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In a timely article published in Trauma Surgery & Acute Care Open (TSACO), investigators Fredric Pieracci, Clay Cothren Burlew, David Spain, David Livingston, Eileen Bulger, Kimberly Davis and Christopher Michetti provide urgent guidance for trauma and acute care surgeons regarding chest tube management during the COVID-19 pandemic. All investigators serve on the Acute Care Surgery and Critical Care Committees of the American Association for the Surgery of Trauma (AAST), a Core member of the Coalition for National Trauma Research.

The article–Tube thoracostomy during the COVID-19 pandemic: guidance and recommendations from the AAST Acute Care Surgery and Critical Care Committees–describes special precautions for thoracic procedure teams. The procedure carries increased risks during the coronavirus outbreak, as aerosolization can occur during tube insertion, drainage system management and tube removal.

Pieracci et al. recommend thoracostomy insertion for patients with known or suspected COVID-19 should be performed by the most experienced provider on the team and include the fewest number of staff members possible, and give five suggestions for drainage system management:

• Create a standard algorithm for handling thoracic procedures based on your institution’s resources and expertise;
• Create a “Go Bag” containing the necessary supplies and house it in a central location and restocked after each use;
• Modify the drainage system to minimize the aerosolizing of virus by setting it up prior to beginning the procedure and adding dilute bleach to the water seal chamber;
• Attach an in-line viral filter to suction tubing;
• Attach a gravity bag-based viral filter to suction port of the drainage system; and
• Remove the gravity bag-based filter and reattach to suction with in-line filter, in event of an acute decompensation while on water seal.

The authors offer more than 20 suggestions to minimize risks during tube insertion and removal; but caution, “The information provided here is not intended to supersede clinical judgement. Given the limited data, the lack of any of the special equipment [noted] should not prevent or delay the placement of a tube thoracostomy in a life-threatening situation.”

Read the article, first published in TSACO on April 30, 2020.