TUBE THOROCOSTOMY: MANAGEMENT AND OUTCOME IN PATIENTS WITH PENETRATING CHEST TRAUMA

Muhammad Muslim, Amer Bilal, Muhammad Salim, Muhammad Abid Khan, Abdul Baseer, Manzoor Ahmed

Abstract


Background: Penetrating chest trauma is common in this part of the world due to present situation in
tribal areas. The first line of management after resuscitation in these patients is tube thoracostomy
combined with analgesia and incentive spirometry. After tube thoracostomy following surgery or trauma
there are two schools of thought one favours application of continuous low pressure suction to the chest
tubes beyond the water seal while other are against it. We studied the application of continuous low
pressure suction in patients with penetrating chest trauma. This Randomized clinical controlled trial was
conducted in the department of thoracic surgery Post Graduate Medical Institute Lady Reading Hospital
Peshawar from July 2007 to March 2008. The objectives of study were to evaluate the effectiveness of
continuous low pressure suction in patients with penetrating chest trauma for evacuation of blood,
expansion of lung and prevention of clotted Haemothorax. Methods: One hundred patients who
underwent tube thoracostomy after penetrating chest trauma from fire arm injury or stab wounds were
included in the study. Patients with multiple trauma, blunt chest trauma and those intubated for any
pulmonary or pleural disease were excluded from the study. After resuscitation, detailed examination and
necessary investigations patients were randomized to two groups. Group I included patients who had
continuous low pressure suction applied to their chest drains. Group II included those patients whose chest
drains were placed on water seal only. Lung expansion development of pneumothorax or clotted
Haemothorax, time to removal of chest drain and hospital stay was noted in each group. Results: There
were fifty patients in each group. The two groups were not significantly different from each other
regarding age, sex, pre-intubation haemoglobin and pre intubation nutritional status. Full lung expansion
was achieved in forty six (92%) patients in group I and thirty seven (74%) in group II. Partial lung
expansion or pneumothorax was present in three (6%) in group I and 10 (20%) in group II. One patient in
group I and three (6%) patients in group II had no response. The mean time to removal of chest drains
were 8.2±3.14 days in group I and 12.6±4.20 days in group II. The length of hospital stay was 7.2±2.07
days and 12.4±3.63 days in group I and II respectively. Clotted Haemothorax requiring surgery developed
in three (6%) patients in group I and 8 (16%) patients in group II. Conclusion: Placing chest tubes on
continuous low pressure suction after penetrating chest trauma helps evacuation of blood, expansion of
lung and prevents the development of clotted Haemothorax. It also reduces the time to removal of chest
drains, the hospital stay and the chances of surgery for clotted Haemothorax or Empyema.
Keywords: Penetrating chest trauma, low pressure suction, clotted Haemothorax, lung expansion,
pneumothorax, tube thoracostomy.

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