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Thoracostomy tube withdrawal during latter phases of expiration or inspiration: a systematic review and meta-analysis

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

Abstract

Purpose

In patients with thoracic injuries, tube thoracostomy is routinely employed. There is disagreement over which manner of tube withdrawal is best, the latter phases of expiration or inspiration. Considering several earlier investigations’ inconsistent findings, their comparative effectiveness is still up for debate. In light of this, we carried out a systematic analysis of studies contrasting the withdrawal of thoracostomy tubes during the latter stages of expiration versus inspiration for traumatic chest injuries. Analyzed outcomes are recurrent pneumothoraces, reinsertion of the thoracostomy tube, and hospital stay.

Methods

We looked for papers comparing the withdrawal of the thoracostomy tube during the last stages of expiration and inspiration for the management of thoracic injuries on Embase, Pubmed, Cochrane Library and Google Scholar. Review Manager was used to determine mean differences (MD) and risk ratios (RR) using a 95% confidence interval (CI).

Results

The primary outcomes showed no significant difference between the inspiration and expiration groups: recurrent pneumothorax (RR 1.27, 95% CI 0.83–1.93, P 0.28) and thoracostomy tube reinsertion (OR: 1.84, CI 0.50–6.86, P 0.36, I2 5%). However, the duration of hospital stay was significantly lower in patients in whom the thoracostomy tube was removed at the end of inspiration (RR 1.8, 95% CI 1.49–2.11, P < 0.00001, I2 0%). The implications of these findings warrant cautious interpretation, accounting for potential confounding factors and inherent limitations that may shape their significance.

Conclusion

The thoracostomy tube can be removed during both the end-expiratory and end-inspiratory stages of respiration with no appreciable difference. Nevertheless, caution should be exercised when ascertaining the implications of these findings, taking into account the potential limitations and confounding variables that may exert influence upon the outcomes.

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Data availability

The primary data remains inherently accessible and can be granted upon the solicitation of a justifiable inquiry.

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Acknowledgements

We gratefully recognize the valuable contributions made by the articles listed and acknowledged in this manuscript's references.

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Authors and Affiliations

  1. Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan

    Samna Haider, Navaira Shoaib & Mariyam Zahid

  2. Department of General Surgery, Jinnah Medical and Dental College, Karachi, Pakistan

    Mohammed Taha Kamal

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Contributions

SH literature search, data gathering, data analysis, data interpretation, and writing. NS and MZ interpretation and revision of data. NS, MTK and SH designed the study, looking through the literature, analyzing and interpreting the data, and revising it critically.

Corresponding author

Correspondence to Samna Haider.

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Conflict of interest

Samna Haider, Mohammed Taha Kamal, Navaira Shoaib, and Mariyam Zahid report no interest-based conflict during this systematic review. There was no specific grant for this analysis from private, public, or nonprofit funding organizations.

Study involving animals and/or human participants

There are no investigations by any of the authors in this article that used human subjects.                      

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All participants in each study that made up this review gave their informed consent.

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Haider, S., Kamal, M.T., Shoaib, N. et al. Thoracostomy tube withdrawal during latter phases of expiration or inspiration: a systematic review and meta-analysis. Eur J Trauma Emerg Surg 49, 2389–2400 (2023). https://doi.org/10.1007/s00068-023-02306-9

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  • DOI: https://doi.org/10.1007/s00068-023-02306-9

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