Is Bedside Ultrasound Useful for Chest Tube Removal? Description of an Initial Experience

Abstract

Introduction: Point-of-care ultrasound is a propaedeutic modality more often used in a daily basis practice. Since the establishment of sonography bases for lung ultrasound, it has become a valuable extension of physical examination, providing new information about lungs, pleural structures and volume status. Currently, the removal of chest tubes is based on clinical data, associated with chest X-ray control. The objective of this manuscript is to describe two cases that ultrasound was used in order to test whether it could be an alternative control tool on these specific scenarios.
Methods: Bedside ultrasound was daily performed on two patients with iatrogenic pneumothorax until they met clinical criteria for chest tube removal. Ultrasound exam was performed before and after chest tube removal.
Results: In both cases patients were submitted to chest tube placement due to iatrogenic pneumothorax. One of the patients had a pneumothorax during diagnostic thoracocentesis for pleural effusion and the other patient during the placement of a central venous line. In both the cases, bedside ultrasound presented similar results to the chest X-ray. Bedside ultrasound was able to adequately identify chest tube placement and lung expansion. In none of the present cases was possible to see residual pneumothorax also unidentified by the chest X-ray.
Conclusion: Even though there is extensive data showing ultrasound superiority when compared to chest X-ray in the diagnosis of pneumothorax, there is little or no data using this method as image criteria for chest tube removal. This article shows two suggestive cases that lung ultrasound could be a simple, bedside manner, to show adequate lung expansion and serve as useful tool for chest tube removal. A prospective study is necessary to provide evidence based data on the subject.