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

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European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

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.

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Authors and Affiliations

  1. Programa de Pós-Graduação Do Instituto de Assistência Médica Ao Servidor Público Estadual (IAMSPE), Av. Ibirapuera, 981 - 2º andar, Vila Clementino, São Paulo, SP, 04029-000, Brazil

    Alexandre Zanchenko Fonseca, Eric Kunizaki, Jaques Waisberg & Marcelo Augusto Fontenelle Ribeiro Jr.

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  1. Alexandre Zanchenko Fonseca
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  2. Eric Kunizaki
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  3. Jaques Waisberg
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  4. Marcelo Augusto Fontenelle Ribeiro Jr.
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by AZF, EK, JW and MAFRJ. The first draft of the manuscript was written by AZF and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Alexandre Zanchenko Fonseca.

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Conflict of interest

All authors declare no conflict of interest.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Registration number: RBR-9hg244 (www.ensaiosclinicos.gov.br).

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Fonseca, A.Z., Kunizaki, E., Waisberg, J. et al. Managing tube thoracostomy with thoracic ultrasound: results from a randomized pilot study. Eur J Trauma Emerg Surg 48, 973–979 (2022). https://doi.org/10.1007/s00068-020-01554-3

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  • DOI: https://doi.org/10.1007/s00068-020-01554-3

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