Pigtails for Traumatic Pneumothoraces

Interesting approach, although I'm not sure what happens when there is an associated hemothorax...

Journal of Trauma-Injury Infection & Critical Care:

November 2011 - Volume 71 - Issue 5 - pp 1104-1107

Two-Year Experience of Using Pigtail Catheters to Treat Traumatic Pneumothorax: A Changing Trend

Kulvatunyou, Narong MD; Vijayasekaran, Aparna MD; Hansen, Adam MD; Wynne, Julie L. MD; O'Keeffe, Terrance MD; Friese, Randall S. MD; Joseph, Bellal MD; Tang, Andy MD; Rhee, Peter MD

Abstract

Background: The traditional treatment of patients with traumatic hemopneumothorax has been an insertion of a chest tube (CT). But CT, because of its large caliber and significant trauma during an insertion, can cause pain, prevent full lung expansion, and worsen pulmonary outcome. Pigtail catheters (PCs) are smaller and less invasive; they have worked well in patients with nontraumatic pneumothorax (PTX). The purpose of this study was to review our early experience of PC use in trauma patients.

Methods: We retrospectively reviewed the charts of trauma patients who required CT or PC placement over a 2-year period (January 2008 through December 2009) at a Level I trauma center. The PCs were 14-French (14-F) Cook catheters placed by the trauma team, using a Seldinger technique. We compared outcome for the subgroups that had CT or PC placed for a PTX. For our statistical analysis, we used the unpaired Student t-test, χ² test, and Wilcoxon rank-sum test; we considered a p value < 0.05 as significant.

Results: Of 9,624 trauma patients evaluated, 94 were treated with PC and 386 with CT. Of the PC patients, 89% was inserted for PTX. When comparing patients with PC and CT inserted for PTX, demographics, tube days, need for mechanical ventilation, and insertion-related complications were similar. The tube failure rate, defined by a requirement for an additional tube or by recurrence that needed intervention, was higher in PC (11%) than in CT (4%) (p = 0.06), but the difference was not statistically significant. We observed a trend of increased PC use over time.

Conclusion: PC is safe and can be performed at the bedside. It has a comparable efficacy to CT in patients with PTX. A prospective study is needed to determine the precise role of PC placement, including its indication, the associated tube-site pain, and any significant clinical advantages.