Abstract

Background: Thoracostomy is done frequently in cases of chest trauma, pneumothorax, hydrothorax, or after cardiothoracic surgeries to drain the collected fluid, blood, or air. Thoracostomy most often is a bedside procedure done by general surgeons, intensivists, emergency room physicians, or respiratory physicians either electively or in emergency. There are two common types of chest tubes one is with trocar and other is without trocar. It is an invasive procedure and complications may result from inadequate training, inadequate experience or lack knowledge of anatomy. However, trocar thoracostomy is by far associated with a higher rate of complication.

Objectives: The aim of the stud0y was to assess the safety profile of trocar thoracostomy versus blunt thoracostomy, in terms of the injury to various structures in and around the lung. The nature of the study was prospective and randomized.

Materials and Methods: We selected patients of blunt chest trauma with hemothorax, pneumothorax or both in the age group of 18–67 years, male or female, with or without other associated injuries during January 2017–December 2017. Complications of thoracostomy were recorded as insertional (for example, lung or other organ laceration or perforation, and hemorrhage), positional (for example, extrathoracic placement, persistent hemothoraces, or pneumothoraces), or infective (for example, minor wound infection and empyema thoracis). All chest drains were placed between anterior and posterior axillary lines using the recommendation by advanced trauma life support and another expert.

Results: The overall complication rate related to trocar chest tube placement was 48% as against blunt chest tubes (12%). Malpositioned chest tubes constituted the major bulk of these complications; they were replaced on the basis of clinical and radiological grounds. Infectious complications were noted in 6 (13.33%) patients in both the groups. Insertional complications were noted in one patient in this series with trocar tube. 38 patients (76%) with isolated chest injuries had a mean duration of stay of 9 days (range 7–26 days). 12 patients (24%) whose chest injury was part of multiple trauma had a mean duration of stay of 28 days (range 20–46 days). Significant associations were observed while comparing complications of trocar thoracostomy with blunt thoracostomy. There was also a propensity of more positional complications with trocar thoracostomy P < 0.001.

Conclusions: Blunt tube thoracostomy is an effective measure in managing patients with chest trauma but associated with significant morbidity. Most of the complications were the consequence of trocar insertion technique rather than blunt method. Hence, it is recommended that trocar insertional technique is not safe and preference should be given to the blunt methods. With the increasing frequency of traumatic chest injuries, a large number of patients are dealt with by doctors in the emergency department. Tube thoracostomy is an essential lifesaving measure for the management of pneumothorax, hemothorax, and hemopneumothorax developed as a consequence of chest trauma.

Key words: Thoracostomy; Trocar Thoracostomy; Bronchopleural Fistula; Subcutaneous Emphysema; Empyema