Managing tube thoracostomy with thoracic ultrasound: results from a randomized pilot study

• Published in: European journal of trauma and emergency surgery (Munich : 2007) Vol. 48; no. 2; pp. 973 - 979
• Main Authors: Fonseca, Alexandre Zanchenko, Kunizaki, Eric, Waisberg, Jaques, Ribeiro, Marcelo Augusto Fontenelle
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-04-2022; Springer Nature B.V
• Subjects: Chest Tubes - adverse effects; Critical Care Medicine; Emergency medical care; Emergency Medicine; Endoscopy; Hemothorax; Hemothorax - diagnostic imaging; Hemothorax - etiology; Hemothorax - surgery; Humans; Intensive; Intubation; Male; Medicine; Medicine & Public Health; Original Article; Pilot Projects; Pneumothorax; Pneumothorax - diagnostic imaging; Pneumothorax - etiology; Prospective Studies; Retrospective Studies; Sports Medicine; Surgery; Surgical Orthopedics; Thoracic Injuries - complications; Thoracic Injuries - diagnostic imaging; Thoracic Injuries - surgery; Thoracostomy - methods; Thorax; Traumatic Surgery; Ultrasonic imaging; Ventilation; Tube thoracostomy; Pneumothorax; Thoracic; Ultrasound; Hemothorax
• ISSN: 1863-9933; 1863-9941
• DOI: 10.1007/s00068-020-01554-3

Purpose
Tube thoracostomy (TT) is a simple and a life-saving procedure; nevertheless, it carries morbidity, even after its removal. Currently, TT is managed and removed by chest X-ray (CXR) evaluation. There are limitations and these are directly linked to complications. The use of thoracic ultrasound (US) has already been established in the diagnosis of pneumothorax (PTX) and hemothorax (HTX); its use, in substitution of CXR can lead to improvement in care. Our aim is to evaluate the efficiency and safety of US in the management of TT.
Methods
Prospective and randomized study with patients requiring TT. They were divided in groups according to their thoracic injuries (PTX and HTX) and randomized into two groups according to TT management: US and CXR. Data collected included gender, age, mechanism of injury, days to TT removal, complications after TT removal and presence of mechanical ventilation.
Results
Sixty-one patients were randomized, of which 68.8% were male. The most frequent diagnosis was PTX, present in 37 cases. Median time for TT removal was 2.5 days in the US group and 4.9 in the control group (
p
 = 0.009). The complication rate was 6.6%, with no morbidity in the US group. TT removal in patients with mechanical ventilation did not increase the incidence of complications.
Conclusions
The use of US in the management is efficient and safe. It allows early TT removal regardless the cause of the thoracic injury.