University of North Texas Health Science Center, Fort Worth, TX, USA.
Dr Kiran C. Patel College of Allopathic Medicine, NOVA Southeastern University, Fort Lauderdale, FL, USA.
Am Surg. 2023 Jun;89(6):2743-2754. doi: 10.1177/00031348231157809. Epub 2023 Feb 20.
A debate currently exists regarding the efficacy of pigtail catheters vs chest tubes in the management of thoracic trauma. This meta-analysis aims to compare the outcomes of pigtail catheters vs chest tubes in adult trauma patients with thoracic injuries.
This systematic review and meta-analysis were conducted using PRISMA guidelines and registered with PROSPERO. PubMed, Google Scholar, Embase, Ebsco, and ProQuest electronic databases were queried for studies comparing the use of pigtail catheters vs chest tubes in adult trauma patients from database inception to August 15th, 2022. The primary outcome was the failure rate of drainage tubes, defined as requiring a second tube placement or VATS, unresolved pneumothorax, hemothorax, or hemopneumothorax requiring additional intervention. Secondary outcomes were initial drainage output, ICU-LOS, and ventilator days.
A total of 7 studies satisfied eligibility criteria and were assessed in the meta-analysis. The pigtail group had higher initial output volumes vs the chest tube group, with a mean difference of 114.7 mL [95% CI (70.6 mL, 158.8 mL)]. Patients in the chest tube group also had a higher risk of requiring VATS vs the pigtail group, with a relative risk of 2.77 [95% CI (1.50, 5.11)].
In trauma patients, pigtail catheters rather than chest tubes are associated with higher initial output volume, reduced risk of VATS, and shorter tube duration. Considering the similar rates of failure, ventilator days, and ICU length-of-stay, pigtail catheters should be considered in the management of traumatic thoracic injuries.
Systematic Review and meta-analysis.
目前对于胸外伤患者的治疗中，猪尾导管与胸腔引流管的疗效存在争议。本荟萃分析旨在比较猪尾导管与胸腔引流管治疗成人创伤性胸部损伤的效果。
本系统评价和荟萃分析按照 PRISMA 指南进行，并在 PROSPERO 上注册。通过 PubMed、Google Scholar、Embase、Ebsco 和 ProQuest 电子数据库检索比较猪尾导管与胸腔引流管在成人创伤患者中的应用的研究，检索时间从数据库建立至 2022 年 8 月 15 日。主要结局是引流管失败率，定义为需要再次置管或 VATS、未解决的气胸、血胸或血气胸需要额外干预。次要结局是初始引流量、ICU 住院时间和呼吸机使用时间。
共有 7 项研究符合纳入标准并进行了荟萃分析。猪尾组的初始引流量高于胸腔引流组，平均差异为 114.7mL[95%CI（70.6mL，158.8mL）]。胸腔引流组需要 VATS 的风险也高于猪尾组，相对风险为 2.77[95%CI（1.50，5.11）]。
在创伤患者中，与胸腔引流管相比，猪尾导管具有更高的初始引流量、更低的 VATS 风险和更短的置管时间。考虑到失败率、呼吸机使用时间和 ICU 住院时间相似，猪尾导管在创伤性胸部损伤的治疗中应得到考虑。
系统评价和荟萃分析。
