Incidence of chest tube malposition in the critically ill: a prospective computed tomography study.
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.
Remérand
Francis
F
Service de Radiologie Polyvalente Diagnostique et Interventionnelle, La Pitié-Salpêtrière Hospital, University Pierre et Marie Curie, Tours, France. sabetrem@yahoo.com
Luce
Virginie
V
Badachi
Yasmina
Y
Lu
Qin
Q
Bouhemad
Belaïd
B
Rouby
Jean-Jacques
JJ
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