chest tubes


Summary: Plastic tubes used for drainage of air or fluid from the pleural space. Their surgical insertion is called tube thoracostomy.

Top Publications

  1. Laws D, Neville E, Duffy J. BTS guidelines for the insertion of a chest drain. Thorax. 2003;58 Suppl 2:ii53-9 pubmed
  2. Rice T, Okereke I, Blackstone E. Persistent air-leak following pulmonary resection. Chest Surg Clin N Am. 2002;12:529-39 pubmed
    ..To stop persistent air leaks, early cessation of suction and placing chest tubes to an underwater seal is more effective than continuous suction...
  3. Bjessmo S, Hylander S, Vedin J, Mohlkert D, Ivert T. Comparison of three different chest drainages after coronary artery bypass surgery--a randomised trial in 150 patients. Eur J Cardiothorac Surg. 2007;31:372-5 pubmed
    ..and pleura following open cardiac procedures is usually carried out using one or more large-bore plastic chest tubes. Recently small diameter siliastic drains have been reported to evacuate blood with a better patient comfort...
  4. Brunelli A, Salati M, Refai M, Di Nunzio L, Xiume F, Sabbatini A. Evaluation of a new chest tube removal protocol using digital air leak monitoring after lobectomy: a prospective randomised trial. Eur J Cardiothorac Surg. 2010;37:56-60 pubmed publisher
    ..Although future studies are warranted to confirm these results in other settings, the use of this new protocol is now routinely applied in our practice. ..
  5. Varela G, Brunelli A, Jimenez M, Di Nunzio L, Novoa N, Aranda J, et al. Chest drainage suction decreases differential pleural pressure after upper lobectomy and has no effect after lower lobectomy. Eur J Cardiothorac Surg. 2010;37:531-4 pubmed publisher
    ..In three cases of each group, no suction was indicated, while in the other three cases, chest tubes were placed under 15 cm H(2)O suction, according to the standard local perioperative care protocol in each ..
  6. Dural K, Gulbahar G, Kocer B, Sakinci U. A novel and safe technique in closed tube thoracostomy. J Cardiothorac Surg. 2010;5:21 pubmed publisher
    ..25 days. In the patients who did not develop TM, it was 3.39 +/- 1.18 days (p = 0.001). The modified combination technique is a reliable method in preventing TM and its potential complications. ..
  7. Zabeck H, Muley T, Dienemann H, Hoffmann H. Management of chylothorax in adults: when is surgery indicated?. Thorac Cardiovasc Surg. 2011;59:243-6 pubmed publisher
    ..The aim of this retrospective study was to analyze the etiology, management and outcome of patients with chylothorax and identify clinical parameters for appropriate treatment decisions...
  8. Light R. Pleural controversy: optimal chest tube size for drainage. Respirology. 2011;16:244-8 pubmed publisher
    ..percentage of patients with pleural effusions or pneumothorax are being treated with small-bore (10-14 F) chest tubes rather than large-bore (>20 F)...
  9. De Leyn P, Muller M, Oosterhuis J, Schmid T, Choong C, Weder W, et al. Prospective European multicenter randomized trial of PleuraSeal for control of air leaks after elective pulmonary resection. J Thorac Cardiovasc Surg. 2011;141:881-7 pubmed publisher
    ..We sought to evaluate the efficacy and safety of a synthetic bioresorbable pleural sealant (PleuraSeal; Covidien, Bedford, Mass) to treat air leaks after pulmonary resection...

More Information


  1. Marta G, Facciolo F, Ladegaard L, Dienemann H, Csekeo A, Rea F, et al. Efficacy and safety of TachoSil® versus standard treatment of air leakage after pulmonary lobectomy. Eur J Cardiothorac Surg. 2010;38:683-9 pubmed publisher
    ..TachoSil® was superior to standard surgical treatment in reducing both postoperative air leakage duration and intra-operative air leakage intensity in patients undergoing elective pulmonary lobectomy. ..
