Ignite Creation Date:
2024-05-06 @ 4:05 PM
Last Modification Date:
2024-10-26 @ 2:03 PM
Study NCT ID:
NCT04863989
Status:
UNKNOWN
Last Update Posted:
2021-04-28
First Post:
2020-09-17
Brief Title:
Emergency Small vs Large Tube Thoracostomy in Chest Trauma Patients
Sponsor:
Assiut University
Organization:
Assiut University
Study Overview
Official Title:
Emergency Small vs Large Tube Thoracostomy in Chest Trauma Patients
Status:
UNKNOWN
Status Verified Date:
2021-04
Last Known Status:
NOT_YET_RECRUITING
Delayed Posting:
No
If Stopped, Why?:
Not Stopped
Has Expanded Access:
False
If Expanded Access, NCT#:
N/A
Has Expanded Access, NCT# Status:
N/A
Acronym:
None
Brief Summary:
To compare between small sized tube thoracostomy and large sized tube thoracostomy regarding the need for another chest tube for the fear of obstruction in hemomothorax or ineffective drainage in hemothorax pneumothorax or hemo-pneumothorax pain score or repositioning and need for thoracotomy
Detailed Description:
To evacuate abnormal fluid and air chest tubes are placed in the pleural space either surgically or percutaneously Therapeutic drainage of pleural conditions such as pneumothorax hemothorax empyema chylothorax and malignant effusions as well as prophylaxis drainage of air blood and other fluids after chest surgery are the indications for chest tubes
Closed water-seal chest drainage has been described in 1875 by Gotthard Bülau to treat an empyema as an alternative to the standard rib resection and open tube drainage in the acute phase or rib excision saucerization in the chronic phase
Bülau emphasized the necessity of negative intrapleural pressure for re-expansion of a collapsed lung in the setting of thoracic empyema although most surgeons in his time attributed deaths from thoracic empyema to infection and not superimposed respiratory compromise due to open pneumothorax
He understood that closed water seal drainage could facilitate lung re-expansion via the patients natural respiratory movements Unfortunately until mechanical ventilation was introduced application of these principles was limited to the treatment of thoracic empyema
During both the Second World War and the Korean one lung function restoration was the primary goal of thoracic wound treatment emergency tube thoracostomy became extremely frequent in haemothorax and tension pneumothorax treatment For the first time the drain was connected to a two-bottle water seal suction system since 1952 synthetic ones more flexible and easy to place replaced metal tubes and modern three chamber thoracic drain for a more efficient suction were employed New flexible and plastic drains were widely used by the 1980s they ranged between 6 and 40 French F in size Since it was believed that smaller drains were less effective in adult medicine being more prone to the risk of obstruction the smaller ones 20 F were commonly used in children the bigger in adults In the last two decades small-bore chest tubes SBCT have gained increasing popularity In traumatic pneumothorax or hemothorax the optimal tube size for an emergent thoracostomy is unknown For the nonemergent management of patients with traumatic pneumothorax or hemothorax both small catheter tube thoracostomy and large-bore chest tube thoracostomy have been shown to work
In stable trauma patients small catheter tube thoracostomy is effective and comparable with large catheter tube thoracostomy in managing chest trauma
While the available evidence suggests that in resolving traumatic haemothoraces without additional complications small bore drains may be as effective as large bore drains there is insufficient evidence currently available to recommend a change to standard practice ie large bore drains
Inaba K et al 2012 concluded that chest tube size did not impact the clinically relevant outcomes tested for injured patients with chest trauma There was no difference in the efficacy of drainage need for additional tube drainage or invasive procedures and rate of complications including retained hemothorax Pain felt by patients at the site of insertion was not affected by tube size
Most occurrences of traumatic pneumothorax PTX and hemothorax HTX can be managed non-operatively by means of chest tube thoracostomy Although most guidelines for chest trauma recommend a large-bore chest tube eg the 9th edition of the ATLSTM Advanced Trauma Life Support program recommends a 36 or 40 Fr tube and the JATECTM Japan Advanced Trauma Evaluation and Care course recommends a 28 Fr or larger tube and choosing the tube size based on the patients physique these recommendations are mainly based on traditional clinical habits These large-bore chest tubes may cause pain related to the insertion site and discomfort especially in conscious patients Smaller tubes were reported to reduce the pain associated with the tube insertion site in patients with pleural infection
Closed water-seal chest drainage has been described in 1875 by Gotthard Bülau to treat an empyema as an alternative to the standard rib resection and open tube drainage in the acute phase or rib excision saucerization in the chronic phase
Bülau emphasized the necessity of negative intrapleural pressure for re-expansion of a collapsed lung in the setting of thoracic empyema although most surgeons in his time attributed deaths from thoracic empyema to infection and not superimposed respiratory compromise due to open pneumothorax
He understood that closed water seal drainage could facilitate lung re-expansion via the patients natural respiratory movements Unfortunately until mechanical ventilation was introduced application of these principles was limited to the treatment of thoracic empyema
During both the Second World War and the Korean one lung function restoration was the primary goal of thoracic wound treatment emergency tube thoracostomy became extremely frequent in haemothorax and tension pneumothorax treatment For the first time the drain was connected to a two-bottle water seal suction system since 1952 synthetic ones more flexible and easy to place replaced metal tubes and modern three chamber thoracic drain for a more efficient suction were employed New flexible and plastic drains were widely used by the 1980s they ranged between 6 and 40 French F in size Since it was believed that smaller drains were less effective in adult medicine being more prone to the risk of obstruction the smaller ones 20 F were commonly used in children the bigger in adults In the last two decades small-bore chest tubes SBCT have gained increasing popularity In traumatic pneumothorax or hemothorax the optimal tube size for an emergent thoracostomy is unknown For the nonemergent management of patients with traumatic pneumothorax or hemothorax both small catheter tube thoracostomy and large-bore chest tube thoracostomy have been shown to work
In stable trauma patients small catheter tube thoracostomy is effective and comparable with large catheter tube thoracostomy in managing chest trauma
While the available evidence suggests that in resolving traumatic haemothoraces without additional complications small bore drains may be as effective as large bore drains there is insufficient evidence currently available to recommend a change to standard practice ie large bore drains
Inaba K et al 2012 concluded that chest tube size did not impact the clinically relevant outcomes tested for injured patients with chest trauma There was no difference in the efficacy of drainage need for additional tube drainage or invasive procedures and rate of complications including retained hemothorax Pain felt by patients at the site of insertion was not affected by tube size
Most occurrences of traumatic pneumothorax PTX and hemothorax HTX can be managed non-operatively by means of chest tube thoracostomy Although most guidelines for chest trauma recommend a large-bore chest tube eg the 9th edition of the ATLSTM Advanced Trauma Life Support program recommends a 36 or 40 Fr tube and the JATECTM Japan Advanced Trauma Evaluation and Care course recommends a 28 Fr or larger tube and choosing the tube size based on the patients physique these recommendations are mainly based on traditional clinical habits These large-bore chest tubes may cause pain related to the insertion site and discomfort especially in conscious patients Smaller tubes were reported to reduce the pain associated with the tube insertion site in patients with pleural infection
Study Oversight
Has Oversight DMC:
None
Is a FDA Regulated Drug?:
False
Is a FDA Regulated Device?:
False
Is an Unapproved Device?:
None
Is a PPSD?:
None
Is a US Export?:
None
Is an FDA AA801 Violation?:
None