does (chest tube) size matter?

29 Apr

nice post from the Emergency Medicine Literature of Note blog, on the issue of chest tube size in trauma (click through for the original post)

 

HIGHLIGHTS:

“Traditionally…hemothorax is routinely treated by the largest chest tube possible.”

“Theoretically, smaller chest tubes will clog with debris or blood clot…”

 

“…authors note several simulations of chest tube drainage indicating tubes as small as 14 French may be adequate.  They also hypothesize these larger chest tubes are as painful as tragically possible, and the tradition of large chest tubes results in undue suffering.”

 

“There was no difference observed in their analysis of chest tubes of maximum size versus smaller-than-maxiumum size.  But, a 28-32 Fr chest tube is still a pretty darn large tube.

 

THE STUDY:

28-32 versus 36-40 French chest tube size in trauma. (not a huge difference)

a total of 353 chest tubes

no difference in the:

  • efficacy of drainage,
  • retained hemothorax,
  • need for additional tube drainage,
  • invasive procedures.
  • pain felt by patients at the site of insertion.

 

‘smaller’ study 

36 patients received 14-French pigtail catheters (prospective) vs. 191 chest tubes (retrospective database review).

the patients who got pigtails were all stable blunt-trauma patients (maybe not a perfect sampling of our patient population)

both groups had similar results for:

  • mean initial output
  • Tube duration,
  • rate of insertion-related complications,
  • failure rate

 

BOTTOM LINE:

dogma for traumatic hemothorax chest tube size: ‘bigger is better’

some studies starting to challenge that notion (of clot/debris issues with smaller tubes), but data is not slam-dunk just yet

 

References: emlitofnote post; original article; 14-french article; picture

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