  2. Coughlin S, Emmerton Coughlin H, Malthaner R. Management of chest tubes after pulmonary resection: a systematic review and meta-analysis. Can J Surg. 2012;55:264-70 pubmed publisher
    ..a systematic review and meta-analysis to determine the effect of suction with water seal, compared with water seal alone, applied to intra pleural chest tubes on the duration of air leaks in patients undergoing pulmonary surgery.
  3. Klijian A. A novel approach to control air leaks in complex lung surgery: a retrospective review. J Cardiothorac Surg. 2012;7:49 pubmed publisher
    ..Nevertheless, systematic reviews have not presented sufficient evidence to recommend their general use in lung resection...
  4. Fysh E, Smith N, Lee Y. Optimal chest drain size: the rise of the small-bore pleural catheter. Semin Respir Crit Care Med. 2010;31:760-8 pubmed publisher
    ..The onus now is on those who favor large tubes to produce clinical data to justify the more invasive approach. ..
  5. Cerfolio R, Bryant A. Results of a prospective algorithm to remove chest tubes after pulmonary resection with high output. J Thorac Cardiovasc Surg. 2008;135:269-73 pubmed publisher
    ..Follow-up was 100% at 4 weeks and 93% at 8 weeks. Chest tubes can be removed with up to 450 mL/day of nonchylous drainage after pulmonary resection, and perhaps a higher ..
  6. Cerfolio R, Bryant A, Singh S, Bass C, Bartolucci A. The management of chest tubes in patients with a pneumothorax and an air leak after pulmonary resection. Chest. 2005;128:816-20 pubmed
    Placing chest tubes to water seal is superior for patients with an air leak, but when a patient has a pneumothorax and an air leak the best chest tube setting is unknown...
  7. Brunelli A, Monteverde M, Borri A, Salati M, Marasco R, Al Refai M, et al. Comparison of water seal and suction after pulmonary lobectomy: a prospective, randomized trial. Ann Thorac Surg. 2004;77:1932-7; discussion 1937 pubmed
    The objective of the present study was to assess whether placing chest tubes on water seal after pulmonary lobectomy reduced the duration of air leak compared with suction...
  8. Parulekar W, Di Primio G, Matzinger F, Dennie C, Bociek G. Use of small-bore vs large-bore chest tubes for treatment of malignant pleural effusions. Chest. 2001;120:19-25 pubmed
    To evaluate the efficacy of small-bore (12 French vanSonnenberg) catheters compared with standard large-bore chest tubes in the drainage and sclerotherapy of malignant pleural effusions.
  9. Alphonso N, Tan C, Utley M, Cameron R, Dussek J, Lang Lazdunski L, et al. A prospective randomized controlled trial of suction versus non-suction to the under-water seal drains following lung resection. Eur J Cardiothorac Surg. 2005;27:391-4 pubmed
    ..The anticipated gains are that this will reduce work and cost and aid mobilization. ..
  10. Jones R, Hollingsworth J. Tension pneumothoraces not responding to needle thoracocentesis. Emerg Med J. 2002;19:176-7 pubmed
  11. Payne M, Magovern G, Benckart D, Vasilakis A, Szydlowski G, Cardone J, et al. Left pleural effusion after coronary artery bypass decreases with a supplemental pleural drain. Ann Thorac Surg. 2002;73:149-52 pubmed
    ..8% (45 of 460). Symptomatic left pleural effusion occurred in 11.9% (41 of 345) patients when only chest tubes were used, and in 3.5% (4 of 115) when a supplemental drain was placed...
  12. Huber Wagner S, Korner M, Ehrt A, Kay M, Pfeifer K, Mutschler W, et al. Emergency chest tube placement in trauma care - which approach is preferable?. Resuscitation. 2007;72:226-33 pubmed
    ..The attending physician was free to choose the location of insertion. Chest tubes placed both on-scene and in-hospital chest tubes were investigated...
