scholarly journals Factors Associated with Chest Tube Placement in Blunt Trauma Patients with an Occult Pneumothorax

2019 ◽  
Vol 2019 ◽  
pp. 1-6
Author(s):  
Michael Paplawski ◽  
Swapna Munnangi ◽  
Jody C. Digiacomo ◽  
Edwin Gonzalez ◽  
Ashley Modica ◽  
...  
Keyword(s):  
Blunt Trauma ◽  
Chest Tube ◽  
Rib Fractures ◽  
Tube Placement ◽  
Chest Tubes ◽  
Chest Tube Placement ◽  
X Ray ◽  
Factors Associated ◽  
Occult Pneumothorax ◽  
Chest X Ray

Background. An occult pneumothorax is identified by computed tomography but not visualized by a plain film chest X-ray. The optimal management remains unclear. Methods. A retrospective review of an urban level I trauma center’s trauma registry was conducted to identify patients with occult pneumothorax over a 2-year period. Factors predictive of chest tube placement were identified using univariate and multivariate logistic regression analysis. Results. A total of 131 patients were identified, of whom 100 were managed expectantly with an initial period of observation. Ultimately, 42 (32.0%) patients received chest tubes and 89 did not. The patients who received chest tubes had larger pneumothoraces at initial assessment, a higher incidence of rib fractures, and an increased average number of rib fractures, of which significantly more were displaced. Conclusions. Displaced rib fractures and moderate-sized pneumothoraces are significant factors associated with chest tube placement in a victim of blunt trauma with occult pneumothorax. The optimal timing for the first follow-up chest X-ray remains unclear.

scholarly journals Pre-Hospital and In-Hospital Thoracostomy: Indications and Complications

2008 ◽  
Vol 90 (1) ◽  
pp. 54-57 ◽  
Author(s):  
Christopher J Aylwin ◽  
Karim Brohi ◽  
Gareth D Davies ◽  
Michael S Walsh
Keyword(s):  
Emergency Department ◽  
Chest Tube ◽  
Tension Pneumothorax ◽  
Tube Placement ◽  
Thoracic Injury ◽  
Complication Rates ◽  
Pleural Drainage ◽  
Chest Tubes ◽  
Chest Tube Placement ◽  
Output State

INTRODUCTION Pleural drainage with chest tube insertion for thoracic trauma is a common and often life-saving technique. Although considered a simple procedure, complication rates have been reported to be 2–25%. We conducted a prospective cohort observational study of emergency pleural drainage procedures to validate the indications for pre-hospital thoracostomy and to identify complications from both pre- and in-hospital thoracostomies. PATIENTS AND METHODS Data were collected over a 7-month period on all patients receiving either pre-hospital thoracostomy or emergency department tube thoracostomy. Outcome measures were appropriate indications, errors in tube placement and subsequent complications. RESULTS Ninety-one chest tubes were placed into 52 patients. Sixty-five thoracostomies were performed in the field without chest tube placement. Twenty-six procedures were performed following emergency department identification of thoracic injury. Of the 65 pre-hospital thoracostomies, 40 (61%) were for appropriate indications of suspected tension pneumothorax or a low output state. The overall complication rate was 14% of which 9% were classified as major and three patients required surgical intervention. Twenty-eight (31%) chest tubes were poorly positioned and 15 (17%) of these required repositioning. CONCLUSIONS Pleural drainage techniques may be complicated and have the potential to cause life-threatening injury. Pre-hospital thoracostomies have the same potential risks as in-hospital procedures and attention must be paid to insertion techniques under difficult scene conditions. In-hospital chest tube placement complication rates remain uncomfortably high, and attention must be placed on training and assessment of staff in this basic procedure.

Displacement Patterns of Blunt Rib Fractures and Their Relationship to Thoracic Coinjuries: Minimal Displacements Count

2016 ◽  
Vol 82 (3) ◽  
pp. 199-206 ◽  
Author(s):  
Nikolay Bugaev ◽  
Janis L. Breeze ◽  
Majid Alhazmi ◽  
Hassan S. Anbari ◽  
Sandra S. Arabian ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Length Of Stay ◽  
Chest Tube ◽  
Hospital Length ◽  
Rib Fractures ◽  
Axial Displacement ◽  
Hospital Length Of Stay ◽  
Tube Placement ◽  
Chest Tube Placement ◽  
Displacement Patterns

Displacement patterns of rib fractures (RF) and their association with thoracic coinjuries and outcomes are unknown. This is a retrospective review of adult patients with blunt closed RF who underwent chest CT at a Level I trauma center (2007–2012). Displacement patterns of RF were compared among the three-dimensional planes using CT images. An analysis of receiver operating characteristic (ROC) curves was performed to identify displacements in each plane most strongly associated with chest coinjuries. Univariate analysis was used to find association of displaced RF with hospital course and outcome. There were 1127 RF (245 patients, most in ribs 3–9, 45 per cent displaced). Axial displacement was the most common, with odds ratios 7.20 and 2.13 compared with cranio-caudal, and impaction-separation (along rib axis) movement, respectively. Axial displacement thresholds performed well with hemothorax (2.8 mm, ROC = 0.74), pneumothorax (2.6 mm, ROC = 0.70), hemopneumothorax (3.1 mm, ROC = 0.77), flail chest (3.4 mm, ROC = 0.80), and chest tube placement (2.8 mm, ROC = 0.75). RF displacement was associated with increased days on mechanical ventilation and hospital length of stay. In conclusion, even minimal RF displacement is associated with increased risk of chest coinjuries and chest tube placement, and displacements correlated with increased days on mechanical ventilation and hospital length of stay. Future studies are required to investigate these associations, especially in relationship to the indications for rib plating.

