Hemothorax is a collection of blood in the thoracic cavity. Many times, this occurs in the setting of chest trauma, either penetrating (i.e., gun shot wounds) or blunt (i.e., a car accident). When a significant collection of blood occurs in the chest, it is drained many times by insertion of a tube in the chest.
The conventional wisdom is that this tube should be large, so that the blood can drain easily, and the blood does not clog the tube. Yet, many studies have shown that smaller tubes can do just as well. Yet, is this actually the case in the literature?
Enter this study.
It was a systemic review and meta-analysis of nine studies comparing small bore (less than 14F) and large bore (greater than 20F) tubes. 1847 patients were included in the analysis (714 SBTT and 1,233 LBTT). They found no significant differences between the tubes:
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No significant difference in failure rate between SBTT (17.8%) and LBTT (21.5%) (p = 0.166)
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No significant difference in mortality between SBTT vs. LBTT (2.9% vs. 6.1%, p = 0.062)
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No significant difference in complication rate, either (12.3% vs. 12.5%, p = 0.941),
What was very interesting was that small bore chest tubes had greater initial drainage (753 vs. 398 mL) and fewer tube days (4.3 vs. 6.2 days), and these findings were statistically significant (p < .001).
Now, there were a number of limitations to this review, and they did not answer the question as to whether small bore chest tubes would be good enough in a patient who is hemodynamically stable. Thus, we have to take these results with a little skepticism.
That said, in the right patient, this study does give some literature credence to using a small bore chest tube to drain a hemothorax, and this is important: small bore tubes are much more comfortable for the patient, and they are much less traumatic to insert.
