Impact of positive pressure ventilation on thoracostomy tube removal in traumatic patients who admitted in ICU

AUTHORS

Mohammad Karbalaei 1 , Abbas Rahimi 2 , * , Shahram Zare 3 , Mohammad Vahid Hoseini 2

1 Resident of General Surgery, Hormozgan University of Medical Sciences, Bandar Abbas, Iran.

2 Assistant Professor Departtment of Generral Surgery, Hormozgan University of Medical Sciences, Bandar Abbas, Iran.

3 Associate Professor Department of Community Medicine, Hormozgan University of Medical Sciences, Bandar Abbas, Iran.

How to Cite: Karbalaei M, Rahimi A, Zare S , Hoseini M V. Impact of positive pressure ventilation on thoracostomy tube removal in traumatic patients who admitted in ICU, Hormozgan Med J. 2013 ; 17(3):e88134.

ARTICLE INFORMATION

Hormozgan Medical Journal: 17 (3); e88134
Published Online: March 05, 2012
Article Type: Research Article
Received: December 07, 2011
Accepted: March 05, 2012

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Abstract

Introduction: Few studies is in literature related to evaluation of impact of positive
pressure ventilation (PPV) on thoracostomy tube removal in Iran. We decided, in this
study, to evaluate the impact of PPV on recurrent pneumothorax (PTX) after removal of
thoracostomy tubes (TT).
Methods: A case-control study was performed for evaluating 122 chest tubes in 109
mechanically ventilatedtrauma patients during a one year period. 61 chest tubes randomly
assigned tobeclamped and the others observed as control group. After 6 hours, portable
CXR obtained. All chest radiographs were reviewed to identify recurrent PTX. The
collected data was analyzed using SPSS statistical software and P<0.05 was considered
significant.
Results: Rate of post-clamping PTX was 11.5%, (7 of 61). There was a significant
difference between case and control groups in recurrent pneumothorax (P=0.013). 6 of these
7 patients (85%) who their chest tube discontinuation resulted in recurrent pneumothorax,
underwent tube thoracostomy for pneumothorax or hemopneumothorax. 5 of these 7 patients
had been demonstrated airleak during hospitalization. A significant statistical association
between the first CXR in emergency department and presence of airleak in ICU was detected
(P<0.001). Moreover, there was a significant association between airleak during admission
and incidence of recurrent pneumothorax (P<0.001).
Conclusion: Regarding to remarkable incidence of post-clamping pneumothorax (11.5%)
in despite of careful patient selection for chest tube discontinuation in this study, chest tube
removal for patients on PPV is not a safe method. It has been demonstrated that once
discontinuation criteria were met, in patients who undergone tube thoracostomy for pure
hemothorax and did not reveal airleak during their hospitalization, thoracostomy tube
removal is safe, even on positive pressure ventilation. Nevertheless, the surgeon decision for
timing of chest tube removal is superior.

Keywords

Positive Pressure Ventilation – Chest Tubes - Pneumothorax

© 2013, Hormozgan Medical Journal. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/) which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited.

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