Marc de Moya, MD FACS

Medical College of Wisconsin-Froedtert Trauma Center

Hemothoraces and

Pneumothoraces:

What do you do with them?

?

RCT’s

Endersen

J of T, 1993

40 pts 38% required

chest tubes

Some OPTX

can be

observed All

pts with PPV

should have

CT

Brasel

J of T,

1999

39 pts 10% required

chest tubes

OPTX can be

observed

Objective Measures

•379 OPTX

•Cut-off: 20 O.K. to

watch

•28 OPTX:

•Minuscule < 1cm (4/6)

•Anterior >1cm (7/14)

•Anterolateral: cross mid-

coronal line (0/8)

Hypothesis

Observation of

hemodynamically stable

patients with ct-scan proven

pneumothoraces ≤ 35mm is

safe

Primary Outcome

Successful observation

Failure: Physiologic

deterioration; RR > 30,

SpO2<93, HR>110,

SBP<90

28mm 9 mm

How to Measure

Total PTXs included in

analysis

N=165

>35 mm

N=17 (10.2%)

TT

N=15 (88.2%)

Observation

N=2 (11.8%)

TT

N=1 (5.9%)

Observation

N=1 (5.9%)

≤35 mm

N=148 (89.7%)

TT

N=10 (6.8%)

Observation

N=138 (93.2%)

TT

N=9 (6.1%)*

Observation

N=129 (93.5%)

FAILURE = 4.3%

Cutoff Sensitivity Specificity PPV NPV AUC

Size (mm) 35 100% 98.5% 100% 95.7% 0.90

Hemodynamically stable with

a PTX up to 35mm can be

safely observed

Conclusion

VS

Large Bore vs Small Bore Injury 1.4% 0.2% Malposition 6.5% 0.6% Empyema 1.4% 0.2% Blockage 5.2% 8.1%

Havelock T, Teoh R, Laws D, et al. Pleural procedures and thoracic ultrasound: British Thoracic Society Pleural Disease Guideline 2010. Thorax 2010;65 (Suppl.2):ii61-76

40 patients randomized

NON-EMERGENT

J Trauma. 2012;72:422-427.

For Hemothorax does size matter?

Probably NOT Recommendation: Place 28 Fr

instead of larger tubes Pigtail for Pneumothorax

Consider 14Fr Pigtail for Stable patient with Hemothorax

THANKS