TY - JOUR
T1 - The small (14 Fr) percutaneous catheter (P-CAT) versus large (28–32 Fr) open chest tube for traumatic hemothorax
T2 - A multicenter randomized clinical trial
AU - Kulvatunyou, Narong
AU - Bauman, Zachary M.
AU - Edine, Savo Bou Zein
AU - de Moya, Marc
AU - Krause, Casandra
AU - Mukherjee, Kaushik
AU - Gries, Lynn
AU - Tang, Andrew L.
AU - Joseph, Bellal
AU - Rhee, Peter
N1 - Funding Information:
This study was partially funded by Cook Medical LLC. However, the sponsor had no role in study design, study conduct, site selection and participation, data collection, data interpretation, or article preparation. The corresponding author collected and had access to all data and had final responsibility for the decision to submit for publication.
Publisher Copyright:
Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.
PY - 2021/11
Y1 - 2021/11
N2 - INTRODUCTION: The traditional treatment of traumatic hemothorax (HTX) has been an insertion of a large-bore 36- to 40-Fr chest tube. Our previous single-center randomized controlled trial (RCT) had shown that 14-Fr percutaneous catheters (PCs) (pigtail) were equally as effective as chest tube. We performed a multicenter RCT, hypothesizing that PCs are as equally effective as chest tubes in the management of patients with traumatic HTX (NCT03546764). METHODS: We performed a multi-institution prospective RCT comparing 14-Fr PCs with 28- to 32-Fr chest tubes in the management of patients with traumatic HTX from July 2015 to September 2020. We excluded patients who were in extremis and required emergent tube placement and those who refused to participate. The primary outcome was failure rate, defined as a retained HTX requiring a second intervention. Secondary outcomes included daily drainage output, tube days, intensive care unit and hospital length of stay, and insertion perception experience (IPE) score on a scale of 1 to 5 (1, tolerable experience; 5, worst experience). Unpaired Student’s t test, χ2, and Wilcoxon rank sum test were used with significance set at p < 0.05. RESULTS: After exclusion, 119 patients participated in the trial, 56 randomized to PCs and 63 to chest tubes. Baseline characteristics between the two groups were similar. The primary outcome, failure rate, was similar between the two groups (11% PCs vs. 13% chest tubes, p = 0.74). All other secondary outcomes were also similar, except PC patients reported lower IPE scores (median, 1: “I can tolerate it”; interquartile range, 1–2) than chest tube patients (median, 3: “It was a bad experience”; interquartile range, 2–5; p < 0.001). CONCLUSION: Small caliber 14-Fr PCs are equally as effective as 28- to 32-Fr chest tubes in their ability to drain traumatic HTX with no difference in complications. Patients reported better IPE scores with PCs over chest tubes, suggesting that PCs are better tolerated.
AB - INTRODUCTION: The traditional treatment of traumatic hemothorax (HTX) has been an insertion of a large-bore 36- to 40-Fr chest tube. Our previous single-center randomized controlled trial (RCT) had shown that 14-Fr percutaneous catheters (PCs) (pigtail) were equally as effective as chest tube. We performed a multicenter RCT, hypothesizing that PCs are as equally effective as chest tubes in the management of patients with traumatic HTX (NCT03546764). METHODS: We performed a multi-institution prospective RCT comparing 14-Fr PCs with 28- to 32-Fr chest tubes in the management of patients with traumatic HTX from July 2015 to September 2020. We excluded patients who were in extremis and required emergent tube placement and those who refused to participate. The primary outcome was failure rate, defined as a retained HTX requiring a second intervention. Secondary outcomes included daily drainage output, tube days, intensive care unit and hospital length of stay, and insertion perception experience (IPE) score on a scale of 1 to 5 (1, tolerable experience; 5, worst experience). Unpaired Student’s t test, χ2, and Wilcoxon rank sum test were used with significance set at p < 0.05. RESULTS: After exclusion, 119 patients participated in the trial, 56 randomized to PCs and 63 to chest tubes. Baseline characteristics between the two groups were similar. The primary outcome, failure rate, was similar between the two groups (11% PCs vs. 13% chest tubes, p = 0.74). All other secondary outcomes were also similar, except PC patients reported lower IPE scores (median, 1: “I can tolerate it”; interquartile range, 1–2) than chest tube patients (median, 3: “It was a bad experience”; interquartile range, 2–5; p < 0.001). CONCLUSION: Small caliber 14-Fr PCs are equally as effective as 28- to 32-Fr chest tubes in their ability to drain traumatic HTX with no difference in complications. Patients reported better IPE scores with PCs over chest tubes, suggesting that PCs are better tolerated.
KW - Percutaneous catheter
KW - chest tube
KW - hemothorax
KW - pigtail catheter
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UR - http://www.scopus.com/inward/citedby.url?scp=85120834420&partnerID=8YFLogxK
U2 - 10.1097/TA.0000000000003180
DO - 10.1097/TA.0000000000003180
M3 - Article
C2 - 33843831
AN - SCOPUS:85120834420
SN - 2163-0755
VL - 91
SP - 809
EP - 813
JO - Journal of Trauma and Acute Care Surgery
JF - Journal of Trauma and Acute Care Surgery
IS - 5
ER -