Impact of positive pressure ventilation on thoracostomy tube removal in traumatic patients who admitted in ICU

Introduction: Few studies is in literature related to evaluation of impact of positive pressure ventilation (PPV) on thoracostomy tube removal in Iran. We decided, in this study, to evaluate the impact of PPV on recurrent pneumothorax (PTX) after removal of thoracostomy tubes (TT). Methods: A case-control study was performed for evaluating 122 chest tubes in 109 mechanically ventilatedtrauma patients during a one year period. 61 chest tubes randomly assigned tobeclamped and the others observed as control group. After 6 hours, portable CXR obtained. All chest radiographs were reviewed to identify recurrent PTX. The collected data was analyzed using SPSS statistical software and P<0.05 was considered significant. Results: Rate of post-clamping PTX was 11.5%, (7 of 61). There was a significant difference between case and control groups in recurrent pneumothorax (P=0.013). 6 of these 7 patients (85%) who their chest tube discontinuation resulted in recurrent pneumothorax, underwent tube thoracostomy for pneumothorax or hemopneumothorax. 5 of these 7 patients had been demonstrated airleak during hospitalization. A significant statistical association between the first CXR in emergency department and presence of airleak in ICU was detected (P<0.001). Moreover, there was a significant association between airleak during admission and incidence of recurrent pneumothorax (P<0.001). Conclusion: Regarding to remarkable incidence of post-clamping pneumothorax (11.5%) in despite of careful patient selection for chest tube discontinuation in this study, chest tube removal for patients on PPV is not a safe method. It has been demonstrated that once discontinuation criteria were met, in patients who undergone tube thoracostomy for pure hemothorax and did not reveal airleak during their hospitalization, thoracostomy tube removal is safe, even on positive pressure ventilation. Nevertheless, the surgeon decision for timing of chest tube removal is superior.