The goal of this clinical trial is to compare the effect of placing chest tubes to water seal versus suction initially, in patients with traumatic pneumothoraces, on overall chest tube duration. The main question it aims to answer is: * Does placing chest tubes to water seal initially results in a shorter chest tube duration, without an increase in complications? Alternating each month, patients' chest tubes will either be placed to water seal or to suction initially. All other management decisions related to the chest tube will be left to the providers.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
72
After chest tube placement, the chest tube will be placed to 20cm H2O of suction for 1 minute to evacuate all pneumothorax. After this, the chest tube will be placed to water seal, defined as the water seal chamber on the chest tube drainage system being filled up to the 2cm line and not on suction. All other management decisions related to the chest tube will be left to the providers.
After chest tube placement, the suction group will have their chest tube placed to 20cm H2O of suction delivered by the chest tube drainage suction. All other management decisions related to the chest tube will be left to the providers.
Vanderbilt University Medical Center
Nashville, Tennessee, United States
Chest tube duration
Duration of the initial chest tube, measured in hours
Time frame: Through study completion, an average of 1 year
Change from water seal to suction
Yes/No
Time frame: Through study completion, an average of 1 year
Additional chest tube placement on affected side
Yes/no
Time frame: Through study completion, an average of 1 year
Pneumothorax reaccumulation with chest tube to water seal
Yes/no Yes if growth of pneumothorax on chest x-ray with tube to water seal
Time frame: Through study completion, an average of 1 year
Replacement of chest tube
Yes/no Yes if chest tube removed and then a new one is place on the same side at a later time
Time frame: Through study completion, an average of 1 year
Pneumothorax reaccumulation after chest tube removal
Yes/no Yes if pneumothorax grows on chest x-ray after chest tube removal
Time frame: Through study completion, an average of 1 year
Hypoxic events
Yes/no Yes if \<90% O2 saturation is recorded in chart
Time frame: Through study completion, an average of 1 year
Empyema
Yes/no Yes if clinically diagnosed by provider based off of imaging, operative findings, clinical picture, culture results, or operative findings
Time frame: Through study completion, an average of 1 year
Pneumonia
Yes/no Yes if clinically diagnosed and treated for pneumonia
Time frame: Through study completion, an average of 1 year
Retained hemothorax
Yes/no Yes if \>300cc hemothorax seen on CT scan after chest tube placement
Time frame: Through study completion, an average of 1 year
TPA administration
Yes/no Yes if any TPA administered to the affected side of the chest
Time frame: Through study completion, an average of 1 year
Chest tube site, skin and soft tissue infection
Yes/no Yes if skin and soft tissue infection treated with incision and drainage, or antibiotics
Time frame: Through study completion, an average of 1 year
Video-assisted thoracoscopic surgery
Yes/no Yes if receives video-assisted thoracoscopic surgery on the affected side during initial admission
Time frame: Through study completion, an average of 1 year
Acute respiratory failure requiring intubation
Yes/no Yes if intubated for hypoxia or hypercapnea during hospital stay
Time frame: Through study completion, an average of 1 year
Unplanned ICU admission
Yes/no Yes if admitted to ICU unexpectedly, for clinical deterioration
Time frame: Through study completion, an average of 1 year
30-day mortality
Yes/no Yes if died within 30 days of initial presentation
Time frame: Through study completion, an average of 1 year
Length of hospital stay
Integer, measured in days, length of initial hospital stay
Time frame: Through study completion, an average of 1 year
30-day readmission
Yes/no Yes if readmitted within 30 days of discharge
Time frame: Through study completion, an average of 1 year
Thoracic intervention during readmission
Yes/no Yes if readmitted and receives chest tube, video-assisted thoracoscopic surgery, or thoracotomy on the affected side
Time frame: Through study completion, an average of 1 year
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