The size paradox: An analysis of tube thoracostomy in trauma

• Published in: The American journal of surgery 2024-12, Vol.238, p.115829, Article 115829
• Main Authors: Johnson, Emily H., Lee, Janet S., Clement, L. Paige, Brockman, Valerie, Schmoekel, Nathan, Schroeppel, Thomas J.
• Format: Article
• Language: English
• Subjects: Adult; Analgesics, Opioid - administration & dosage; Analgesics, Opioid - therapeutic use; Catheters; Chest; Chest Tubes; Clinical outcomes; Empyema; Equipment Design; Failure; Female; Hemothorax - etiology; Hemothorax - surgery; Humans; Injuries; Male; Middle Aged; Mortality; Narcotics; Opioids; Pain management; Patients; Pneumothorax; Pneumothorax - etiology; Regression analysis; Retrospective Studies; Subgroups; Thoracic Injuries - complications; Thoracic Injuries - surgery; Thoracic trauma; Thoracostomy - instrumentation; Thoracostomy - methods; Trauma; Treatment Failure; Tubes; Vital signs
• ISSN: 0002-9610; 1879-1883; 1879-1883
• DOI: 10.1016/j.amjsurg.2024.115829

Debate continues over chest tube (CT) size for traumatic hemothorax (HTX) and pneumothorax (PTX). We compared CT failure and opioid use between large-bore chest tubes (LB-CT) and small-bore chest tubes (SB-CT). A retrospective study comparing trauma patients with SB-CT (≤14Fr) or LB-CT (≥24Fr) was performed. CT failure includes HTX, PTX, or empyema requiring intervention. Secondary outcomes included opioid use (MME), mortality, and favorable discharge. Of 252 patients, 65.1 ​% had SB-CT. SB-CT were older with lower ISS. Failure rate was lower for SB-CT (9.2 vs 22.7 ​%, p ​= ​0.003), as was opioid use (332 vs 767, p ​