ABSTRACT

Introduction: One third of thoracic injuries require hospitalization and the insertion of a chest drain is the only invasive procedure needed most of the times ( › 85%). Between 7.6-30% of patients undergoing this procedure experience some complication. Material and methods: A retrospective, descriptive, observational study was conducted at the Central Hospital of the Mexican Red Cross with the review of the records of all patients admitted during the period of February 2007 to December 2013 with history of blunt or penetrating trauma and whose injuries required the insertion of a chest drain. Results: 812 patients were included —758 men and 54 women—, between 18-45 years old; 68 had history of blunt chest trauma and 744 of penetrating trauma. The frequency of the injuries that were considered as an indication to insert a chest drain was: 206 pneumothorax, 249 hemothorax and 357 hemopneumothorax. The average dwelling time of the drains was 4.53 days and there were 13 (1.60%) complications recorded, 8 residual pneumothorax needing drain reinsertion and 5 retained hemothorax requiring thoracotomy for resolution. Discussion: Thoracic injuries predominated among males with a ratio of 14:1, most (91.62%) with penetrating mechanism. The occurrence of complications related to the pleural cavity was evaluated in the period between the placement of the chest drain and the first consultation a week after its withdrawal; these were observed only in 1.60% of patients and only 0.61%of them required surgery, involving a reduction of 78.95 and 93.90% in comparison with the studies analyzed; in addition, the average dwelling time of the probes was 4.53 days, i.e. 30.95% less than in the reviewed literature. Conclusions: Our protocol for handling chest drains in trauma situations has proven to be an effective technique with almost no inherent complications.

KEYWORDS

Chest drain, chest trauma, pneumothorax, hemothorax.

REFERENCES

1. Villegas-Carlos F, Vázquez-Martínez AM, Pinedo-Onofre JA, Guevara-Torres L, Belmares-Taboada JA, Sánchez-Aguilar M. Utilidad de los antimicrobianos en la toracostomía cerrada por trauma. Cir Ciruj 2009;77(1):29-32.

2. Mattox KL, Matthew JW, Tsai P. Trauma thoracotomy: principles and techniques. In: Mattox KL, Moore EE, Feliciano DV, editors. Trauma. 7th ed. United States: McGraw-Hill; 2013. p. 461-467.

3. Fitzgerald M, Mackenzie CF, Marasco S, Hoyle R, Kossmann T. Pleural decompression and drainage during trauma reception and resuscitation. Injury 2008;39(1):9-20. doi: 10.1016/j.injury.2007.07.021.

4. Colegio Americano de Cirujanos. Comité de trauma. Programa avanzado de apoyo vital en trauma. Manual del curso para estudiantes. 9a. ed. Estados Unidos: American College of Surgeons; 2012.

5. Menger R, Telford G, Kim P, et al. Complications following thoracic trauma managed with tube thoracostomy. Injury 2012;43(1):46-50. doi: 10.1016/j.injury.2011.06.420.

6. Rivera L, O’Reilly EB, Sise MJ, et al. Small catheter tube thoracostomy: effective in managing chest trauma in stable patients. J Trauma 2009;66(2):393-399. doi: 10.1097/TA.0b013e318173f81e.

7. Durai R, Hoque H, Davies TW. Managing a chest tube and drainage system. AORN J 2010;91(2):275-280; quiz 281-3. doi: 10.1016/j.aorn.2009.09.026.

8. Huber-Wagner S, Körner M, Ehrt A, et al. Emergency chest tube placement in trauma care-which approach is preferable? Resuscitation 2007;72:226-233.

9. Maritz D, Wallis L, Hardcastle T. Complications of tube thoracostomy for chest trauma. S Afr Med J 2009;99(2):114-117.

10. Martino K, Merrit S, Boyakye K, et al. Prospective randomized trial of thoracostomy removal algorithms. J Trauma 1999;46(3):369-371.

11. Tawil I, Gonda JM, King RD, Marinaro JL, Crandall CS. Impact of positive pressure ventilation on thoracostomy tube removal. J Trauma 2010;68(4):818-821. doi: 10.1097/TA.0b013e3181a5973c.

12. Baumann MH. What size chest tube? What drainage system is ideal? And other chest tube management questions. Curr Opin Pulm Med 2003;9(4):276-281.

13. Tsai WK, Chen W, Lee JC, et al. Pigtail catheter vs large-bore chest tubes for management of secondary spontaneous pneumothoraces in adults. Am J Emerg Med 2006;24(7):795-800.

14. Flato UA, Guimarães HP, Lopes RD, Valiatti JL, Flato EM, Lorenzo RG. Usefulness of extended-FAST (EFAST-Extended Focused Assessment with Sonography for Trauma) in critical care setting. Rev Bras Ter Intensiva 2010;22(3):291-299.

15. Bell RL, Ovadia P, Abdullah F, Spector S, Rabinovici R. Chest tube removal: end-inspiration or end-expiration? J Trauma 2001;50(4):674-677.

16. Fox SI. Fisiología humana. 12a ed. México: McGraw-Hill; 2011. p. 524-573.

17. Eren S, Esme H, Sehitogullari A, Durkan A. The risk factors and management of posttraumatic empyema in trauma patients. Injury 2008;39(1):44-49.

18. Karmy-Jones R, Holevar M, Sullivan RJ, Fleisig A, Jurkovich GJ. Residual hemothorax after chest tube placement correlates with increased risk of empyema following traumatic injury. Can Respir J 2008;15(5):255-258.

19. Hernández LA, Ruiz GJ, Escamilla AC. Epidemiología del trauma. En: Morales JL, editor. Tratado de cirugía general. 2a ed. México: El Manual Moderno; 2008. p. 1047-1054.

20. Belzunegui T. Protocolo de drenaje torácico del servicio de urgencias del Hospital de Navarra. Técnicas de Urgencias. Edición electrónica. España: Universidad de Navarra; 2000.

21. Rahman NM, Maskell NA, Davies CW, et al. The relationship between chest tube size and clinical outcome in pleural infection. Chest 2010;137(3):536-543. doi: 10.1378/chest.09-1044.

22. Cueto LGA. Colocación de un drenaje torácico. Neumosur 1994;6(2):40-42.

23. Yadav K, Jalili M, Zehtabchi S. Management of traumatic occult pneumothorax. Resuscitation 2010;81(9):1063-1068. doi: 10.1016/j.resuscitation.2010.04.030.

24. Cothren CC, Biffl WL, Moore EE. Traumatismos. En: Brunicardi FC, Andersen DK, Billiar TR, et al., editores. Principios de cirugía. 9a ed. México: McGraw-Hill; 2011. p. 135-195.