This article is part of the Topical Collection on Pleural Diseases and Mesothelioma
Small-bore chest tubes are widely used in the management of common pleural disease. Guidelines suggest that patients with malignant pleural effusions, pneumothorax and pleural infection may be successfully managed with small-bore drains. However, good quality data is often lacking. This article reviews the evidence for the treatment efficacy and potential adverse effects of different chest tube sizes.
In a large randomised study, the small difference in pain scores between large and small drains was not clinically significant. However, small-bore chest tubes commonly suffer from blockage or inadvertent removal, and may not be as effective in providing successful pleurodesis for malignant pleural effusions.
Although they may be effective in managing pleural infection, and less painful than large drains, small bore drains may be less effective for pleurodesis.
•• Rahman NM, Pepperell J, Rehal S, Saba T, Tang A, Ali N, et al. Effect of opioids vs NSAIDs and larger vs smaller chest tube size on pain control and pleurodesis efficacy among patients with malignant pleural effusion: the TIME1 randomized clinical trial. JAMA. 2015;314:2641–53. Large multicentre randomised study assessing effect of chest drain size and analgesia regime upon pain and pleurodesis efficacy. CrossRefPubMed
Shaw P, Agarwal R. Pleurodesis for malignant pleural effusions. Cochrane Database Syst Rev. 2004; CD002916.
Bhatnagar R, Laskawiec-Szkonter M, Piotrowska HE, Kahan BC, Hooper CE, Davies HE, et al. Evaluating the efficacy of thoracoscopy and talc poudrage versus pleurodesis using talc slurry (TAPPS trial): protocol of an open-label randomised controlled trial. BMJ Open. 2014;4, e007045. CrossRefPubMedPubMedCentral
Baumann MH. Pleural disease: an international textbook. London: Arnold Publishers; 2003.
• Kulvatunyou N, Erickson L, Vijayasekaran A, Gries L, Joseph B, Friese RF, et al. Randomized clinical trial of pigtail catheter versus chest tube in injured patients with uncomplicated traumatic pneumothorax. Br J Surg. 2014;101:17–22. Small randomised study chest drain size in traumatic pneumthorax. CrossRefPubMed
• Hooper CE, Welham SA, Maskell NA, British Thoracic Society. Pleural procedures and patient safety: a national BTS audit of practice. Thorax. 2015;70:189–91. Recent British Thoracic Society audit of chest drain usage includes data on 1394 patients.
Terzi A, Feil B, Bonadiman C, Lonardoni A, Spilimbergo I, Pergher S, et al. The use of flexible spiral drains after non-cardiac thoracic surgery. A clinical study. Eur J Cardiothorac Surg. 2005;27:34–7.
- Chest Drain Size: the Debate Continues
Robert J. Hallifax
Najib M. Rahman
- Springer US
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