Traumatic pneumothorax: a scheme for rapid patient turnover

Tube thoracostomy is a well-established method for treating traumatic pneumothorax. Using a protocol based on the presence of air leakage and degree of expansion of the lung, it is possible in most cases to remove the drain within 24 h with minimal morbidity and excellent results. The early identification of patients needing operative or other intervention minimizes the hospital stay and complications associated with continued air leak. Experience using this protocol in a prospective series of 803 consecutive adult patients with traumatic pneumothorax is presented. A total of 300 patients (37.3 per cent) were successfully managed without drainage. Of the 504 patients drained, 333 (66.1 per cent) had the intercostal drain removed within 24 h. Mean hospital stay was 22 h for straightforward cases, and 49 h for those with a continuing leak. Ten patients required thoracotomy, a rate of 1.24 per cent. There were no deaths and no empyemata in our patients.