title: Impact and predictors of prolonged chest tube duration in mechanically ventilated patients with acquired pneumothorax.
abstract: BACKGROUND
  Prolonged chest tube duration is less well studied in patients who are supported by mechanical ventilation and have acquired pneumothorax. We investigated the impact of prolonged chest tube duration on patient outcomes and the risk factors associated with prolonged chest tube duration.
  
  
  METHODS
  This retrospective observational study included 106 ventilated subjects who had been treated with thoracostomy for pneumothorax between May 2004 and December 2011. We analyzed 61 subjects and 63 events. The subjects were divided into a prolonged chest tube duration group (> 18 d) and a non-prolonged group (≤ 18 d).
  
  
  RESULTS
  Subjects with prolonged chest tube duration had significantly higher ICU mortality (P = .006), longer ICU stay (P = .001), longer hospitalization (P = .004), longer mechanical ventilation after development of pneumothorax (P = .003), higher maximum peak inspiratory pressure (P = .03), and a higher rate of surgical emphysema (P = .009). High peak inspiratory pressure and surgical emphysema remained independent predictors of prolonged chest tube duration after multivariate logistic regression analysis. The probability of chest tube removal within 28 days was significantly lower in subjects with both high peak inspiratory pressure and surgical emphysema, compared to subjects without any risk factors (log rank P = .001).
  
  
  CONCLUSIONS
  High peak inspiratory pressure and surgical emphysema are independent predictors of prolonged chest tube duration and negatively impact clinical outcomes in this patient group. These findings may provide information for better chest tube management.
authors: Department of Respiratory Therapy, Taipei Veterans General Hospital, Taipei, Taiwan.
authors: Jiann-Hwa
authors: JH
authors: Kao
authors: Hsin-Kuo
authors: HK
authors: Kao
authors: Yen-Wen
authors: YW
authors: Chen
authors: Wen-Kuang
authors: WK
authors: Yu
authors: Sheng-Wei
authors: SW
authors: Pan
authors: Jia-Horng
authors: JH
authors: Wang
authors: Te-Cheng
authors: TC
authors: Lien
authors: Li-Ing
authors: LI
authors: Ho
authors: Yu Ru
authors: YR
authors: Kou
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015505:Chest Tubes / Q000009:adverse effects*; D004646:Emphysema / Q000453:epidemiology / Q000209:etiology; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007431:Intraoperative Complications / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D063868:Patient Outcome Assessment; D011030:Pneumothorax / Q000209:etiology / Q000601:surgery*; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology; D012121:Respiration, Artificial / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods / Q000401:mortality; D012129:Respiratory Function Tests / Q000379:methods; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D013624:Taiwan / Q000453:epidemiology; D013907:Thoracostomy / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D013995:Time
keywords: chest tube; mechanical ventilation; peak inspiratory pressure; pneumothorax; subcutaneous emphysema; thoracostomy