Avoiding a Chest Tube for Traumatic PTX

Spoon Feed
In this prospective cohort of 602 patients with fairly small traumatic pneumothoraces, 277 of 602 (46%) were managed without tube thoracostomy; 90% of these did well, including those receiving positive pressure ventilation.

Why does this matter?
Placing a chest tube is an invasive procedure, with complications of its own.  But it is often done on patients with pneumothorax from trauma, especially if the patient is on positive pressure ventilation.  But is it always necessary?

Hold the tube
This was a prospective cohort study of patients with traumatic pneumothorax at a single center.  They found that 277 of 602 (46%) patients were managed non-operatively, without a chest tube.  62 of these were receiving positive pressure ventilation.  Of these 277, 90% never required subsequent chest tube placement.  Similarly, 90% (56 of 62) on PPV never required chest tube placement.  Most patients with a pneumothorax size > 2cm were managed with initial tube placement.  Patients with a large hemothorax >2cm were most likely to fail non-operative management. The study was limited by its observational nature.  Management was determined by the treating physicians and may have reflected individual treatment biases.

Source
Conservative Management in Traumatic Pneumothoraces: An Observational Study.  Chest. 2017 Nov 15. pii: S0012-3692(17)32917-3. doi: 10.1016/j.chest.2017.10.015. [Epub ahead of print]

Peer reviewed by Thomas Davis, MD.

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