TUBE THOROCOSTOMY: MANAGEMENT AND OUTCOME IN PATIENTS WITH PENETRATING CHEST TRAUMA
AbstractBackground: Penetrating chest trauma is common in this part of the world due to present situation intribal areas. The first line of management after resuscitation in these patients is tube thoracostomycombined with analgesia and incentive spirometry. After tube thoracostomy following surgery or traumathere are two schools of thought one favours application of continuous low pressure suction to the chesttubes beyond the water seal while other are against it. We studied the application of continuous lowpressure suction in patients with penetrating chest trauma. This Randomized clinical controlled trial wasconducted in the department of thoracic surgery Post Graduate Medical Institute Lady Reading HospitalPeshawar from July 2007 to March 2008. The objectives of study were to evaluate the effectiveness ofcontinuous 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 whounderwent tube thoracostomy after penetrating chest trauma from fire arm injury or stab wounds wereincluded in the study. Patients with multiple trauma, blunt chest trauma and those intubated for anypulmonary or pleural disease were excluded from the study. After resuscitation, detailed examination andnecessary investigations patients were randomized to two groups. Group I included patients who hadcontinuous low pressure suction applied to their chest drains. Group II included those patients whose chestdrains were placed on water seal only. Lung expansion development of pneumothorax or clottedHaemothorax, time to removal of chest drain and hospital stay was noted in each group. Results: Therewere fifty patients in each group. The two groups were not significantly different from each otherregarding age, sex, pre-intubation haemoglobin and pre intubation nutritional status. Full lung expansionwas achieved in forty six (92%) patients in group I and thirty seven (74%) in group II. Partial lungexpansion or pneumothorax was present in three (6%) in group I and 10 (20%) in group II. One patient ingroup I and three (6%) patients in group II had no response. The mean time to removal of chest drainswere 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±2.07days and 12.4±3.63 days in group I and II respectively. Clotted Haemothorax requiring surgery developedin three (6%) patients in group I and 8 (16%) patients in group II. Conclusion: Placing chest tubes oncontinuous low pressure suction after penetrating chest trauma helps evacuation of blood, expansion oflung and prevents the development of clotted Haemothorax. It also reduces the time to removal of chestdrains, 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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