TY - JOUR T1 - Impact and Predictors of Prolonged Chest Tube Placement in Mechanically Ventilated Patients with Acquired Pneumothorax JF - Respiratory Care DO - 10.4187/respcare.02273 SP - respcare.02273 AU - Jiann-Hwa Kao AU - Hsin-Kuo Kao AU - Yen-Wen Chen AU - Wen-Kuang Yu AU - Sheng-Wei Pan AU - Jia-Horng Wang AU - Te-Cheng Lien AU - Li-Ing Ho AU - Yu Ru Kou Y1 - 2013/05/07 UR - http://rc.rcjournal.com/content/early/2013/05/07/respcare.02273.abstract N2 - Introduction: Prolonged chest tube placement is less well studied in patients who are supported by mechanical ventilation and have acquired pneumothorax. We investigated the impact of prolonged chest tube placement on patient outcomes and the risk factors associated with prolonged placement. Methods: This retrospective observational study included 106 ventilated patients who had been treated with thoracostomy for pneumothorax between May 2004 and December 2011; 61 patients involving 63 events were analyzed. The patients were divided into prolonged (>18 days) and control groups (≤18 days) according to their median chest tube duration. Results: Patients who had undergone prolonged chest tube placement had a significantly higher ICU mortality (p = .006), a longer ICU stay (p = .001), a longer hospitalization (p = .004), and a longer duration of mechanical ventilation after development of pneumothorax (p = .003) compared to the control group. The prolonged group also had a higher level of maximum peak inspiratory pressure (p = .03) and a higher rate of surgical emphysema (p = .009), which remained independent predictors of prolonged chest tube duration after multivariate logistic regression analysis. Notably, the probability of chest tube removal within 28 days was significantly lower for patients with both risk factors compared to patients without any risk factor (log rank p = .001). Conclusions: A high peak inspiratory pressure and surgical emphysema are two independent predictors of prolonged chest tube placement that negatively impact on the clinical outcomes of this patient group. These findings may provide information for better management of chest tube. ER -