Panamerican Journal of Trauma, Critical Care & Emergency Surgery

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VOLUME 8 , ISSUE 3 ( September-December, 2019 ) > List of Articles

Original Article

Conservative Management of Residual Pneumothorax Following Tube Thoracostomy Removal in Trauma Patients

Hannah M Sadek, Kwame A Akuamoah-Boateng, Christopher T Borchers, James F Whelan, Michel B Aboutanos

Keywords : Blunt trauma, Chest tube, Chest tube insertion, Penetrating trauma, Pneumothorax, Residual pneumothorax, Tube thoracostomy

Citation Information : Sadek HM, Akuamoah-Boateng KA, Borchers CT, Whelan JF, Aboutanos MB. Conservative Management of Residual Pneumothorax Following Tube Thoracostomy Removal in Trauma Patients. Panam J Trauma Crit Care Emerg Surg 2019; 8 (3):154-157.

DOI: 10.5005/jp-journals-10030-1257

License: CC BY-NC 4.0

Published Online: 01-12-2014

Copyright Statement:  Copyright © 2019; The Author(s).


Abstract

Introduction: Residual pneumothorax (rPTX) after tube thoracostomy (TT) is not an uncommon occurrence (10–20%) in any active trauma center. Many different practice patterns exist on how to deal with this clinical conundrum. These differing strategies can include more invasive procedures and increased length of stay (LOS). We hypothesize that the vast majority of these patients can be safely managed with observation and most can be discharged home without complete resolution. Materials and methods: A retrospective study was conducted on trauma patients managed in a level I center over a 2-year period. A “post-pull” chest X-ray was obtained on all TT patients after removal. All patient with rPTX were included for analysis. Results: A total of 412 patients required chest tubes. Since 98 patients were deceased, we excluded them from the study. A total of 314 patients were studied. Forty-two percent of the patients were male, with median age 40. Sixty-one percent of the patients were blunt trauma victims and 39% were penetrating trauma victims. The indications for chest TT were pneumothorax, hemothorax, and hemopneumothorax. A total of 163 had post-pull pneumo and discharged home with residual pathology prior to discharge. Five of these patients were readmitted (3%), and only one required repeat TT, roughly 0.6%. Conclusion: The vast majority of “post-pull” rPTX patients can be managed conservatively and can be safely discharged even without complete resolution.


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  1. Kugler NW, Milia DJ, Carver TW, et al. Natural history of a post pull pneumothorax or effusion: observation is safe. J Trauma Acute Care Surg 2015;78(2):391–395. DOI: 10.1097/TA.0000000000000525.
  2. Kwiatt M, Tarbox A, Seamon MJ, et al. Thoracostomy tubes: a comprehensive review of complications and related topics. Int J Crit Illn Inj Sci 2014;4(2):143–155. DOI: 10.4103/2229-5151.134182.
  3. Goodman MD, Huber NL, Johannigman JA, et al. Omission of routine chest X-ray after TT removal is safe in selected trauma patients. Am J Surg 2010;199(2):199–203. DOI: 10.1016/j.amjsurg.2009.03.011.
  4. Anand RJ, Whelan JF, Ferrada P, et al. Thin chest wall is an independent risk factor for the development of pneumothorax after TT removal. Am Surg 2012;78(4):478–480.
  5. Mao M, Hughes R, Papadimos TJ, et al. Complications of chest tubes: a focused clinical synopsis. Curr Opin Pulm Med 2015;21(4):376–386. DOI: 10.1097/MCP.0000000000000169.
  6. Pierucci P, Harkness M, Rigby A, et al. Risk of pneumothorax after chest drain removal. Am J Respir Crit Care Med 2014;189:A4366.
  7. Kong VY, Oosthuizen GV, Clarke DL. Selective Conservatism in the management of thoracic trauma remains appropriate in the 21st century. Ann R Coll Surg Engl 2015;97(3):224–228. DOI: 10.1308/003588414X14055925061559.
  8. Bridges LC, Torrent DJ, Mosquera C, et al. Chest tube removal in simple pneumothorax: does water-seal duration matter? Am Surg 2017;83(8):901–905.
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