Pleural decompression and drainage during trauma reception and resuscitation

M. Fitzgerald, C. F. Mackenzie, S. Marasco, R. Hoyle, T. Kossmann

Research output: Contribution to journalReview ArticleResearchpeer-review

73 Citations (Scopus)

Abstract

This review examines pleural decompression and drainage during initial hospital adult trauma reception and resuscitation, when it is indicated for haemodynamically unstable patients with signs of pneumothorax or haemothorax. The relevant historical background, techniques, complications and current controversies are highlighted. Key findings of this review are that:1.Needle thoracocentesis is an unreliable means of decompressing the chest of an unstable patient and should only be used as a technique of last resort.2.Blunt dissection and digital decompression through the pleura is the essential first step for pleural decompression, as decompression of the pleural space is a primary goal during reception of the haemodynamically unstable patient with a haemothorax or pneumothorax. Drainage and insertion of a chest tube is a secondary priority.3.Techniques to prevent tube thoracostomy (TT) complications include aseptic technique, avoidance of trocars, digital exploration of the insertion site and guidance of the tube posteriorly and superiorly during insertion.4.Whenever possible, blunt thoracic trauma patients should undergo definitive CT imaging after TT to check for appropriate tube position.

Original languageEnglish
Pages (from-to)9-20
Number of pages12
JournalInjury
Volume39
Issue number1
DOIs
Publication statusPublished - 1 Jan 2008

Keywords

  • Chest tube
  • Haemothorax
  • Needle thoracocentesis
  • Pleural decompression
  • Pneumothorax
  • Thoracostomy
  • Trauma resuscitation

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