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When to Remove Chest Tubes: Use of Volume Threshold



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Am Fam Physician. 2003 Feb 15;67(4):869-870.

Chest tubes are commonly used to drain fluid following surgery involving the pleural space. Removal can be considered when there is no empyema or air leak, and fluid drainage has decreased to an acceptable level. Patients are rarely discharged from the hospital with a chest tube, so earlier removal could result in shorter hospital stays. Younes and associates evaluated the efficacy and complication rates resulting from chest tube removal using three different drainage thresholds. Patients undergoing an open thoracotomy with routine chest tube placement were randomized to chest tube removal at an uninfected fluid drainage level of less than 200 mL per day, less than 150 mL per day, or less than 100 mL per day. The diagnoses of these patients were non–small-cell lung cancer (N = 25) and pulmonary metastases from extrathoracic primaries (N = 114), with similar distribution among the three trial groups. All patients were followed with regular physical examinations and chest radiographs after discharge from the hospital.

The overall median drainage time was three days, and patients randomized to the less-than 100 mL per day group had the tubes removed one day after other groups and stayed a median of one day later in the hospital. Earlier removal of the chest tube, at a drainage rate of less than 200 mL per day, was safe and was not associated with a greater risk of fluid reaccumulation or thoracocentesis.

The authors conclude that using a drainage threshold of 200 mL per day for chest tube removal in patients with uninfected pleural fluid and no evidence of air leaks may safely decrease costs and length of stay following thoracic operative procedures. Further studies are recommended to evaluate thresholds of even higher volume per day for chest tube removal.

Younes RN, et al. When to remove a chest tube? A randomized study with subsequent prospective consecutive validation. J Am Coll Surg. November 2002;195:658–62.



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