Chest tube insertion direction: Is it always necessary to insert a chest tube posteriorly in primary trauma care?

Shokei Matsumoto, Kazuhiko Sekine, Tomohiro Funabiki, Motoyasu Yamazaki, Tomohiko Orita, Masayuki Shimizu, Kei Hayashida, Masanobu Kishikawa, Mitsuhide Kitano

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Background The advanced trauma life support guidelines suggest that, in primary care, the chest tube should be placed posteriorly along the inside of the chest wall. A chest tube located in the posterior pleural cavity is of use in monitoring the volume of hemothoraces. However, posterior chest tubes have a tendency to act as nonfunctional drains for the evacuation of pneumothoraces, and additional chest tube may be required. Thus, it is not always necessary to insert chest tubes posteriorly. The purpose of this study was to determine whether posterior chest tubes are unnecessary in trauma care.

Methods We reviewed the volume of hemothoraces from 78 chest drains emergently placed posteriorly at a primary trauma care in 75 blunt chest trauma patients who were consecutively admitted over a 6-year period, excluding those with cardiopulmonary arrest and occult pneumothoraces. Massive acute hemothorax (MAH), in which the chest tube should be inserted posteriorly, was defined as the evacuation of more than 500 mL of blood or the need for hemostatic intervention within 24 hours of trauma admission. Demographics, interventions, and outcomes were analyzed. We also reviewed the malpositioning of 74 chest tubes based on anterior and posterior insertion directions in patients who subsequently underwent computed tomography.

Results The overall incidence of MAH was 23% (n = 18). In the univariate analysis, the presence of multiple rib fractures, shock, pulmonary opacities on chest x-ray, and the need for intubation were found to be independent predictors for the development of MAH. If all 4 independent predictors were absent, none of the patients developed MAH. The incidence of nonfunctional chest drains that required reinsertion or the addition of a new drainage was 27% (n = 20). The rates of both radiologic and functional malposition in chest tubes with posterior insertion were significantly higher than in patients with anterior insertion (64% and 43% vs 13% and 6%, respectively; P <.01).

Conclusions Chest tubes did not need to be directed posteriorly in many trauma cases. Posterior chest tubes have a high incidence of being malpositioned. This malpositioning may be prevented by judging the necessity for posterior insertion.

Original languageEnglish
Pages (from-to)88-91
Number of pages4
JournalAmerican Journal of Emergency Medicine
Volume33
Issue number1
DOIs
Publication statusPublished - 2015 Jan 1
Externally publishedYes

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Chest Tubes
Primary Health Care
Hemothorax
Wounds and Injuries
Thorax
Pneumothorax
Incidence
Direction compound
Advanced Trauma Life Support Care
Rib Fractures
Pleural Cavity
Thoracic Wall
Hemostatics
Heart Arrest
Intubation
Drainage
Shock
Tomography
X-Rays
Demography

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

Chest tube insertion direction : Is it always necessary to insert a chest tube posteriorly in primary trauma care? / Matsumoto, Shokei; Sekine, Kazuhiko; Funabiki, Tomohiro; Yamazaki, Motoyasu; Orita, Tomohiko; Shimizu, Masayuki; Hayashida, Kei; Kishikawa, Masanobu; Kitano, Mitsuhide.

In: American Journal of Emergency Medicine, Vol. 33, No. 1, 01.01.2015, p. 88-91.

Research output: Contribution to journalArticle

Matsumoto, S, Sekine, K, Funabiki, T, Yamazaki, M, Orita, T, Shimizu, M, Hayashida, K, Kishikawa, M & Kitano, M 2015, 'Chest tube insertion direction: Is it always necessary to insert a chest tube posteriorly in primary trauma care?', American Journal of Emergency Medicine, vol. 33, no. 1, pp. 88-91. https://doi.org/10.1016/j.ajem.2014.10.042
Matsumoto, Shokei ; Sekine, Kazuhiko ; Funabiki, Tomohiro ; Yamazaki, Motoyasu ; Orita, Tomohiko ; Shimizu, Masayuki ; Hayashida, Kei ; Kishikawa, Masanobu ; Kitano, Mitsuhide. / Chest tube insertion direction : Is it always necessary to insert a chest tube posteriorly in primary trauma care?. In: American Journal of Emergency Medicine. 2015 ; Vol. 33, No. 1. pp. 88-91.
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abstract = "Background The advanced trauma life support guidelines suggest that, in primary care, the chest tube should be placed posteriorly along the inside of the chest wall. A chest tube located in the posterior pleural cavity is of use in monitoring the volume of hemothoraces. However, posterior chest tubes have a tendency to act as nonfunctional drains for the evacuation of pneumothoraces, and additional chest tube may be required. Thus, it is not always necessary to insert chest tubes posteriorly. The purpose of this study was to determine whether posterior chest tubes are unnecessary in trauma care.Methods We reviewed the volume of hemothoraces from 78 chest drains emergently placed posteriorly at a primary trauma care in 75 blunt chest trauma patients who were consecutively admitted over a 6-year period, excluding those with cardiopulmonary arrest and occult pneumothoraces. Massive acute hemothorax (MAH), in which the chest tube should be inserted posteriorly, was defined as the evacuation of more than 500 mL of blood or the need for hemostatic intervention within 24 hours of trauma admission. Demographics, interventions, and outcomes were analyzed. We also reviewed the malpositioning of 74 chest tubes based on anterior and posterior insertion directions in patients who subsequently underwent computed tomography.Results The overall incidence of MAH was 23{\%} (n = 18). In the univariate analysis, the presence of multiple rib fractures, shock, pulmonary opacities on chest x-ray, and the need for intubation were found to be independent predictors for the development of MAH. If all 4 independent predictors were absent, none of the patients developed MAH. The incidence of nonfunctional chest drains that required reinsertion or the addition of a new drainage was 27{\%} (n = 20). The rates of both radiologic and functional malposition in chest tubes with posterior insertion were significantly higher than in patients with anterior insertion (64{\%} and 43{\%} vs 13{\%} and 6{\%}, respectively; P <.01).Conclusions Chest tubes did not need to be directed posteriorly in many trauma cases. Posterior chest tubes have a high incidence of being malpositioned. This malpositioning may be prevented by judging the necessity for posterior insertion.",
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AU - Yamazaki, Motoyasu