  13. Palesty J, McKelvey A, Dudrick S. The efficacy of X-rays after chest tube removal. Am J Surg. 2000;179:13-6 pubmed
    The insertion and subsequent removal of chest tubes are frequently performed procedures...
  14. Ball C, Lord J, Laupland K, Gmora S, Mulloy R, Ng A, et al. Chest tube complications: how well are we training our residents?. Can J Surg. 2007;50:450-8 pubmed
    ..The primary purpose of this study was to define the incidence and risk factors for complications in chest tubes placed exclusively by resident physicians...
  15. Sartori S, Tombesi P, Tassinari D, Ceccotti P, Nielsen I, Trevisani L, et al. Sonographically guided small-bore chest tubes and sonographic monitoring for rapid sclerotherapy of recurrent malignant pleural effusions. J Ultrasound Med. 2004;23:1171-6 pubmed
  16. Lim K, Tai S, Chan C, Hsu Y, Hsu W, Lin B, et al. Diagnosis of malpositioned chest tubes after emergency tube thoracostomy: is computed tomography more accurate than chest radiograph?. Clin Imaging. 2005;29:401-5 pubmed
    ..the accuracy between computed tomography (CT) and frontal chest radiography in the diagnosis of malpositioned chest tubes (MCT). CT scans positive for MCT between March 2000 and March 2004 were reviewed...
  17. Lancey R, Gaca C, Vander Salm T. The use of smaller, more flexible chest drains following open heart surgery : an initial evaluation. Chest. 2001;119:19-24 pubmed
  18. Gervais D, Levis D, Hahn P, Uppot R, Arellano R, Mueller P. Adjunctive intrapleural tissue plasminogen activator administered via chest tubes placed with imaging guidance: effectiveness and risk for hemorrhage. Radiology. 2008;246:956-63 pubmed publisher
    ..of and risk for hemorrhage with intrapleural adjunctive tissue plasminogen activator (tPA) administered via chest tubes placed with imaging guidance...
  19. Remerand F, Luce V, Badachi Y, Lu Q, Bouhemad B, Rouby J. Incidence of chest tube malposition in the critically ill: a prospective computed tomography study. Anesthesiology. 2007;106:1112-9 pubmed
    Malposition of percutaneously inserted chest tubes is considered as a rare complication in critically ill patients. Its incidence, however, remains uncertain...
  20. Cerfolio R, Minnich D, Bryant A. The removal of chest tubes despite an air leak or a pneumothorax. Ann Thorac Surg. 2009;87:1690-4; discussion 1694-6 pubmed publisher
    ..One hundred and ninety-nine patients (3.8%) with a persistent air leak had their chest tubes placed to a suctionless portable drainage device and were discharged home...
  21. Varela G, Jimenez M, Novoa N, Aranda J. Postoperative chest tube management: measuring air leak using an electronic device decreases variability in the clinical practice. Eur J Cardiothorac Surg. 2009;35:28-31 pubmed publisher
    ..a prospective randomized study aimed at measuring inter-observer variability in deciding when to withdraw chest tubes after lung resection and to evaluate if the use of an electronic device to measure postoperative air leak ..
  22. Aylwin C, Brohi K, Davies G, Walsh M. Pre-hospital and in-hospital thoracostomy: indications and complications. Ann R Coll Surg Engl. 2008;90:54-7 pubmed publisher
    ..We conducted a prospective cohort observational study of emergency pleural drainage procedures to validate the indications for pre-hospital thoracostomy and to identify complications from both pre- and in-hospital thoracostomies...
  23. Dernevik L, Belboul A, Rådberg G. Initial experience with the world's first digital drainage system. The benefits of recording air leaks with graphic representation. Eur J Cardiothorac Surg. 2007;31:209-13 pubmed
    ..To evaluate the clinical efficacy of a new digital drainage system, the DigiVent Chest Drainage System that gives accurate measurements of air leakage and pleural pressures and can display those measurements over time...
