title: Impact of positive pressure ventilation on thoracostomy tube removal.
abstract: BACKGROUND
  Little data exist examining the impact of positive pressure ventilation on safe thoracostomy tube removal. We sought to evaluate the impact of positive-pressure ventilation (PPV) on recurrent pneumothoraces (PTX) after removal of thoracostomy tubes (TT).
  
  
  METHODS
  A retrospective cohort analysis was performed evaluating all trauma patients requiring TT drainage of PTX or hemothoraces during a 3-year period. All chest radiographs before and after TT removal were reviewed to identify PTX recurrence. The principle outcome was recurrent PTX after TT removal. The 95% confidence intervals were calculated to assess for significance.
  
  
  RESULTS
  We studied 234 TT removals in 190 patients. One hundred thirty-six (58%) TTs were removed under PPV. PTX recurred in 15 (11%) and 6 (4%) required reinsertion. In 10 patients (7.4%), there was a radiographically stable small PTX before and after removal not requiring TT reinsertion. In comparison, 98 (42%) TTs were removed under spontaneous ventilation. PTX recurred in 16 (16%) and 3 (3%) required reinsertion. There were 25 (25.5%) stable small PTXs before and after removal. The overall recurrence rate difference was -5.3% (confidence interval: -14.8 to 3.5) and reinsertion rate difference was 1.35% (confidence interval: -4.7 to 6.6).
  
  
  CONCLUSIONS
  The rate of recurrent PTX or TT replacement after removal is not associated with PPV status. The slightly lower recurrence rate on PPV combined with the smaller proportion of patients with stable small PTX before removal may reflect more careful clinician selection of ideal patients or technique of TT removal among patients on PPV. Prospective data are needed to clarify these associations.
authors.affiliation: Department of Emergency Medicine, University of New Mexico Health Science Center, Albuquerque, New Mexico 87131-0001, USA. itawil@salud.unm.edu
authors.forename: Isaac
authors.initials: I
authors.lastname: Tawil
authors.forename: Jeremy M
authors.initials: JM
authors.lastname: Gonda
authors.forename: Richard D
authors.initials: RD
authors.lastname: King
authors.forename: Jonathan L
authors.initials: JL
authors.lastname: Marinaro
authors.forename: Cameron S
authors.initials: CS
authors.lastname: Crandall
mesh_terms: D000328:Adult; D015505:Chest Tubes; D016001:Confidence Intervals; D020878:Device Removal / Q000379:methods*; D004322:Drainage / Q000295:instrumentation; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D011030:Pneumothorax / Q000401:mortality / Q000628:therapy*; D011175:Positive-Pressure Respiration; D012008:Recurrence; D012189:Retrospective Studies; D013907:Thoracostomy; D013997:Time Factors; D016896:Treatment Outcome