Prospective randomized trial of thoracostomy removal algorithms.

Area of Science:

• Trauma Surgery
• Thoracic Surgery
• Critical Care Medicine

Background:

• The optimal algorithm for chest tube (CT) removal remains undetermined.
• Current practices vary regarding water seal versus suction methods for CT management.
• Establishing best practices is crucial for improving patient outcomes in thoracic trauma.

Purpose of the Study:

• To compare the efficacy of water seal versus suction in chest tube removal.
• To determine the impact of each method on chest tube duration.
• To evaluate recurrent pneumothorax (PTX) rates, CT reinsertion needs, and chest x-ray (CXR) frequency.

Main Methods:

• A prospective randomized trial involving 205 trauma patients (age >15) undergoing tube thoracostomy.
• Patients were randomized to either a water seal or no water seal group upon meeting removal criteria.
• Outcomes measured included CT duration, PTX recurrence, CT reinsertion, and CXR count.

Main Results:

• No significant difference in chest tube duration or hospital length of stay was observed between groups.
• The water seal group showed a trend towards lower rates of pneumothorax requiring reinsertion (1 vs. 7 patients).
• The water seal group had a slightly higher average number of CXRs (6.5 vs. 5.5).

Conclusions:

• A brief trial of water seal before chest tube removal may help identify occult air leaks.
• This approach appears to reduce the need for chest tube reinsertion compared to immediate removal after suction disconnection.
• While chest tube duration was similar, the water seal method may offer advantages in preventing recurrent pneumothorax.