Canadian Association of General Surgeons and American College of Surgeons Evidence Based Reviews in Surgery. 18 - Treatment of occult pneumothoraces from blunt trauma

Question: Can occult pneumothoraces be safely observed without the need for a chest tube? Design: A randomized controlled trial. Setting: Two trauma centres in the United States. Patients: Thirty-nine patients with 44 pneumothoraces ( defined as a pneumothorax seen on abdominal CT scan but not on an anteroposterior chest x-ray as read by the trauma chief resident or attending staff member) were enrolled. Intervention: Within 6 hours of admission, patients were randomized to receive a chest tube (n = 18, group 1) or observation (n = 21, group 2). Chest tubes remained in place for a median 3 days (range 1-12 d). The main outcome measures were: Respiratory distress, pneumothorax progression, pneumonia, retained hemothorax and chest tube insertion. Results: One nonintubated patient with a chest tube developed respiratory distress, and 3 who were being observed had respiratory distress without pneumothorax after these were removed from suction; 3 patients without chest tubes had pneumothorax progression, 2 while being ventilated. No differences were statistically significant. Conclusions: Pneumothoraces can be safely observed in patients with blunt trauma regardless of the need for positive pressure ventilation.