title: Incidence of chest tube malposition in the critically ill: a prospective computed tomography study.
abstract: BACKGROUND
  Malposition of percutaneously inserted chest tubes is considered as a rare complication in critically ill patients. Its incidence, however, remains uncertain. The aims of the study were to assess the true incidence of chest tube malposition in critically ill patients and to identify predicting factors.
  
  
  METHODS
  The authors prospectively studied 122 chest tubes percutaneously inserted in 75 consecutive critically ill patients. For clinical reasons independent of the study, thoracic computed tomography scanning was performed in 63 patients, allowing direct visualization of 106 chest tubes. Based on these findings, chest tube position was classified as intrapleural, intrafissural, or intraparenchymal. Factors predicting chest tube malposition were analyzed by univariate and multivariate analysis.
  
  
  RESULTS
  The mean delay between chest tube placement and thoracic scan was 3.5+/-2.9 days. Twenty-two chest tubes were diagnosed as being intrafissural (21%), and 10 were diagnosed as being intraparenchymal (9%). The only predicting factor associated with the risk of malposition was the use of a trocar for the percutaneous insertion of the chest tube (P=0.032).
  
  
  CONCLUSIONS
  Malposition was detected in 30% of percutaneously inserted chest tubes, a higher incidence than previously reported. Avoiding the use of a trocar may reduce significantly the incidence of chest tube malposition.
authors.affiliation: Service de Radiologie Polyvalente Diagnostique et Interventionnelle, La Pitié-Salpêtrière Hospital, University Pierre et Marie Curie, Tours, France. sabetrem@yahoo.com
authors.forename: Francis
authors.initials: F
authors.lastname: Remérand
authors.forename: Virginie
authors.initials: V
authors.lastname: Luce
authors.forename: Yasmina
authors.initials: Y
authors.lastname: Badachi
authors.forename: Qin
authors.initials: Q
authors.lastname: Lu
authors.forename: Belaïd
authors.initials: B
authors.lastname: Bouhemad
authors.forename: Jean-Jacques
authors.initials: JJ
authors.lastname: Rouby
mesh_terms: D015505:Chest Tubes / Q000009:adverse effects*; D016638:Critical Illness / Q000401:mortality / Q000628:therapy; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D019300:Medical Errors / Q000145:classification / Q000706:statistics & numerical data*; D008875:Middle Aged; D011446:Prospective Studies; D014057:Tomography, X-Ray Computed