Pleural Decompression & Drainage

Pleural decompression with subsequent tube thoracostomy is one of the most commonly performed life-saving procedures for traumatic chest injuries. Thoracic injuries are primarily responsible for 25% of all trauma deaths and contribute to a further 25% of deaths. However, over 85% of patients with thoracic trauma do not require thoracic surgery. Most thoracic trauma is adequately managed with simple manoeuvres including supplemental oxygen, tube thoracostomy, mechanical ventilation, when indicated, and circulatory support. Prospectively gathered trauma registry data at The Alfred Hospital indicates that tube thoracostomy is required in 25% of patients presenting with major trauma and, as such, is a fundamental skill required by all critical care specialities involved in the resuscitation of trauma patients.

Join us at The Procedures Course in Melbourne to practice this and other life and limb saving procedures.


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Further Reading »

Fitzgerald M, Mackenzie CF, Marasco S, Hoyle R, Kossmann T. Pleural decompression and drainage during trauma reception and resuscitation. Injury. 2008;39(1):9-20.

Anderson M, Fitzgerald M, Martin K, Santamaria M, Arendse S, O'Reilly G, et al. A procedural check list for pleural decompression and intercostal catheter insertion for adult major trauma. Injury. 2015;46(1):42-4.

Griffiths JR, Roberts N. Do junior doctors know where to insert chest drains safely? Postgraduate Medical Journal. 2005;81(957):456-8.

Ball CG, Lord J, Laupland KB, Gmora S, Mulloy RH, Ng AK, et al. Chest tube complications: How well are we training our residents? Canadian journal of surgery Journal canadien de chirurgie. 2007;50(6):450-8.

Menger R, Telford G, Kim P, Bergey MR, Foreman J, Sarani B, et al. Complications following thoracic trauma managed with tube thoracostomy. Injury. 2012;43(1):46-50.

Aylwin CJ, Brohi K, Davies GD, Walsh MS. Pre-hospital and in-hospital thoracostomy: Indications and complications. Annals of The Royal College of Surgeons of England. 2008;90(1):54-7.

Etoch SW, Bar-Natan MF, Miller FB, Richardson JD. Tube thoracostomy. Factors related to complications. Archives of surgery (Chicago, Ill : 1960). 1995;130(5):521-5; discussion 5-6.

Kong VY, Clarke DL. The spectrum of visceral injuries secondary to misplaced intercostal chest drains: Experience from a high volume trauma service in South Africa. Injury. 2014;45(9):1435-9.

Millikan JS, Moore EE, Steiner E, Aragon GE, Van Way CW, 3rd. Complications of tube thoracostomy for acute trauma. American journal of Surgery. 1980;140(6):738-41.

Sethuraman KN, Duong D, Mehta S, Director T, Crawford D, St. George J, et al. Complications of tube thoracostomy placement in the emergency department. The Journal of Emergency Medicine. 2011;40(1):14-20.

Cheng CH, Graham CA, Gabbe BJ, Yeung JHH, Kossmann T, Judson RT, et al. Trauma care systems: A comparison of trauma care in Victoria, Australia, and Hong Kong, China. Annals Of Surgery. 2008;247(2):335-42.

Deakin CD, Davies G, Wilson A. Simple thoracostomy avoids chest drain insertion in prehospital trauma. The Journal of Trauma. 1995;39(2):373-4.

Bowness JS, Nicholls K, Kilgour PM, Ferris J, Whiten S, Parkin I, et al. Finding the fifth intercostal space for chest drain insertion: Guidelines and ultrasound. Emergency Medicine Journal. 2015;32(12):951-4.

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

Nasr MM. Closed-tube thoracostomy: A novel emergency surgery technique. Surgical laparoscopy, endoscopy & percutaneous techniques. 2014;24(4):342-4.