Implementing a chest tube removal protocol in patients with thoracic trauma: a prospective clinical study

Timing of chest tube removal in trauma patients is debatable. This study aimed to assess whether protocolized early thoracostomy tube (TT) removal is associated with better outcomes. The study hypothesis is that early removal of TT is feasible and safe.

This was a prospective study for clinical assessment of early TT removal initiated 48 hours post-insertion [early (≤3 days) vs. late (>3 days) groups].

One hundred and fifty patients were enrolled, and a total of 174 TTs were inserted. There were 24 patients with bilateral TTs. The median age was 34 years (range, 15-78 years), and 93% were males. Following this protocol, 105 TTs were removed within 3 days post-insertion. There was a slight increase in the number of patients with recurrent pneumothorax in the early removal group compared to the late removal group (P=0.09). The chest Abbreviated Injury Scale, the rates of recurrent hemothorax, hemopneumothorax, and tube dislodgement were comparable among the two groups. The rate of recurrent pneumothorax (22.2% vs. 5.1%; P=0.02) and chest tube re-insertion (11.1% vs. 0.0%; P=0.002) were significant in patients with TT output 150-200 mL (over 24 h) as compared to those with lesser TT output. There was no significant difference in complications and post-TT removal interventions based on the size and anatomical location of TT insertion.

Although there were post-removal events in the early removal group, the rate of post-removal complications and interventions was comparable to that in the late group. Moreover, the laterality of insertion and the tube size were not associated with complications. The TT removal protocol needs validation in larger multicenter studies.