The Endotracheal Tube Used As A Thoracic Trocar

Abstract

Thoracostomy using a large-bore tube is indicated in patients with pleural effusions of infectious etiology, hemothorax, and those with pneumothorax associated with an underlying lung pathology, especially if they are under mechanical ventilation or in a hemodynamically unstable situation. There are different techniques for the insertion of a chest tube, with blunt dissection being the most frequently used and recommended by researchers and guidelines [1-3]. However, despite guidelines recommending it no longer be used due to high rates of intrathoracic organ injuries [3], there is a group of experienced physicians who continue to perform insertion of the tube through a trocar for educational reasons. Arguments in their favor are that it is well tolerated by patients, can facilitate tube positioning, and requires only a very short insertion time. Furthermore, the insertion of chest tubes by use of a trocar provides an opening that is a better fit to the outside diameter of the tube. Perhaps they think that complications depend not so much on the technique itself as on the skill of the physician performing it. Hence, it may be important for the insertion of a trocar to be reserved for experienced physicians familiar with both the trocar’s use and chest wall anatomy.