Duration of Chest Tube Suction in Traumatic Pneumothorax

Study Overview
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Brief Summary
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The purpose of this pilot study is to determine whether chest tube suction duration, 24 hours vs 48 hours, prior to water seal affects outcome and length of stay after placement for traumatic pneumothorax.

Official Title
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Chest Tube Management in Traumatic Pneumothorax: Does Duration of Suction Matter

Conditions
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Traumatic Pneumothorax

Intervention / Treatment
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* Procedure: Chest tube suction


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Trauma service consult/patient Traumatic pneumothorax with chest tube placed within 0-24 hours of presentation and confirmation of adequate position Age >18 Blunt or penetrating mechanism Chest tubes sizes 14 to 32Fr Chest tubes placed by residents on the trauma surgery service supervised by attending trauma surgeons or placed by the attending surgeon themselves Presence of single chest tube in one or both pleural cavities (single unilateral or bilateral tubes) Subjects with decision making capacity (DMC) who are able to provide written consent. DMC will be determined by the consenting physician through a teach back mechanism. Subjects must demonstrate understanding of the situation, appreciation of the consequences of their decision, reasoning of their thought process, and be able to communicate their wishes. Exclusion Criteria: Age <18 Pregnant patients Prisoners Mechanically ventilated in ICU for more than 24 hours while chest tube in place Chest tubes placed as part of, or present during, a thoracic operation History of surgery involving pleural cavity ipsilateral to chest tube Subjects with more than one chest tube on the ipsilateral side at any time prior to study chest tube removal Subjects with chylothorax or empyema Subjects with chest tubes that are withdrawn or removed unintentionally Subjects with known or suspected bronchial injury Subjects with bullous emphysema.

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: 24 hours of suction<br>Subjects with chest tubes kept to -20 cmH2O suction for 24 hours prior to water seal | Procedure: Chest tube suction<br>* The chest tubes will be inserted using our institutional standard chest tube insertion tray. The chest tubes used will be our institutional standard and will range from 14 to 32Fr in size. After chest tube placement, an Atrium Oasis Dry Suction Water Seal Chest Drain (Getinge USA Sales, LLC) will be used.<br>|
| Experimental: 48 hours of suction<br>Subjects with chest tubes kept to -20 cmH2O suction for 48 hours prior to water seal | Procedure: Chest tube suction<br>* The chest tubes will be inserted using our institutional standard chest tube insertion tray. The chest tubes used will be our institutional standard and will range from 14 to 32Fr in size. After chest tube placement, an Atrium Oasis Dry Suction Water Seal Chest Drain (Getinge USA Sales, LLC) will be used.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Chest tube dwell time | Total time that chest tube is in place from insertion to removal | up to 1 month | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of participants with reaccumulation of pneumothorax | After transition to water seal and stopping suction, incidence of reaccumulation of pneumothorax requiring suction or replacement of chest tube. | up to 3 days | 
| Number of participants with at least one pulmonary complications | Pulmonary complications are defined as increased oxygen requirements, shortness of breath or unplanned intubations following placement to suction. | up to 1 week | 
| Readmission to hospital | Number of participants readmitted to the hospital within 30 days | 30 days | 
| Transfer to ICU | Number of participants with an unplanned transfer to the intensive care unit | up to 1 week | 
| Median length of stay | Median length of stay in the hospital after chest tube placement | Up to 1 year |