Chest Tube Removal in Simple Pneumothorax: Does Water-Seal Duration Matter?

Abstract

Timing of chest tube (CT) removal after transition from suction to water-seal (WS) varies when treating traumatic simple pneumothoraces (PTXs). Longer periods of WS may identify slow-occurring PTXs reducing CT replacement, whereas shorter periods may expedite patient disposition and have associated cost savings. Prior studies support the need for an interval of WS. We compare durations of WS, looking at rates of CT reinsertion. A 10-year retrospective review on trauma patients with a simple PTX requiring a CT was performed. WS duration of 1 to 8 hours (short - SG) versus 18 to 36 hours (long - LG) were compared. Univariate analysis and multivariate logistic regression were used. Of the 2000 patient charts reviewed, 209 met the criteria, with 43 in the SG and 166 in the LG. Patient demographics and mechanism of injury were similar. There was no difference in CT replacement [6.9% (SG) vs 4.8% (LG), P 0.59]. Logistic regression revealed an increase in CT replacement if the patient ever had positive pressure ventilation (OR 4.1, CI 1.1–17, P 0.04) and if returned to suction from WS (OR 6.3, CI 1.2–28, P 0.03). Short intervals of WS do not increase CT reinsertion while decreasing the total time and morbidity associated with CT.

Systematic review and meta-analysis of tube thoracostomy following traumatic chest injury; suction versus water seal

“…In 1994 Davis et al [ 32 ] compared continuing suction with a short period of water seal before removal of the chest tube, and found that continuing suction until chest tube removal reduced total chest tube duration and required shorter time to remove the chest tube following air leak resolution. In contrast, Martino et al and Bridges et al, found no difference between continuing suction and a short water seal in chest tube duration or hospital length of stay between suction or a short water seal before chest tube removal [ 33 , 34 ]. Because the results from these studies are contradictory, it is hard to give a firm recommendation for the management just before drain removal.…”

Conservative Management of Residual Pneumothorax Following Tube Thoracostomy Removal in Trauma Patients

“…As noted by Bridges et al, using a short interval of water seal can reduce the time of TT by almost a day as well as reduce costs and decrease hospital LOS. 8 Mao et al points out that increased duration of water seal can show increased hospital length of stay and increase number of chest radiographs. 5 Also, some institutions utilize high-flow oxygen for the "nitrogen washout" effect to facilitate complete resolution of the pneumothorax.…”