Bauman Zachary M, Kulvatunyou Narong, Joseph Bellal, Jain Arpana, Friese Randall S, Gries Lynn, O'Keeffe Terence, Tang Andy L, Vercruysse Gary, Rhee Peter
Division of Trauma, Emergency General Surgery, and Critical Care, Department of Surgery, University of Nebraska, Omaha, NE, USA.
Division of Acute Care Surgery, Department of Surgery, University of Arizona, Tucson, AZ, USA.
World J Surg. 2018 Jan;42(1):107-113. doi: 10.1007/s00268-017-4168-3.
The effectiveness of 14-French (14F) pigtail catheters (PCs) compared to 32-40F chest tubes (CTs) in patients with traumatic hemothorax (HTX) and hemopneumothorax (HPTX) is becoming more well known but still lacking. The aim of our study was to analyze our cumulative experience and outcomes with PCs in patients with traumatic HTX/HPTX. We hypothesized that PCs would be as effective as CTs.
Using our PC database, we analyzed all trauma patients who required chest drainage for HTX/HPTX from 2008 to 2014. Primary outcomes of interest, comparing PCs to CTs, included initial drainage output in milliliters (mL), tube insertion-related complications, and failure rate. For our statistical analysis, we used the unpaired Student's t test, Chi-square test, and Wilcoxon rank-sum test. We defined statistical significance as P < 0.05.
During the 7-year period, 496 trauma patients required chest drainage for traumatic HTX/HPTX: 307 by CTs and 189 by PCs. PC patients were older (52 ± 21 vs. 42 ± 19, P < 0.001), demonstrated a significantly higher occurrence of blunt trauma (86 vs. 55%, P ≤ 0.001), and had tubes placed in a non-emergent fashion (Day 1 [interquartile range (IQR) 1-3 days] for PC placement vs. Day 0 [IQR 0-1 days] for CT placement, P < 0.001). All primary outcomes of interest were similar, except that the initial drainage output for PCs was higher (425 mL [IQR 200-800 mL] vs. 300 mL [IQR 150-500], P < 0.001). Findings for subgroup analysis among emergent and non-emergent PC placement were also similar to CT placement.
PCs had similar outcomes to CTs in terms of failure rate and tube insertion-related complications, and the initial drainage output from PCs was not inferior to that of CTs. The usage of PCs was, however, selective. A future multi-center study is needed to provide additional support and information for PC usage in traumatic HTX/HPTX.
在创伤性血胸（HTX）和血气胸（HPTX）患者中，14法式（14F）猪尾导管（PC）与32 - 40F胸管（CT）相比的有效性正逐渐为人所知，但仍缺乏相关研究。我们研究的目的是分析我们在创伤性HTX/HPTX患者中使用PC的累积经验和结果。我们假设PC与CT一样有效。
利用我们的PC数据库，我们分析了2008年至2014年所有因HTX/HPTX需要胸腔引流的创伤患者。将PC与CT进行比较，感兴趣的主要结果包括初始引流出血量（毫升）、置管相关并发症和失败率。对于我们的统计分析，我们使用了非配对学生t检验、卡方检验和威尔科克森秩和检验。我们将统计学显著性定义为P < 0.05。
在这7年期间，496例创伤患者因创伤性HTX/HPTX需要胸腔引流：307例使用CT，189例使用PC。使用PC的患者年龄更大（52 ± 21岁 vs. 42 ± 19岁，P < 0.001），钝性创伤的发生率显著更高（86% vs. 55%，P ≤ 0.001），并且置管方式为非急诊（PC置管在第1天[四分位间距（IQR）1 - 3天]，而CT置管在第0天[IQR 0 - 1天]，P < 0.001）。除了PC的初始引流出血量更高（425毫升[IQR 200 - 800毫升] vs. 300毫升[IQR 150 - 500毫升]，P < 0.001）外，所有感兴趣的主要结果都相似。急诊和非急诊PC置管的亚组分析结果也与CT置管相似。
在失败率和置管相关并发症方面，PC与CT的结果相似，并且PC的初始引流出血量不低于CT。然而，PC的使用是有选择性的。未来需要进行多中心研究，为创伤性HTX/HPTX中PC的使用提供更多支持和信息。
