Chest
Volume 112, Issue 3, September 1997, Pages 709-713
Journal home page for Chest

Clinical Investigations: The Pleura
Analysis of Tube Thoracostomy Performed by Pulmonologists at a Teaching Hospital

https://doi.org/10.1378/chest.112.3.709Get rights and content

Study objective

To evaluate all tube thoracostomies (TTs) done by pulmonary/critical care fellows and attending physicians in the Medical University of South Carolina's health-care system documenting patient demographics, indication for placement, size and characteristics of the tube, and associated problems.

Design

Prospective.

Setting

University health-care system, including a university hospital, a Veterans Affairs hospital, and a county hospital.

Patients

All adult patients requiring consultation by a member of the pulmonary/critical care staff for a tube thoracostomy.

Results

One hundred twenty-six tube thoracostomies were performed over a 24-month period in 91 patients. The most common initial indication for a TT was pneumothorax (69/103, 67%). Overall mortality in the patient population was 35% (32/91). Early problems (<24 hours following placement) occurred in 3% (4/126); late problems (>24 h after placement) occurred in 8% (10/126). Problems occurred in 36% (4/11) of small-bore tube placements vs 9% (10/115) of standard TT placements (p=0.02).

Conclusions

Tube thoracostomy can be safely performed by pulmonologists with relatively few associated problems.

Section snippets

Materials and Methods

We prospectively followed up all patients who had TTs placed by physicians in the Pulmonary/Critical Care Division at the Medical University of South Carolina from August 1992 through July 1994. The procedures were performed by a pulmonary/critical care fellow under the supervision of a pulmonary/critical care attending physician at one of three hospitals in our university system: the Medical University Hospital; the Ralph H. Johnson Veterans Affairs Medical Center; and the Charleston Memorial

Demographics and Indications

Data were collected for 24 months. A total of 126 TTs were placed in 91 patients. Five patients were hospitalized on two separate occasions and required chest tubes during both hospitalizations. Descriptive data are displayed in Table 1. Of the 96 hospitalizations, 57 (59%) were at the university hospital, 18 (19%) were at the Veterans Affairs hospital, and 21 (22%) were at the county hospital. The Pulmonary/Critical Care Division manages the medical ICU at all hospitals. The patient was on the

Discussion

Our data suggest that chest tubes can be placed safely by pulmonologists for a variety of causes.

Indications for TT include the following: pneumothorax (spontaneous, related to barotrauma, iatrogenic); hemothorax or hemopneumothorax; pleural effusions (malignant, complicated parapneumonic, symptomatic, chylothorax); and following trauma or thoracic surgery.3 Our TTs were not placed for trauma or surgical-related indications, but usually for treatment of pneumothorax or pleural effusions. The

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