  24. Shackcloth M, Poullis M, Jackson M, Soorae A, Page R. Intrapleural instillation of autologous blood in the treatment of prolonged air leak after lobectomy: a prospective randomized controlled trial. Ann Thorac Surg. 2006;82:1052-6 pubmed
    ..5 days) were both significantly (p < 0.001) shorter in the study group. This technique is effective in sealing air leaks after lobectomy. It allows earlier chest drain removal and shortens hospital stay. ..
  25. Ponrartana S, LaBerge J, Kerlan R, Wilson M, Gordon R. Management of patients with "ex vacuo" pneumothorax after thoracentesis. Acad Radiol. 2005;12:980-6 pubmed
    ..Survival among patients treated by observation was 191.4 days versus 71.7 days for patients receiving chest tubes. Life expectancy for most patients who develop "ex vacuo" pneumothorax following therapeutic ..
  26. Cerfolio R, Bryant A. The benefits of continuous and digital air leak assessment after elective pulmonary resection: a prospective study. Ann Thorac Surg. 2008;86:396-401 pubmed publisher
    ..Pulmonary function, types of pulmonary resection, number of chest tubes, and pathology were not statistically different between the groups...
  27. Waydhas C, Sauerland S. Pre-hospital pleural decompression and chest tube placement after blunt trauma: A systematic review. Resuscitation. 2007;72:11-25 pubmed
    Pre-hospital insertion of chest tubes or decompression of air within the pleural space is one of the controversial topics in emergency medical care of trauma patients...
  28. Akowuah E, Ho E, George R, Brennan K, Tennant S, Braidley P, et al. Less pain with flexible fluted silicone chest drains than with conventional rigid chest tubes after cardiac surgery. J Thorac Cardiovasc Surg. 2002;124:1027-8 pubmed
  29. Fitzgerald M, Mackenzie C, Marasco S, Hoyle R, Kossmann T. Pleural decompression and drainage during trauma reception and resuscitation. Injury. 2008;39:9-20 pubmed publisher
    ..4. Whenever possible, blunt thoracic trauma patients should undergo definitive CT imaging after TT to check for appropriate tube position. ..
  30. Bell R, Ovadia P, Abdullah F, Spector S, Rabinovici R. Chest tube removal: end-inspiration or end-expiration?. J Trauma. 2001;50:674-7 pubmed
    ..A prospective study of 102 chest tubes in 69 trauma patients (1...
  31. Pacharn P, Heller D, Kammen B, Bryce T, Reddy M, Bailey R, et al. Are chest radiographs routinely necessary following thoracostomy tube removal?. Pediatr Radiol. 2002;32:138-42 pubmed
    ..Future prospective investigations may examine reserving chest radiography following chest tube removal for select groups, such as symptomatic patients or those with tenuous cardiovascular status. ..
  32. Younes R, Gross J, Aguiar S, Haddad F, Deheinzelin D. When to remove a chest tube? A randomized study with subsequent prospective consecutive validation. J Am Coll Surg. 2002;195:658-62 pubmed
    ..Subsequently, another 91 consecutive patients had chest tubes removed when drainage was less than 200 mL/d (G-val, prospective validation group)...
  33. Anegg U, Lindenmann J, Matzi V, Smolle J, Maier A, Smolle Jüttner F. Efficiency of fleece-bound sealing (TachoSil) of air leaks in lung surgery: a prospective randomised trial. Eur J Cardiothorac Surg. 2007;31:198-202 pubmed
    ..This reduction in air leakage resulted in a significant reduction in both the time to chest drain removal and the period of hospitalisation. ..
  34. Belboul A, Dernevik L, Aljassim O, Skrbic B, Rådberg G, Roberts D. The effect of autologous fibrin sealant (Vivostat) on morbidity after pulmonary lobectomy: a prospective randomised, blinded study. Eur J Cardiothorac Surg. 2004;26:1187-91 pubmed
    ..both air leakage and bleeding/exudation (drainage volume) were recorded every morning postoperatively until the chest tubes were removed. Personnel recording these parameters were blinded to the intervention received...
