Abstract
Chest injuries cause a significant number of pneumothorax (PTX) and hemothorax (HTX). The most commonly used treatment is chest-tube drainage. The position of the tube is a prime necessity to achieve adequate drainage. To analyze the duration of chest drainage at the occurrence of PTX and HTX. To find what the underlying cause of drainage insufficiency is and whether there is any relation between the surgical qualification needed to the procedure. Clinical data of 110 injured patients from 2011 to 2015 were collected and retrospectively analyzed. In the case of tube breaking or drainage insufficiency it was investigated if repositioning, usage of new tubes or insertion of additional tubes resolved the drainage insufficiency. Authors investigated the location of the tube on x-ray and CT, and the connection between the drainage insufficiency and the surgical qualifications needed to the procedure. The average duration of chest drainage was 6.5 days. The duration of drainage was shorter by 1.9 days regarding the tube inserted in the middle section of the chest compared to the upper one and shorter by 1.2 days regarding the tube inserted in the lower section of the chest compared to the upper one. In the case of HTX, the duration of drainage was shorter by 2.8 days regarding the lower and by 3.6 days regarding the middle section compared to the upper position. Drainage insufficiency occurred in 30% of all cases. The duration of chest drainage was shorter after application of new tubes (9.5 days) than after reposition (10.2 days), but there was no significant difference. Chest injury is a wide entity, thus one standard protocol cannot be developed on the management of these injuries. Authors concluded that drainage duration decreases significantly if the position of the tube is in the middle or lower section of the chest. The high occurrence of drainage insufficiency was caused by inadequate tube positioning and tube breaking. The practical qualification of trauma surgeons did not play a significant role regarding the prevalence of drainage insufficiency rather if the tube positioning was appropriate. Orv Hetil. 2019; 160(5): 172-178.
Highlights
Chest injuries cause a significant number of pneumothorax (PTX) and hemothorax (HTX)
Authors investigated the location of the tube on x-ray and CT, and the connection between the drainage insufficiency and the surgical qualifications needed to the procedure
Chest injury is a wide entity, one standard protocol cannot be developed on the management of these injuries
Summary
Csonka Ákos dr. ■ Dózsai Dávid dr. ■ Ecseri Tamás dr. Gárgyán István dr. ■ Csonka István dr. ■ Varga Endre dr. A mellkasi cső pozíciója kiemelt fontosságú a megfelelő drenázs eléréséhez. Célkitűzés: Tanulmányunkban választ kerestünk arra, hogy a PTX és HTX esetén alkalmazott mellkascsövezés során hogyan alakulnak a drenázsidőtartamok, mi a felmerülő drenázselégtelenség oka, valamint szerepet játszik-e a baleseti sebészek tapasztalata. A mellkas középső harmadába eső drénpozíció a felsőhöz viszonyítva 1,9 nappal, míg az alsó a felső pozícióhoz viszonyítva 1,2 nappal rövidebb drenázsidőt vett igénybe. HTX esetében az alsó 2,8 nappal, a középső 3,6 nappal rövidebb drenázsidőt igényelt a felső pozícióhoz képest. Tanulmányunk alapján igazolást nyert, hogy a mellkasi csőnek a mellkas alsó és középső harmadába történő megfelelő pozicionálása jelentősen csökkenti a drenázsidőtartamot. A magas drenázselégtelenséget a cső nem megfelelő pozicionálása és megtörése okozta. Tanulmányunk szerint a baleseti sebészek tapasztalata nem játszik szignifikáns szerepet, a cső megfelelő pozicionálása lényegesebb.
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