Emergency small- vs large-tube thoracostomy in chest trauma patients

Hussein Khairy Abdelaziz  Elkhayat; Ahmed Mohamed Fathy Ghoneim; Moamen Shalkamy   Abdelgawaad; Amr Mohamed Mamdouh Hussein; Amr Ibrahiem   Abdelaal Osman

Hussein Khairy Abdelaziz Elkhayat Department of Cardiothoracic Surgery, Assiut University Hospitals, Assiut, Egypt
Ahmed Mohamed Fathy Ghoneim Department of Cardiothoracic Surgery, Assiut University Hospitals, Assiut, Egypt
Moamen Shalkamy Abdelgawaad Department of General Surgery, Assiut University Hospitals, Assiut, Egypt
Amr Mohamed Mamdouh Hussein Department of Cardiothoracic Surgery, Assiut University Hospitals, Assiut, Egypt
Amr Ibrahiem Abdelaal Osman Department of Cardiothoracic Surgery, Assiut University Hospitals, Assiut, Egypt

Keywords: Emergency, Large tube thoracostomy, Chest trauma patients

Abstract

Background: Therapeutic drainage is used to treat pleural disorders such as pneumothorax, hemothorax, empyema, chylothorax, and malignant effusions. This study aimed to conduct a comparative analysis of small (24-26 Fr) versus large (30-32 Fr) tube thoracostomy in terms of the efficacy of drainage due to concerns about obstruction (in the case of hemothorax) or inadequate drainage (in the case of hemothorax, pneumothorax, or hemopneumothorax), pain score, repositioning, and the need for thoracotomy.

Methods: This randomized prospective study included 112 chest trauma patients who experienced significant hemothorax, pneumothorax, or a combination of these conditions in a trauma unit (reception, inpatient, or ICU) between December 2021 and December 2022. Patients were randomly divided into two groups. Group I included 56 patients who underwent small (24–26 Fr) tube thoracostomy and 56 patients in Group II, in which a large (30-32 Fr) tube thoracostomy was performed.

We investigated the differences between the two groups in terms of pain score, complication rate, duration of tube insertion, and need for another chest tube or thoracotomy.

Results: There was no statistically significant difference between the two groups concerning the mode of trauma, chest trauma, or effect of trauma (p= 0.781, 0.622, >0.99, and >0.99, respectively). The two groups had a highly statistically significant difference regarding the pain score (p<0.001). There was no statistically significant difference between the two groups regarding the duration of tube insertion (P<0.001). There were no statistically significant differences between the two groups regarding outcomes (drainage efficacy, tube repositioning, tube replacement, or the need for thoracotomy) (p= 0.315, 0.344, and 0.814, respectively).

Conclusion: Increasing the tube size might not affect the efficacy of drainage, the duration of tube insertion, the need for another tube, or the need for thoracotomy. Small (24-26 Fr) tube thoracostomies could also have favorable pain score outcomes.