Abdulrahman Yassir, Al-Ani Mushreq, Farhat Mohammed, Khallafalla Hosam, Abu Amr Ahmad, Ajaj Ahmed, Al-Zubaidi Ammar, Chughtai Talat, El-Menyar Ayman, Asim Mohammad, Rizoli Sandro, Al-Thani Hassan
Hamad Level 1 Trauma Center, Hamad Medical Corporation, Doha, Qatar.
Honors Kinesiology, McMaster University, Hamilton, Ontario, Canada.
J Thorac Dis. 2025 Mar 31;17(3):1301-1311. doi: 10.21037/jtd-24-1229. Epub 2025 Mar 24.
Timing of chest tube removal in trauma patients is debatable. This study aimed to assess whether protocolized early thoracostomy tube (TT) removal is associated with better outcomes. The study hypothesis is that early removal of TT is feasible and safe.
This was a prospective study for clinical assessment of early TT removal initiated 48 hours post-insertion [early (≤3 days) late (>3 days) groups].
One hundred and fifty patients were enrolled, and a total of 174 TTs were inserted. There were 24 patients with bilateral TTs. The median age was 34 years (range, 15-78 years), and 93% were males. Following this protocol, 105 TTs were removed within 3 days post-insertion. There was a slight increase in the number of patients with recurrent pneumothorax in the early removal group compared to the late removal group (P=0.09). The chest Abbreviated Injury Scale, the rates of recurrent hemothorax, hemopneumothorax, and tube dislodgement were comparable among the two groups. The rate of recurrent pneumothorax (22.2% 5.1%; P=0.02) and chest tube re-insertion (11.1% 0.0%; P=0.002) were significant in patients with TT output 150-200 mL (over 24 h) as compared to those with lesser TT output. There was no significant difference in complications and post-TT removal interventions based on the size and anatomical location of TT insertion.
Although there were post-removal events in the early removal group, the rate of post-removal complications and interventions was comparable to that in the late group. Moreover, the laterality of insertion and the tube size were not associated with complications. The TT removal protocol needs validation in larger multicenter studies.
创伤患者胸腔引流管拔除的时机存在争议。本研究旨在评估按照方案早期拔除胸腔闭式引流管（TT）是否能带来更好的结果。研究假设为早期拔除TT是可行且安全的。
这是一项前瞻性研究，用于临床评估在TT插入后48小时开始早期拔除的情况（分为早期组[≤3天]和晚期组[>3天]）。
共纳入150例患者，共插入174根TT。有24例患者双侧插入TT。中位年龄为34岁（范围15 - 78岁），93%为男性。按照此方案，105根TT在插入后3天内拔除。与晚期拔除组相比，早期拔除组复发性气胸患者数量略有增加（P = 0.09）。两组的胸部简明损伤量表、复发性血胸、血气胸和引流管移位发生率相当。与TT引流量较少的患者相比，TT引流量为150 - 200 mL（24小时以上）的患者复发性气胸发生率（22.2%对5.1%；P = 0.02）和胸腔引流管重新插入率（11.1%对0.0%；P = 0.002）显著更高。基于TT插入的大小和解剖位置，并发症及TT拔除后干预措施无显著差异。
尽管早期拔除组存在拔除后事件，但拔除后并发症和干预率与晚期组相当。此外，插入侧别和引流管大小与并发症无关。TT拔除方案需要在更大规模的多中心研究中进行验证。