Chest Tubes: Indications, Placement, Management, and Complications

1993 ◽  
Vol 8 (2) ◽  
pp. 73-86 ◽  
Author(s):  
Timothy B. Gilbert ◽  
Brian J. McGrath ◽  
Mark Soberman
Keyword(s):  
Intensive Care ◽  
Chest Tube ◽  
Pleural Space ◽  
Tube Thoracostomy ◽  
Tube Placement ◽  
Chest Tubes ◽  
Tube Insertion ◽  
Chest Tube Placement ◽  
Insertion Techniques ◽  
Review Current

Use of tube thoracostomy in intensive care units for evacuation of air or fluid from the pleural space has become commonplace. In addition to recognition of pathological states necessitating chest tube insertion, intensivists are frequently involved in placement, maintenance, troubleshooting, and discontinuation of chest tubes. Numerous advances have permitted safe use of tube thoracostomy for treatment of spontaneous or iatrogenic pneumothoracies and hydrothoracies following cardiothoracic surgery or trauma, or for drainage of pus, bile, or chylous effusions. We review current indications for chest tube placement, insertion techniques, and available equipment, including drainage systems. Guidelines for maintenance and discontinuation are also discussed. As with any surgical procedure, complications may arise. Appropriate training and competence in usage may reduce the incidence of complications.

scholarly journals Comparison of non-intubated and intubated video-assisted thoracoscopic surgeries of major pulmonary resections for lung cancer—a meta-analysis

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Wenfei Xue ◽  
Guochen Duan ◽  
Xiaopeng Zhang ◽  
Hua Zhang ◽  
Qingtao Zhao ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Thoracic Surgery ◽  
Postoperative Complication ◽  
Complication Rate ◽  
Chest Tube ◽  
Meta Analysis ◽  
Tube Placement ◽  
Postoperative Complication Rate ◽  
Chest Tube Placement ◽  
Video Assisted

Abstract Objective The aim of this study was to compare the safety feasibility and safety feasibility of non-intubated (NIVATS) and intubated video-assisted thoracoscopic surgeries (IVATS) during major pulmonary resections. Methods A meta-analysis of eight studies was conducted to compare the real effects of two lobectomy or segmentectomy approaches during major pulmonary resections. Results Results showed that the patients using NIVATS had a greatly shorter hospital stay and chest-tube placement time (weighted mean difference (WMD): − 1.04 days; 95% CI − 1.50 to − 0.58; P < 0.01) WMD − 0.71 days; 95% confidence interval (CI), − 1.08 to − 0.34; P < 0.01, respectively) while compared to those with IVATS. There were no significant differences in postoperative complication rate, surgical duration, and the number of dissected lymph nodes. However, through the analysis of highly selected patients with lung cancer in early stage, the rate of postoperative complication in the NIVATS group was lower than that in the IVATS group [odds ratio (OR) 0.44; 95% CI 0.21–0.92; P = 0.03, I2 = 0%]. Conclusions Although the comparable postoperative complication rate was observed for major thoracic surgery in two surgical procedures, the NIVATS method could significantly shorten the hospitalized stay and chest-tube placement time compared with IVATS. Therefore, for highly selected patients, NIVATS is regarded as a safe and technically feasible procedure for major thoracic surgery. The assessment of the safety and feasibility for patients undergoing NIVATS needs further multi-center prospective clinical trials.

scholarly journals An alternative chest tube placement after uniportal video-assisted thoracic surgery

2018 ◽  
Vol 10 (5) ◽  
pp. 3078-3080
Author(s):  
Alessandro Palleschi ◽  
Paolo Mendogni ◽  
Alessio Vincenzo Mariolo ◽  
Mario Nosotti ◽  
Lorenzo Rosso
Keyword(s):  
Thoracic Surgery ◽  
Chest Tube ◽  
Tube Placement ◽  
Chest Tube Placement ◽  
Video Assisted Thoracic Surgery ◽  
Video Assisted

Uncommon complications during chest tube placement

2002 ◽  
Vol 28 (6) ◽  
pp. 812-813 ◽  
Author(s):  
Sophie M. Jaillard ◽  
Alain Tremblay ◽  
Massimo Conti ◽  
Alain J. Wurtz
Keyword(s):  
Chest Tube ◽  
Tube Placement ◽  
Chest Tube Placement
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