AU - Orita, Tomohiko

AU - Shimizu, Masayuki

AU - Hayashida, Kei

AU - Kishikawa, Masanobu

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N2 - Background The advanced trauma life support guidelines suggest that, in primary care, the chest tube should be placed posteriorly along the inside of the chest wall. A chest tube located in the posterior pleural cavity is of use in monitoring the volume of hemothoraces. However, posterior chest tubes have a tendency to act as nonfunctional drains for the evacuation of pneumothoraces, and additional chest tube may be required. Thus, it is not always necessary to insert chest tubes posteriorly. The purpose of this study was to determine whether posterior chest tubes are unnecessary in trauma care.Methods We reviewed the volume of hemothoraces from 78 chest drains emergently placed posteriorly at a primary trauma care in 75 blunt chest trauma patients who were consecutively admitted over a 6-year period, excluding those with cardiopulmonary arrest and occult pneumothoraces. Massive acute hemothorax (MAH), in which the chest tube should be inserted posteriorly, was defined as the evacuation of more than 500 mL of blood or the need for hemostatic intervention within 24 hours of trauma admission. Demographics, interventions, and outcomes were analyzed. We also reviewed the malpositioning of 74 chest tubes based on anterior and posterior insertion directions in patients who subsequently underwent computed tomography.Results The overall incidence of MAH was 23% (n = 18). In the univariate analysis, the presence of multiple rib fractures, shock, pulmonary opacities on chest x-ray, and the need for intubation were found to be independent predictors for the development of MAH. If all 4 independent predictors were absent, none of the patients developed MAH. The incidence of nonfunctional chest drains that required reinsertion or the addition of a new drainage was 27% (n = 20). The rates of both radiologic and functional malposition in chest tubes with posterior insertion were significantly higher than in patients with anterior insertion (64% and 43% vs 13% and 6%, respectively; P <.01).Conclusions Chest tubes did not need to be directed posteriorly in many trauma cases. Posterior chest tubes have a high incidence of being malpositioned. This malpositioning may be prevented by judging the necessity for posterior insertion.

AB - Background The advanced trauma life support guidelines suggest that, in primary care, the chest tube should be placed posteriorly along the inside of the chest wall. A chest tube located in the posterior pleural cavity is of use in monitoring the volume of hemothoraces. However, posterior chest tubes have a tendency to act as nonfunctional drains for the evacuation of pneumothoraces, and additional chest tube may be required. Thus, it is not always necessary to insert chest tubes posteriorly. The purpose of this study was to determine whether posterior chest tubes are unnecessary in trauma care.Methods We reviewed the volume of hemothoraces from 78 chest drains emergently placed posteriorly at a primary trauma care in 75 blunt chest trauma patients who were consecutively admitted over a 6-year period, excluding those with cardiopulmonary arrest and occult pneumothoraces. Massive acute hemothorax (MAH), in which the chest tube should be inserted posteriorly, was defined as the evacuation of more than 500 mL of blood or the need for hemostatic intervention within 24 hours of trauma admission. Demographics, interventions, and outcomes were analyzed. We also reviewed the malpositioning of 74 chest tubes based on anterior and posterior insertion directions in patients who subsequently underwent computed tomography.Results The overall incidence of MAH was 23% (n = 18). In the univariate analysis, the presence of multiple rib fractures, shock, pulmonary opacities on chest x-ray, and the need for intubation were found to be independent predictors for the development of MAH. If all 4 independent predictors were absent, none of the patients developed MAH. The incidence of nonfunctional chest drains that required reinsertion or the addition of a new drainage was 27% (n = 20). The rates of both radiologic and functional malposition in chest tubes with posterior insertion were significantly higher than in patients with anterior insertion (64% and 43% vs 13% and 6%, respectively; P <.01).Conclusions Chest tubes did not need to be directed posteriorly in many trauma cases. Posterior chest tubes have a high incidence of being malpositioned. This malpositioning may be prevented by judging the necessity for posterior insertion.

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