Improvised chest tube drainage: A practical approach to thoracic emergencies in humanitarian crises

Abstract

• Developed an improvised chest tube drainage system using locally available materials for conflict zones. • Achieved 90 % lung re-expansion within 72 h, comparable to conventional systems. • Recorded low complication rates, including empyema (12 %) and subcutaneous emphysema (20 %). • Demonstrated cost-effectiveness and adaptability in resource-limited settings. • Offers a scalable model for emergency thoracic care in low-resource and disaster environments. Thoracic injuries pose a challenge in conflict zones, where disrupted healthcare infrastructure and supply shortages limit access to conventional chest tube drainage (CTD) systems. This study evaluates the safety and efficacy of an improvised CTD system as a viable alternative in resource-limited settings in Sudan. A prospective, single-center analytical cohort study was conducted at a tertiary hospital in Sudan from June to December 2023. A total of 120 adult patients (aged 18–70 years) requiring CTD for thoracic injuries were included. The improvised CTD system consisted of a radiopaque nasogastric (NG) tube and a repurposed 1.5-liter plastic water bottle as an underwater seal. Clinical outcomes, complications, and patient satisfaction were assessed. Serial imaging at baseline and 24-hour intervals evaluated lung re-expansion and drainage efficacy. Data were analyzed using SPSS, with p < 0.05 considered significant. Lung re-expansion was achieved in 90 % ( N = 108) of patients within 72 h. Complications included atelectasis in 15 % ( N = 18), subcutaneous emphysema in 20 % ( N = 24), and empyema in 12 % ( N = 14). Tube repositioning was required in 25 % ( N = 30) of cases, and obstruction occurred in 10 % ( N = 12). The mean hospital stay was 6.5 days, and mortality was 5 % ( N = 6). Smoking status, age, and injury type significantly predicted complications. Patient satisfaction was high, with 85 % ( N = 102) rating their experience as satisfactory. The improvised CTD system is a safe, effective, and cost-efficient alternative for managing thoracic emergencies in conflict settings. Its adaptability addresses critical gaps in emergency care, offering a scalable model for humanitarian crises worldwide.