hemothorax ; Pneumothorax ; Hemopneumothorax
• 刊名：Journal of Surgical Research
• 出版年：2016
• 出版时间：December 2016
• 年：2016
• 卷：206
• 期：2
• 页码：380-385
• 全文大小：502 K

文摘

Hemothorax and/or pneumothorax can be managed successfully managed with tube thoracostomy (TT) in the majority of cases. Improperly placed tubes are common with rates near 30%. This study aimed to determine whether TT trajectory affects the rate of secondary intervention.

sSec_2">Methods

spara0015">A retrospective review of all adult trauma patients undergoing TT placement over a 4-y period was performed. TT trajectory was classified as ideal, nonideal, or kinked-based on anterior&ndash;posterior chest x-ray. TTs with sentinel port outside the thoracic cavity were excluded. The primary outcome was any secondary intervention.

sSec_3">Results

spara0020">Four-hundred eighty-six patients and a total of 547 hemithoraces underwent placement and met inclusion criteria. The majority of patients were male (76%), with a median age of 41 y, and majority suffered blunt trauma ideal trajectory was identified in 429 (78.4%). Kinked TTs were noted in 33 (6%) hemothoraces with a 45.5% replacement rate. Review with staff demonstrates inherent bias to replace kinked TTs. The overall secondary intervention rate was 27.8%. Kinked TTs were removed from final analysis due to treatment bias. Subsequent analysis demonstrated no significant difference between ideal and nonideal trajectories (25.1% versus 34.1%, P = 0.09).

sSec_4">Conclusions

spara0025">Intrathoracic trajectory of nonkinked TTs with the sentinel port within the thoracic cavity does not affect secondary intervention rates, including the rate of surgical intervention.