ROLE OF CLAMPING TUBE THORACOSTOMY PRIOR TO REMOVAL IN NON-CARDIAC THORACIC TRAUMA
Abstract
Background: The frequently encountered thoracic trauma in surgical emergencies is a major cause of mortality and morbidity. Eighty percent of thoracic trauma can be managed by simple insertion of tube thoracostomy. Though guidelines for insertion are comprehensively explained in literature, an ideal algorithm for discontinuation is not available. A standard and safe defined protocol would eliminate hesitancy in confident removal among general surgeons. The objective of this study was to determine role of clamping trial prior to removal in terms of frequency of recurrent pneumothorax. Methods: This study was conducted in department of Surgery Combined military hospital/Military Hospital Rawalpindi from April 2013 to March 2014. Total 180 patients with blunt or penetrating thoracic trauma were included in the study. Chest tube (28-36 Fr) was inserted in Trauma centre under strict asepsis. Tubes were then connected to under water seal for minimum six hours. Patients were randomly divided in two equal groups (90 in each). In Group A, Clamping trial was given before attempting removal while in Group B, tube was removed immediately without clamping trial. Patients of both groups were observed two hourly for development of recurrent pneumothorax. Data was analysed using SPSS-18. Results: The comparison of frequency of recurrent pneumothorax in Group A (9 patients, 10%) and in Group B (4 patients, 4.5%) was not found to be statistically significant. (p-value 2.073). Conclusion: Clamping trial is unnecessary prior to removal of tube thoracostomy in blunt and penetrating non-cardiac thoracic trauma in terms of recurrent pneumothorax.
References
Smith GS, Barss PG. Unintentional injuries in developing countries: the epidemiology of a neglected problem. Epidemiol Rev 1991;13:228-66.
Zwi A. The public burden of injuries in developing countries: A critical review of the literature. Trop Dis Bull 1993;90:5-45.
Mackinney T, Baker T. Impact of motor vehicle injury in Taiwan using potential productive years of life lost. Asia Pac J Public Health 1994;7(1):10-5.
Al-Koudmani I, Darwish B, Al-Kateb K, Taifour Y. Chest trauma experience over eleven year period at al-mouassat university teaching hospital Damascus: a retrospective review of 888 cases. J Cardiothorac Surg 2012;7:35-47.
Demirhan R, Onan B, Oz K, Halezeroglu S. Comprehensive analysis of 4205 patients with chest trauma: A 10-year experience. Interact Cardiovasc Thorac Surg 2009;9(3):450-3.
O'Connor JV, Adamski J. The diagnosis and treatment of non-cardiac thoracic trauma. J R Army Med Corps 2010;156(1):5-14.
Deneuville M. Morbidity of percutaneous tube thoracostomy in trauma patients. Eur J Cardiothorac Surg 2002;22(5):673-8.
Helling TS, Gyles NR 3rd, Eisenstein CL, Soracco CA. Complications following blunt and penetrating injuries in 216 victims of chest trauma requiring tube thoracostomy. J Trauma 1989;29(10):1367-70.
American College of Surgeons, Committee on Trauma. ATLS, advanced trauma life support for doctors. Chicago, IL: American College of Surgeons; 2008.
Martino K, Merrit S, Boyakye K, Sernas T, Koller C, Hauser CJ, et al. Prospective randomized trial of thoracostomy removal algorithms. J Trauma 1999;46(3):369-73.
Etoch SW, Bar-Natan MF, Miller FB, Richardson JD. Tube thoracostomy. Arch Surg 1995;130(5):521-6.
Fitzpatrick C, Brasel KJ. Chest tube insertion. Oper Tech Gen Surg 2003;5(3):129-33.
McFadden P, Jones JW. Tube thoracostomy: Anatomical considerations, overview of complications, and a proposed technique to avoid complications. Mil Med 1985;150(12):681-5.
Semrad N. A new technique for closed thoracostomy insertion of a chest tube. Surg Gynecol Obstet 1988;166(2):171-3.
Davis JW, Mackersie RC, Hoyt DB, Garcia J. Randomized study of algorithms for discontinuing tube thoracostomy drainage. J Am Coll Surg 1994;179(5):553-7.
Mefire AC, Pagbe JJ, Fokou M, Nguimbous JF, Guifo ML, Bahebeck J. Analysis of epidemiology, lesions, treatment and outcome of 354 consecutive cases of blunt and penetrating trauma to the chest in an African setting. S Afr J Surg 2010;48(3):90-3.
Lema MK, Chalya PL, Mabula JB, Mahalu W. Pattern and outcome of chest injuries at Bugando Medical Centre in Northwestern Tanzania. J Cardiothorac Surg 2011;6:7.
Liman ST, Kuzucu A, Tastepe AI, Ulasan GN, Topcu S. Chest injury due to blunt trauma. Eur J Cardiothorac Surg 2003;23(3):374-8.
Demirhan R, Küçük HF, Kargi AB, Altintaş M, Kurt N, Gülmen M. Evaluation of 572 cases of blunt and penetrating thoracic trauma. Ulus Travma Derg 2001;7(4):231-5.
Cakan A, Yuncu G, Olgaç G, Alar T, Sevinç S, Ors Kaya S, et al. Thoracic trauma: analysis of 987 cases. Ulus Travma Derg 2001;7(4):236-41.
Peterson RJ, Tepas JJ 3rd, Edwards FH, Kissoon N, Pieper P, Ceithaml EL. Pediatric and adult thoracic trauma: age-related impact on presentation and outcome. Ann Thorac Surg 1994;58(1):14-8.
Parvez M, Malik ZU, Ali MA, Masood T, Muzzaffar S. Management of thoracic injuries: Our experience at military hospitals. Pak Armed Forces J 2007;57(2):104-12.
Daly RC, Mucha P, Pairolero PC, Farnell MB. The risk of percutaneous chest tube thoracostomy for blunt thoracic trauma. Ann Emerg Med 1985;14(9):865-70.
Bell R, Ovadia P, Abdullah F, Spector S, Rabinovici R. Chest tube removal: End-Inspiration or End-Expiration? J Trauma 2001;50(4):674-6.
Funk GA, Petrey LB, Foreman ML. Clamping thoracostomy tubes: A heretical notion? Proc (Bayl Univ Med Cent) 2009;22(3):215-7.
Baumann MH, Strange C, Heffner JE, Light R, Kirby TJ, Klein J, et al. Management of spontaneous pneumothorax: an American College of Chest Physicians Delphi consensus statement. Chest 2001;119(2):590-602.
Younes RN, Gross JL, Aguiar S, Haddad FJ, Deheinzelin D. When to remove a chest tube? A randomized study with subsequent prospective consecutive validation. J Am Coll Surg 2002;195(5):658-62.
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