Highlights from EAST - chest tubes vs pigtail catheters for pneumothorax

A group in Arizona compared chest tubes to pigtail catheters in pneumothorax. They found that pigtails had less associated site pain.

One unanswered question is how effective these pigtails are when there is an associated hemothorax?


A PROSPECTIVE RANDOMIZED STUDY OF 14-FRENCH (14F) PIGTAIL CATHETERS VS. 28F CHEST TUBES IN PATIENTS WITH TRAUMATIC PNEUMOTHORAX: IMPACT ON TUBE-SITE PAIN AND FAILURE RATE

Narong Kulvatunyou , MD , Lisa Erickson , Randall S. Friese , MD , Donald Green , Lynn Gries , Bellal Joseph , MD , Terence S. O'Keeffe , MB ChB, MSPH , Peter Rhee , MD, MPH , Andrew L. Tang , MD , Julie L. Wynne , MD, MPH , University of Arizona

Objective
Small 14-French (14F) pigtail catheters (PCs) works as well as the traditional large-bore 28-40F chest tubes (CTs), particularly in patients with traumatic pneumothorax (PTX). We hypothesized those PCs, while function equally well, have less tube-site pain than CTs

Methods
We performed a prospective randomized study, comparing 14F PCs and 28F CTs in patients seen at our Level I trauma center with traumatic PTX from July 2010 to February 2012. Excluded were patients who required emergency PC or CT placement; those who refused to consent to participate in the study; and those who were unable to respond to pain assessment. The PCs were placed at bedside by the trauma team using a modified Seldinger technique. The primary outcome measures were tube-site pain, as assessed by a visual analog scale (VAS), and total pain medication use. The secondary outcomes included the failure rate and the insertion-related complications. For our statistical analysis, we used the unpaired Student t-test, the χ² (chi-square) test, and the Wilcoxon rank-sum test; we defined significance by a p value < 0.05.

Results
During the study period, 74 patients were eligible to participate; however, after exclusion, 40 patients were enrolled. The baseline characteristics of the PC and CT patients (20 in each group) were similar. Results are summarized in the table.

Conclusion
In patients with traumatic PTX, we found that 14F PCs are safe and functions as well as 28F CTs with significantly less tube-site pain. PCs may have a role for other traumatic indications.

Figures
http://meeting.east.org/content/images/abstracts/Ab_137_Table.jpg