Lateral Thoracostomy Tubes: Is Outcome Affected by Level of Intercostal Space?

Kyle E Walker Elaine Pahilan M

doi:10.4172/2167-1222.1000247

Abstract

Objectives: Tube thoracostomy is a common procedure performed after chest trauma. The current practice is to insert the tube in the 3rd, 4th, or 5th intercostal space (ICS) at the anterior axillary line. In this study we compared the outcome of tubes inserted at lower spaces versus the standard (higher) location. Methods: Patients receiving a chest tube after chest trauma were identified using the trauma registry at a Level 1 trauma center from July 2009 to December 2011. Each tube inserted was categorized as either “High” (3rd-5th ICS) or “Low” (6th-7th ICS) placement. Patient records were reviewed for demographics, Injury Severity Score (ISS), chest tube interval (CTI), length of hospital stay (LOHS), interventions (including thoracoscopy and thoracotomy), and mortality. Results: There were no differences between both groups regarding age, ISS, interventions or mortality. However, patients receiving chest tubes in the 3rd through-5th ICS (High group) demonstrated significantly lower CTI and LOHS when controlling for age and ISS. (Multi-linear Regression, F-Value=3.14 and 9.44; p=0.027 and <0.0001, respectively) Conclusion: Low thoracotomy placement tubes are as safe as High placement with no difference in outcome in terms of morbidity and mortality. However, patients with low placement reported longer CTI and a longer LOHS.

Highlights

Tube thoracostomy is a procedure frequently performed in medical centers
While many health care practitioners believe lower chest tubes are superior for draining fluid, and resulting in reduced risk of retained hemothorax and empyema, others are concerned that inserting low tubes carry the risk of injury to diaphragm and intra-abdominal organs
All deaths were related to severity of injury and there were no complications associated with thoracostomy tube recorded prior to death

Summary

Introduction

Tube thoracostomy is a procedure frequently performed in medical centers. Indications for tube thoracostomy include pneumothorax, hemopneumothorax, and postoperative drainage [1,2]. The most common complications following tube thoracostomy are positional (i.e. kinking, malposition) and infective, insertional (i.e. structural trauma) complications can occur [2]. Infections, when they occur, have a tendency to be drain site infections which are minor in nature. Major infections such as an empyema have a relatively low incidence rate [3]. The purpose of this study is to compare the complication rates of thoracostomy tube placed after chest trauma at a current standard practice, high placement (3-5thICS), versus low (6-7th ICS) placement and to determine if a lower placement yields better outcomes

Objectives

Methods

Results

Discussion

Conclusion