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Correspondence |

Occlusion and Malposition of Small-Bore Chest Tubes for Pleural Infection FREE TO VIEW

Arthur Atchabahian, MD; Christian Laplace, MD; Karim Tazarourte, MD
Author and Funding Information

From the Department of Anesthesiology (Dr Atchabahian), New York University Medical Center; the Department of Anesthesiology (Dr Laplace), Hôpital Bicêtre; and the Hôpital Marc Jacquet (Dr Tazarourte).

Correspondence to: Arthur Atchabahian, MD, Department of Anesthesiology, New York University/Hospital for Joint Diseases Medical Center, 301 E 17th St, New York, NY 10003; e-mail: arthur.atchabahian@gmail.com


Financial/nonfinancial disclosures: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2010 American College of Chest Physicians


Chest. 2010;138(3):760. doi:10.1378/chest.10-0811
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To the Editor:

We read with great interest the recent study by Rahman et al (March 2010),1 which suggests that smaller tubes are as effective for the treatment of pleural infection as larger-bore tubes, while causing less pain. However, no mention was made of two complications that smaller tubes may be more prone to: malposition and occlusion.

Although we are not aware of published data, common sense suggests that occlusion of chest tubes used to drain thick fluid, such as pus, may occur more readily with small-bore tubes. Remérand et al2 showed that chest tube malposition is fairly common (30% in their series), and that avoiding the use of a trocar reduces the risk of malposition. There are, however, no data regarding guidewire insertion.

Despite the fact that tube size was not randomly assigned, we would be very interested to know what the incidence of these complications was in the authors’ series. If they were more frequent with small-bore tubes, that would be an argument against the use of these tubes. Obviously, both this hypothesis and the authors’ conclusion that small-bore tubes yield similar clinical outcomes to large-bore tubes will have to be tested in randomized studies.

Rahman NM, Maskell NA, Davies CWH, et al. The relationship between chest tube size and clinical outcome in pleural infection. Chest. 2010;1373:536-543. [CrossRef] [PubMed]
 
Remérand F, Luce V, Badachi Y, Lu Q, Bouhemad B, Rouby JJ. Incidence of chest tube malposition in the critically ill: a prospective computed tomography study. Anesthesiology. 2007;1066:1112-1119. [CrossRef] [PubMed]
 

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References

Rahman NM, Maskell NA, Davies CWH, et al. The relationship between chest tube size and clinical outcome in pleural infection. Chest. 2010;1373:536-543. [CrossRef] [PubMed]
 
Remérand F, Luce V, Badachi Y, Lu Q, Bouhemad B, Rouby JJ. Incidence of chest tube malposition in the critically ill: a prospective computed tomography study. Anesthesiology. 2007;1066:1112-1119. [CrossRef] [PubMed]
 
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