Ultrasound in the Safe and Efficient Management of Chest Tubes in Trauma: Strategies for Early Removal

Trauma is the leading cause of death during the first four decades of life, primarily due to motor vehicle collisions, but also including falls and firearm-related injuries. Thoracic trauma, although less than half of the cases require surgery, can be severe and is generally categorized as blunt or penetrating. Blunt thoracic trauma often involves rib fractures and complications such as hemothorax and pneumothorax. Penetrating injuries—most commonly from stabbings and gunshot wounds—carry high prehospital mortality, although mortality rates are low when no cardiac injury is present [1]. Tube thoracostomy, widely indicated in cases of pneumothorax, hemothorax, or trauma-related pleural effusion, requires careful and individualized management. This management should consider whether the patient is mechanically ventilated and whether they are symptomatic [2]. Conservative treatment—meaning no procedural intervention—is determined by the severity of the thoracic injury and the amount of blood loss. In hemodynamically stable patients with a hemothorax measuring less than 300 mL, observation, aggressive pulmonary hygiene, and adequate analgesia may be appropriate [3]. The hemothorax volume can be estimated by chest radiography, CT scan, and even thoracic ultrasound (the technique for estimating pleural effusion volume will be addressed in the next chapter). Studies indicate that volumes greater than 260–300 mL are up to four times more likely to require drainage. Patients with hemothorax volumes below this threshold have a 72%–92% chance of resolving without significant complications or the need for intervention. If observation is chosen, frequent imaging within the first 24 hours is recommended to monitor the stability of the hemothorax and detect other potential pathologies [3].