![]() Those who underwent irrigation during TT at the discretion of the trauma surgeon were compared to a control of standard TT without irrigation. This study evaluated the association of thoracic irrigation during TT with the length of stay and outcomes in patients with traumatic hemothorax (HTX).Ī retrospective chart review was performed of adult patients receiving a TT for HTX at a single, urban Level 1 Trauma Center from January 2019 to December 2020. Irrigation of the thoracic cavity at tube thoracostomy (TT) placement may decrease the rate of a retained hemothorax (RHTX) however, other resource utilization outcomes have not yet been quantified. Shelley Williams, the UNLV Research Laboratory Manager for assistance in completing this project. The authors wish to acknowledge the assistance of Mrs. Overall, the 28F tube offered the best combination of high and consistent velocity and ability to maintain patency despite outside pressure on the tube. 24F and 20F tubes had highly variable flowrates from intermittent slower, turbulent flow. Chest tube sizes of 28F and smaller are patent at smaller rib space distances. Proponents of larger tubes argue that the greater size enables the tube to better evacuate the chest cavity due the Conclusionīigger chest tubes of size 28F and up have more consistent, reproducible flowrates and are more resistant to pinching of the tube from outside pressure. Despite utilization in the management of patients with injuries and illnesses of the chest and lungs, the proper chest tube size is not known and is subject to discussion. Its mastery is necessary for training in surgery and many associated disciplines. Tubes 28F and larger were resistant to smaller thoracostomy DiscussionĪ chest tube is the most common thoracic procedure, and its placement is one of the foundational procedures in surgical training. All tubes were patent at 4 mm distance and greater.Īverage velocities are plotted according to the thoracostomy opening in Figure 4. Small thoracostomy opening with rib distance of 3 mm occluded the 36F and 32F tubes, but not the 28F, 24F, and 20F tubes. thoracostomy opening ranged between 12 mm, which caused no obstruction, down to 2 mm which occluded all chest tubes. Instead, a synthetic blood substitute was used consisting of aqueous Xanthan gum and Glycerin, both of Resultsįive chest tubes were tested, sizes 20F, 24F, 28F, 32F, and 36F. The basin had capacity >3L of fluid, which represented the chest cavity.ĭue to concern for higher costs and risks of blood-borne diseases, real blood was not used. This included an Atrium Express pleur-evac dry suction drainage system (Maquet Medical Systems, Wayne NJ), which drained fluid from the bottom of a basin. Additionally, smaller thoracostomy openings will decrease flow through the chest tube circuit, and smaller chest tubes may be better suited for small thoracostomy openings than larger tubes.Ī model of hemothorax drainage was created in a laboratory setting (Fig. 1). ![]() We hypothesize that increasing the chest tube size will not result in a proportional increase in flowrate as predicted by the Hagen–Poiseuille equation, due to constant resistance in the chest tube circuit. 6, 7 No studies exist that simulate chest drainage in a controlled setting to measure flow through a chest tube system, and whether increases in chest tube size increase drainage as predicted. Previous studies have sought to determine whether chest tube size relates to drainage efficacy, postprocedure complications or pain management. ![]() To adequately drain a hemothorax, most chest tubes are sized and positioned to adequately drain accumulated blood. While larger tubes will certainly evacuate blood more rapidly, larger tubes are also more challenging to place and may cause more pain for the patient. For patients with more chronic conditions, this can be expanded to any fluid or material, which might collect in the chest. 4, 5 For trauma patients suffering acute injury, the material drained is almost exclusively blood, air, or both. The placement and management of a chest tube is a core tenet of surgical training and is often one of the earliest procedures learned in surgery residency.Ī common clinical decision is what chest tube size to place to sufficiently drain the pleural space.1, 2, 3 The American College of Surgeons ATLS (Advanced Trauma Life Support) curriculum recommends 36–40F tubes (version 9) or 28–32F tubes (version 10) for the treatment of hemothorax. ![]() ![]() Thus, a chest tube is one of the most common procedures in trauma patients. However, when intervention is necessary, the most patients require drainage of the pleural space through a tube thoracostomy. Most patients suffering chest trauma can be managed with supportive care only, avoiding procedures. Chest trauma is commonly managed in trauma centers, from both blunt and penetrating mechanisms. ![]()
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