Tube Thoracostomy Techniques in Traumatic Chest Management

Tube thoracostomy remains a cornerstone of emergency management for traumatic thoracic injuries, facilitating evacuation of air, blood or mixed collections from the pleural space. Traditionally performed with large-bore drains, the procedure has evolved with the introduction of small-bore and pigtail catheters, guided insertion techniques and adjunctive imaging. Indications include pneumothorax, haemothorax and haemopneumothorax following blunt or penetrating trauma. Technique optimisation has focused on minimising malposition, reducing procedural complications and tailoring tube diameter to injury severity. Advances in insertion methods—ranging from blunt dissection to modified trocar approaches—have been complemented by real-time ultrasonography and computed tomography to confirm positioning and quantify residual collections. Video-assisted thoracoscopic surgery offers a minimally invasive alternative for retained haemothorax or complex pleural injury, enabling direct visualisation and evacuation. Despite robust evidence supporting both large- and small-bore tubes, practitioner experience and training remain critical determinants of success. Global efforts continue to refine protocols for tube selection, insertion site and duration of drainage, with particular emphasis on resource-limited settings where access to imaging and specialist thoracic teams may be constrained.

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Tube Thoracostomy Techniques in Traumatic Chest Management publication trend

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Technical terms

Tube thoracostomy: Surgical placement of a chest tube to drain air or fluid from the pleural space.

Small-bore chest tube: A drain ≤14 French gauge, often pigtail-style, used for less viscous or moderate collections.

Large-bore chest tube: A drain >14 French gauge, traditionally employed for haemothorax and complex effusions.

Haemothorax: Accumulation of blood within the pleural cavity, commonly due to trauma.

Pneumothorax: Presence of air in the pleural space, leading to lung collapse if not evacuated.

Video-assisted thoracoscopic surgery (VATS): Minimally invasive endoscopic approach for direct pleural inspection and evacuation of retained collections.

Empyema: Infected pleural fluid accumulation, often developing secondary to retained haemothorax or inadequate drainage.

References

1. A Novel Rabbit Model of Retained Hemothorax with Pleural Organization. International Journal of Molecular Sciences (2023).
2. Comparing complications of small-bore chest tubes to large-bore chest tubes in the setting of delayed hemothorax: a retrospective multicenter cohort study. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine (2020).
3. Quantification of pleural effusion on CT by simple measurement. Biomedical Papers (2012).
4. Indications and morbidity of tube thoracostomy performed for traumatic and non-traumatic free pleural effusions in a low-income setting. Pan African Medical Journal (2014).