Clamping thoracostomy tubes: a heretical notion?

Area of Science:

• Thoracic Surgery
• Trauma Care
• Pulmonary Medicine

Background:

• Chest tube management is critical for patients with pneumothorax or hemothorax.
• Assessing persistent air leaks and determining optimal chest tube removal timing can be challenging.
• Clamping protocols aim to evaluate air leak resolution before tube removal.

Purpose of the Study:

• To evaluate the safety and complications associated with chest tube clamping in trauma patients.
• To determine if chest tube clamping aids in the assessment of persistent air leaks.
• To explore the impact of clamping on chest tube removal timing and patient outcomes.

Main Methods:

• Retrospective chart review of 243 patients with pneumothorax, hemothorax, or both at a level I trauma center.
• Analysis of 134 patients who underwent chest tube clamping versus 109 who did not.
• Comparison of demographic characteristics, injury types, and outcomes between clamped and non-clamped groups.

Main Results:

• No deaths were associated with chest tube clamping.
• Recurrence or symptoms requiring unclamping occurred in 9.7% of clamped patients.
• Reinsertion was needed in 6.7% due to recurrent pneumothorax after a clamping trial; one patient required a second tube for thrombus.

Conclusions:

• Chest tube clamping appears safe and facilitates definitive assessment of occult air leaks via a 6-hour radiograph.
• The clamping protocol may help avoid premature chest tube removal without compromising patient safety.
• Further refinements and prospective studies are warranted to optimize clamping for potentially faster chest tube removal and reduced length of stay.