What is the management for high volume output from a chest tube?

From the Guidelines

Management of high volume output from a chest tube should prioritize identifying and treating the underlying cause while maintaining hemodynamic stability, with initial management including close monitoring of vital signs and fluid resuscitation as needed, according to the most recent guidelines 1. The approach to managing high volume output from a chest tube involves several key steps:

• Close monitoring of vital signs to quickly identify any signs of hemodynamic instability.
• Fluid resuscitation with crystalloids or blood products if the patient shows signs of hypovolemia or if output exceeds 200 mL/hour for 2-4 consecutive hours.
• Laboratory tests to assess hemoglobin levels and coagulation status, which can guide the need for correction of coagulopathy with fresh frozen plasma, platelets, or specific factor replacements if bleeding is suspected.
• For persistent high-volume bloody drainage, surgical intervention should be considered, especially if output exceeds 200 mL/hour for 3 hours or more than 1500 mL in 24 hours.
• If the drainage is non-bloody, addressing the underlying condition such as heart failure, infection, or malignancy is crucial, and specific treatments like dietary modifications for chylothorax may be necessary.
• Ensuring proper chest tube function by checking for kinks, clots, or positioning issues and maintaining appropriate suction levels, typically -10 to -20 cm H₂O, as recommended by guidelines 1, is vital for effective management. The goal of these measures is to determine whether the high output represents active bleeding requiring intervention or expected drainage that will resolve with conservative management, always prioritizing the patient's morbidity, mortality, and quality of life outcomes, as emphasized in recent studies on chest tube management 1.

From the Research

Management of High Volume Output from Chest Tube

• High volume output from a chest tube can be managed using various strategies, including the use of antifibrinolytic agents such as tranexamic acid, which has been shown to decrease bleeding after cardiac operations 2.
• The size of the chest tube used can also impact the management of high volume output, with large-bore chest tubes generally required for patients with pneumothoraces or those requiring drainage of viscous pleural liquids such as blood 3.
• The type of chest tube used, whether large-bore or small-bore, can also affect the management of high volume output, with large-bore tubes being more effective for draining large amounts of fluid or air 4.
• In some cases, high volume output from a chest tube may be managed conservatively, without the need for surgical intervention, such as in the case of preterm infants with pneumothorax who are hemodynamically stable 5.
• It is also important to monitor the patient's hemodynamic status and adjust the management of the chest tube accordingly, taking into account factors such as fluid responsiveness and the risk of fluid overload 6.

Key Considerations

• The use of antifibrinolytic agents such as tranexamic acid can help reduce bleeding and decrease the volume of output from the chest tube 2.
• The selection of the appropriate size and type of chest tube is crucial for effective management of high volume output 3, 4.
• Conservative management may be an option for some patients, such as preterm infants with pneumothorax who are hemodynamically stable 5.
• Monitoring the patient's hemodynamic status and adjusting the management of the chest tube accordingly is critical to preventing complications such as fluid overload 6.