  35. Al Ashaal Y, Hefny A, Safi F, Abu Zidan F. Tension pneumothorax complicating endoscopic retrograde cholangiopancreatography: case report and systematic literature review. Asian J Surg. 2011;34:46-9 pubmed publisher
    ..Unexplained chest pain, dyspnoea, and oxygen desaturation with abdominal distension during ERCP must raise this possibility. Early clinical recognition and prompt management is essential to improve the outcome...
  36. Demir Y, Khorshid L. The effect of cold application in combination with standard analgesic administration on pain and anxiety during chest tube removal: a single-blinded, randomized, double-controlled study. Pain Manag Nurs. 2010;11:186-96 pubmed publisher
    ..Cold and warm packs covered with gauze dressing were applied to the area surrounding the chest tubes for 20 minutes. Pain intensity, pain quality and situational anxiety for CTR were measured...
  37. Goździk W, Adamik B, Wysoczanski G, Gozdzik A, Rachwalik M, Skalec T, et al. Preoperative thromboelastometry for the prediction of increased chest tube output in cardiac surgery: A retrospective study. Medicine (Baltimore). 2017;96:e7669 pubmed publisher
    ..Monitoring of the coagulation system with thromboelastometry allows rapid diagnosis of coagulation abnormalities even before the start of the surgery. These abnormalities could not always be detected with routine coagulation tests. ..
  38. Takuwa T, Yoshida J, Ono S, Hishida T, Nishimura M, Aokage K, et al. Low-fat diet management strategy for chylothorax after pulmonary resection and lymph node dissection for primary lung cancer. J Thorac Cardiovasc Surg. 2013;146:571-4 pubmed publisher
    ..More than 500 mL of chylous fluid during the first 24 hours after the initiation of the low-fat diet was valid as an indication of the need for surgical intervention. ..
  39. Rivinius R, Futterer S, Puderbach M, Herth F, Heusel C. [Chronic obstructive pulmonary disease, periorbital and subconjunctival swelling]. Med Klin Intensivmed Notfmed. 2012;107:645-8 pubmed publisher
    ..On the basis of the progressive emphysemas and persistent pneumothorax, a second chest tube was inserted. Subsequently, the signs and symptoms disappeared completely. ..
  40. Anand R, Whelan J, Ferrada P, Duane T, Malhotra A, Aboutanos M, et al. Thin chest wall is an independent risk factor for the development of pneumothorax after chest tube removal. Am Surg. 2012;78:478-80 pubmed
    ..Data are presented as average ± standard deviation. Ninety-one chest tubes were inserted into 81 patients...
  41. Berg A, Amirbekian S, Mojibian H, Trow T, Smith S, White R. Hemothorax due to rupture of pulmonary arteriovenous malformation: an interventional emergency. Chest. 2010;137:705-7 pubmed publisher
    ..Hemorrhage from a PAVM may be the first manifestation of hereditary hemorrhagic telangiectasia. Genetic testing and screening for other family members should be considered. ..
  42. Davies H, Davies R, Davies C. Management of pleural infection in adults: British Thoracic Society Pleural Disease Guideline 2010. Thorax. 2010;65 Suppl 2:ii41-53 pubmed publisher
  43. Tang H, Pan T, Qin X, Xue L, Wu B, Zhao X, et al. A portable thoracic closed drainage instrument for hemopneumothorax. J Trauma Acute Care Surg. 2012;72:671-5 pubmed publisher
    ..The newly-designed thoracic drainage package is very effective in the emergency treatment of thoracic trauma and may be more suitable for the emergency treatment of hemopneumothorax. ..
