Efficacy of slow negative pleural suction in thoracic trauma patients undergoing tube thoracostomy-A randomised clinical trial.

Deepak Arora, Indra Singh Choudhary, Akshat Dutt, Niladri Banerjee, Anupam Singh Chauhan, Mahaveer Singh Rodha, Naveen Sharma, Ashok Kumar Puranik, Nishant Kumar Chauhan, Manoj Kumar Gupta, Ramkaran Chaudhary
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引用次数: 0

Abstract

Introduction: Thoracic injuries are prevalent in polytrauma patients, with road traffic accidents being a major cause. In India alone, over 400,000 people were injured in such accidents in 2022. Rib fractures, haemothorax, and pneumothorax are common chest injuries, often managed with tube thoracostomy. While standard procedures for chest tube placement are established, consensus on post-insertion management, particularly regarding negative pleural suction, is lacking. Research on this topic mostly pertains to planned thoracotomies rather than trauma cases. This study seeks to compare outcomes of slow negative suction versus conventional drainage in blunt or penetrating thoracic trauma.

Methods: This single-centre, open-label, randomized controlled trial in a western Indian hospital from Jan 2021 to June 2022 included adult patients with thoracic trauma requiring intercostal drainage tubes. Patients needing emergency thoracotomy, mechanical ventilation, or bilateral chest tubes were excluded. Sample size (n = 64) was calculated based on prior studies. Patients were randomly assigned to experimental (slow negative pleural suction) or control (conventional water seal drainage) groups. Both groups received standard care. Primary outcome was time to chest tube removal; secondary outcomes included hospital stay length, complications, and need for further intervention. Data were analysed using SPSS. Significance was set at p < 0.05.

Results: During the study 64 patients were randomised into experimental (n = 32) or conventional (n = 32) groups. Most of the patients were males (88 %, n = 56). Both groups had similar baseline characteristics. Experimental group patients had shorter median chest tube duration (3 [IQR 2-3.75] vs. 5 [3-8.75] days, p < 0.001) and hospital stay (5 [4-8.75] vs. 10 [6-16.75] days, p = 0.004). No discomfort was reported with slow continuous negative pleural suction. Mortality was 1 (3 %) in the experimental group vs. 2 (6 %) in the conventional group. Four patients suffered retained haemothorax, with only one occurrence in the experimental group (3 %).

Conclusion: Application of slow continuous negative pleural suction to chest tubes in patients of thoracic trauma can decrease the chest tube duration and the hospital stay. This study ought to be followed up with multicentric randomised clinical trials with larger sample sizes to better characterise the effects of slow continuous negative pleural suction.

对接受管式胸腔造口术的胸部创伤患者进行缓慢负性胸膜抽吸的疗效--随机临床试验。
简介胸腔损伤在多发性创伤患者中很常见,而道路交通事故是主要原因。仅在印度,2022 年就有超过 40 万人在此类事故中受伤。肋骨骨折、血胸和气胸是常见的胸部损伤,通常采用胸腔插管术进行处理。虽然已制定了胸管置入的标准程序,但对于置入后的管理,尤其是负性胸膜抽吸,还缺乏共识。有关这一主题的研究大多涉及计划中的开胸手术,而非创伤病例。本研究旨在比较钝性或穿透性胸部创伤中缓慢负压吸引与传统引流的效果:这项单中心、开放标签、随机对照试验于 2021 年 1 月至 2022 年 6 月在印度西部一家医院进行,纳入了需要肋间引流管的胸部创伤成人患者。需要紧急开胸手术、机械通气或双侧胸腔置管的患者除外。样本量(n = 64)根据之前的研究计算得出。患者被随机分配到实验组(缓慢负性胸膜抽吸)或对照组(传统水封引流)。两组患者均接受标准护理。主要结果是拔除胸管的时间;次要结果包括住院时间、并发症和是否需要进一步干预。数据使用 SPSS 进行分析。显著性以 p < 0.05 为标准:研究期间,64 名患者被随机分为实验组(32 人)或常规组(32 人)。大多数患者为男性(88%,n = 56)。两组患者的基线特征相似。实验组患者的中位胸管持续时间(3 [IQR 2-3.75] 天 vs. 5 [3-8.75] 天,p < 0.001)和住院时间(5 [4-8.75] 天 vs. 10 [6-16.75] 天,p = 0.004)较短。慢速持续胸膜负压吸引术后无不适报告。实验组死亡率为 1 例(3%),常规组为 2 例(6%)。有四名患者出现血胸,而实验组只有一人(3%):结论:在胸部创伤患者的胸腔插管上应用缓慢持续的胸膜负压吸引可缩短胸腔插管时间,缩短住院时间。这项研究应通过样本量更大的多中心随机临床试验进行跟进,以更好地描述持续缓慢胸膜负压吸引的效果。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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