From the Guidelines
Chest tube output indicating the need for surgical consultation is typically greater than 2 L within a 24-hour period 1.
Key Indicators for Surgical Consultation
- High-volume bleeding, as evidenced by post-thoracotomy chest tube output of $2 L within a 24-h period 1
- The presence of other signs of significant bleeding, such as overt bleeding in a critical organ, hypovolemic shock, or severe hypotension 1
- Overt bleeding requiring reoperation, surgical exploration, or re-intervention for the purpose of controlling bleeding 1
Important Considerations
- The timing and indication of transfused blood products should be carefully considered in the context of chest tube output and overall patient condition 1
- Overt bleeding associated with a haemoglobin drop of $5 g/dL may also necessitate surgical consultation 1
From the Research
Chest Tube Output Indicating Need for Surgical Consultation
- The study 2 found that a 1-h chest tube output of 404 mL or more can be a predictor for thoracotomy in patients with blunt chest trauma, with a sensitivity of 87.5% and specificity of 96.8%.
- However, the same study notes that high chest tube output as a traditional indicator for thoracotomy may not apply to patients with blunt chest trauma.
- There is no specific mention of chest tube output indicating the need for surgical consultation in studies 3, 4, and 5.
- Study 6 compared chest tube output for pneumothorax and hemothorax seen on computed tomography vs. chest radiograph, but did not provide a specific output value indicating the need for surgical consultation.
Management of Chest Tubes
- Study 3 provides expert recommendations on the management of chest tubes, including conditions for insertion, size of drainage/tube, and technique of insertion, but does not specify chest tube output indicating the need for surgical consultation.
- Study 4 discusses the optimal chest tube size for drainage, recommending small-bore catheters for pleurodesis and patients with complicated parapneumonic effusions, and large-bore catheters for patients with haemothorax.
- Study 5 highlights the importance of standardized management of trauma patients who undergo tube thoracostomy, resulting in a reduction in complications.