Journal of Emergencies, Trauma, and Shock
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LETTERS TO EDITOR  
Year : 2020  |  Volume : 13  |  Issue : 4  |  Page : 318-319
Chest trauma management with small-bore chest tube


1 Department of Emergency and Critical Care Medicine, Tokushima Red Cross Hospital, Komatsushima, Tokushima 773-8502, Japan
2 Department of Thoracic Surgery, Tokushima Red Cross Hospital, Komatsushima, Tokushima 773-8502, Japan

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Date of Submission18-Apr-2020
Date of Acceptance21-Apr-2020
Date of Web Publication7-Dec-2020
 

How to cite this article:
Yoshioka Y, Ishikura H. Chest trauma management with small-bore chest tube. J Emerg Trauma Shock 2020;13:318-9

How to cite this URL:
Yoshioka Y, Ishikura H. Chest trauma management with small-bore chest tube. J Emerg Trauma Shock [serial online] 2020 [cited 2021 Jan 18];13:318-9. Available from: https://www.onlinejets.org/text.asp?2020/13/4/318/302521




In general, large-bore (32-to 36-Fr) chest tubes (CTs) should be inserted for chest trauma management.[1] However, some investigators have described the efficacy of the management with small-bore CTs (SBCTs) for chest trauma.[2],[3],[4],[5] Herein, we described the outcome of cases of chest trauma patients inserted with SBCTs in our institute. Cases of patients with chest trauma managed with a SBCT were identified through chart review from April 2011 to March 2015. The CTs were manufactured by Covidien Japan, Tokyo. The methods of CT insertion were not uniform: Some were inserted with the Seldinger technique and others with an open technique. The size and insertion site of the CT depended on the surgeon. The defined guidelines for when to remove CTs were not available. The timing of removal of CTs depended on the surgeon. In cases of haemothorax (HTX), CTs were removed when the amount of drainage in the tube decreased to less than approximately 200 mL/day.

Over the 5-year period, 62 CTs were inserted in 50 patients with chest trauma. All patients had suffered blunt trauma. [Table 1] shows the demographics and outcomes of this study. The median size of CT was 20-Fr. Additional tubes were inserted in six cases (9.7%; 95% confidence interval, 4.7–20.1]) because of failure to evacuate the pneumothorax in five patients and malpositioning in 1. All evacuations of HTX were successful.
Table 1: Demographics and outcomes of this study

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In this observational study, the rate of re-insertion was 9.7% (95%CI, 4.7–20.1) and sufficiently acceptable for clinical use. In all cases, evacuation of HTX was successful, and there was no case of retained HTX. CTs of size 20-Fr may thus be adequate for evacuating HTX.

We therefore suggest the following treatment strategy: In the treatment of chest trauma patient, SBCT is selected initially and additional tubes are inserted as necessary.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Peter IT, Matthew JW, Kenneth LM. Trauma thoracotomy: General principles and techniques. In: Moore EE, Feliciano DV, Mattox KL, editors. Trauma. 8th ed. New York, NY: McGraw-Hill; 2017. p. 473-8.  Back to cited text no. 1
    
2.
Rivera L, O’Reilly EB, Sise MJ, Norton VC, Sise CB, Sack DI, et al. Small catheter tube thoracostomy: Effective in managing chest trauma in stable patients. J Trauma 2009;66:393-9.  Back to cited text no. 2
    
3.
Kulvatunyou N, Vijayasekaran A, Hansen A, Wynne JL, O’Keeffe T, Friese RS, et al. Two-year experience of using pigtail catheters to treat traumatic pneumothorax: A changing trend. J Trauma 2011;71:1104-7.  Back to cited text no. 3
    
4.
Kulvatunyou N, Joseph B, Friese RS, Green D, Gries L, O’Keeffe T, et al. 14 French pigtail catheters placed by surgeons to drain blood on trauma patients. J Trauma Acute Care Surg 2012;73:1423-7.  Back to cited text no. 4
    
5.
Tanizaki S, Maeda S, Sera M, Nagai H, Hayashi M, Azuma H, et al. Small tube thoracostomy (20-22 Fr) in emergent management of chest trauma. Injury 2017;48:1884-7.  Back to cited text no. 5
    

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Correspondence Address:
Yuki Yoshioka
Department of Emergency and Critical Care Medicine, Tokushima Red Cross Hospital, 103, Irinoguchi, Komatsushima-cho, Komatsushima City, Tokushima 773-8502
Japan
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JETS.JETS_57_20

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