  44. Marulli G, Droghetti A, Di Chiara F, Calabrese F, Rebusso A, Perissinotto E, et al. A prospective randomized trial comparing stapler and laser techniques for interlobar fissure completion during pulmonary lobectomy. Lasers Med Sci. 2013;28:505-11 pubmed publisher
    ..Aero-haemostatic laser properties (by sealing of small blood vessels and checking air leaks) allow a safe application during pulmonary lobectomy in interlobar fissure completion avoiding stapler use. ..
  45. Karangelis D, Karkos C, Tagarakis G, Oikonomou K, Karkos P, Papadopoulos D, et al. Thoracic injuries resulting from intimate partner violence. J Forensic Leg Med. 2011;18:119-20 pubmed publisher
  46. Hussaini B, Thatte H, Rhodes B, Treanor P, Birjiniuk V. Thromboresistant surfaces with low-dose anticoagulation alleviate clopidogrel-related complications in patients undergoing coronary artery bypass grafting. J Thorac Cardiovasc Surg. 2011;141:782-8 pubmed publisher
  47. Gandham S, Nagar A. Delayed pneumothorax following an isolated clavicle injury. BMJ Case Rep. 2013;2013: pubmed publisher
    ..Clinicians should therefore be aware of this rare complication from displaced clavicle fractures both immediately after the initial trauma and also on follow-up. ..
  48. Martin K, Emil S, Zavalkoff S, Lo A, Ganey M, Baird R, et al. Transitioning from stiff chest tubes to soft pleural catheters: prospective assessment of a practice change. Eur J Pediatr Surg. 2013;23:389-93 pubmed publisher
    ..In 2010, a multidisciplinary team at our institution developed a protocol to replace stiff chest tubes with 8.5-French soft pleural catheters in children requiring pleural drainage...
  49. Lopez J, Saad R, Dorgan Neto V, Botter M, Gonçalves R, Rivaben J. Technical validation of pulmonary drainage for the treatment of severe pulmonary emphysema: a cadaver-based study. J Bras Pneumol. 2013;39:16-22 pubmed
    ..2 cm (for both). The placement of a fixed-size chest tube in the specified position is feasible and safe, regardless of the anthropometric characteristics of the patients. ..
  50. Lee C, Kim D, Lee J, Park I, Bae M, Chung K. Bilateral video-assisted thoracoscopic thymectomy has a surgical extent similar to that of transsternal extended thymectomy with more favorable early surgical outcomes for myasthenia gravis patients. Surg Endosc. 2011;25:849-54 pubmed publisher
    ..Long-term follow-up assessment and more extensive data are mandatory to verify the early surgical outcomes. ..
  51. Lüthje L, Zabel M, Seegers J, Zenker D, Vollmann D. Acute and long-term feasibility of contralateral transvenous lead placement with subcutaneous, pre-sternal tunnelling in patients with chronically implanted rhythm devices. Europace. 2011;13:1004-8 pubmed publisher
    ..Contralateral transvenous lead implantation with subcutaneous, pre-sternal TUN appears to be a feasible option in selected patients with an implanted rhythm device and ipsilateral subclavian vein occlusion. ..
  52. Ganigara M, Prabhu A, Varghese R, Pavithran S, Valliatu J, Nair R. Extracardiac Fontan operation after late bidirectional Glenn shunt. Asian Cardiovasc Thorac Ann. 2010;18:253-9 pubmed publisher
    ..Despite a trend towards prolonged pleural effusion, there was no adverse outcome in the short or intermediate term. Long-term follow-up is required to see whether delayed creation of a Glenn shunt is associated with late disadvantages. ..
  53. Bradley M, Okoye O, DuBose J, Inaba K, Demetriades D, Scalea T, et al. Risk factors for post-traumatic pneumonia in patients with retained haemothorax: results of a prospective, observational AAST study. Injury. 2013;44:1159-64 pubmed publisher
    ..The development of pneumonia has previously been reported to be as high as 19.5% in the setting of traumatic RH. The purpose of this study was to identify risk factors for the development of pneumonia as a complication in RH...