Pigtail Catheters for Traumatic Pneumothorax
By Dov Brandis
Kulvatunyou, Narong, Aparna Vijayasekaran, Adam Hansen, Julie L. Wynne,Terrance Oʼkeeffe, Randall S. Friese, Bellal Joseph, Andy Tang, and Peter Rhee. “Two-Year Experience of Using Pigtail Catheters to Treat Traumatic Pneumothorax: A Changing Trend.” The Journal of Trauma: Injury, Infection, and Critical Care 71.5 (2011): 1104-107. Web.
The classic teaching in traumatic pneumothorax is the necessity for placing a large bore (32-40 French) chest tube in order to evacuate potential hemothorax associated with the traumatic pneumothorax. The placement of a large bore chest tube results in significant pain and subsequent decreased mobility of the patient while in the hospital. In this study, the trauma surgeons at the University of Arizona used smaller bore chest tubes, 14 pigtail catheters, and compared them to the standard large bore chest tubes in an attempt to demonstrate equal efficacy for evacuation of traumatic pneumothorax.
This study was a retrospective chart review of trauma patients who required chest tube insertion between January 2008- December of 2009. The review included patients who had traditional large bore chest tubes as well as the patients who received pigtail catheters. The statistical analysis was via the unpaired Student t-test, chi-squared test, and Wicoxon rank-sum test. The outcome measures were hospital length of stay, failure rate, insertion-related complication rate, tube days, mechanical ventilation percentage, and ventilator days.
A total of 9624 trauma patients evaluated, 94 treated with pigtail catheters and 386 with large bore chest tubes. 89% of the pigtail catheters were placed for PTX. There was an 11% failure rate with PC and 4% in the chest tube group. Hospital stay was decreased in the pigtail group with an average of 6 days as compared to the 15 day average of the large bore chest tube group. Insertion related complications in the pigtail group were 4% and 2.7% in the chest tube group. Ventilator days were zero for both groups and the tube days were 4 for the pigtail group and 4.4 for the chest tube group. Mechanical ventilation was needed in 36% of the pigtail group and 47% in the chest tube group.
This paper demonstrates that placing small bore pigtail chest tubes for traumatic pneumothorax has similar efficacy to that of the larger bore tubes. Interestingly, the most statistically significant outcome is hospital stay, which is significantly decreased with the use of smaller chest tubes, although the authors do not directly contribute that to the size of the tube. Nonetheless, given an equivalent complication rate, assuming a skilled physician is placing the tube, there is very little downside to choosing a small tube. Our hospital uses smaller bore chest tubes inserted with a trochar versus the seldinger technique so direct correlation is difficult but this gives baseline data to advocate to the use of smaller chest tubes in traumatic PTX. Ideally, the smaller tube will result in easier and quicker mobility of the patient, decreased pain and decreased length of stay.