Clamping thoracostomy tubes: a heretical notion?

To determine the safety and complications of chest tube clamping, a retrospective chart review was conducted at Baylor University Medical Center's level I trauma center. The records of 243 patients with pneumothoraces, hemothoraces, or a combination were identified and analyzed; 134 patients underwent clamping according to the care path, and 109 did not. The demographic characteristics of age, gender, and mechanism of injury were similar in both groups, as was the frequency of pneumothoraces, hemothoraces, and combined hemo/pneumothoraces. Subsequent radiographs showing recurrence or patient symptoms were noted in 13 patients (9.7%), requiring unclamping. Nine patients (6.7%) who had passed the clamping trial prior to removal required reinsertion of a chest tube due to recurrent pneumothoraces. One clamped patient required urgent insertion of a second thoracostomy tube due to occlusive thrombus within the residing chest tube. No deaths were documented as a result of the care path or of clamping. Overall, the clamped chest tube allows for more definitive assessment of persistent occult air leaks based on a 6-hour chest radiograph and avoidance of premature removal and did not appear to have any adverse effects on patient safety. Further refinements of the clamping procedure may be needed, as some patients still required reinsertion despite an absence of pneumothorax after a 6-hour clamping trial. Given these data, a prospective study with clamping is warranted to evaluate whether or not such a system can increase the speed with which chest tubes are removed and decrease the length of stay while maintaining patient safety.