A National Evaluation of Intercostal Chest Drain Removal Strategies
Year: 2025
Type: article
Study design: Observational Study
Abstract: BACKGROUND: Management of spontaneous pneumothorax often involves intercostal chest drain (ICD) insertion. Determining when to remove the ICD is controversial, with significant variation in practice. Establishing optimal ICD management in pneumothorax could reduce morbidity and improve cost-effectiveness. RESEARCH QUESTION: Do ICD removal strategies, including clamping and use of digital air leak devices, impact the risk of pneumothorax recurrence, need for repeat pleural procedures, or length of stay? STUDY DESIGN AND METHODS: We conducted a multicenter retrospective analysis of patients requiring ICD insertion for spontaneous pneumothorax from May 2021 to October 2023. Data were collected on demographics, clinical course, ICD removal strategy, pneumothorax recurrence (early and late), and repeat pleural intervention. RESULTS: A total of 791 admissions from 27 centers were included. The 30-day recurrence of pneumothorax was 13.0% (n = 103). Clamping trials were undertaken in 32.6% of cases (n = 258), but recurrence of pneumothorax was not significantly different in clamped compared with nonclamped groups (14.0% vs 12.6%, respectively; P = .67). Clamping identified pleural air reaccumulation in 24 episodes (9.3% of the clamped group). Of 234 cases where clamping did not identify air leak, 35 patients (15.0%) developed recurrent pneumothorax. Of the 533 patients whose drains were not clamped, 67 (12.6% of the group) developed recurrence. The median length of stay was 6 (clamped) vs 5 days (nonclamped) (P = .08). Adverse events associated with clamping were few (n = 6), but included tension pneumothorax (n = 1). Digital air leak devices combined with clamping resulted in the lowest rates of pneumothorax recurrence; however, this approach was rare (n = 24, 0.0% recurrence within 7 days). INTERPRETATION: Our results indicate that recurrent pneumothorax after ICD removal is a common complication. Clamping trials are safe but do not appear to be associated with reduced rates of recurrent pneumothorax. An ultracautious approach using digital air leak devices in combination with clamping could represent a viable strategy in selected patients.
Source: CHEST Journal
Authors: Niki Veale, Anthony W. Martinelli, Dheeraj Sethi, Phillip De Souza, Khaing Zar Mon, Joyce Oi Suet Cheng, David Morrow, May Sam, Irfan Saleem, Kay Por Yip, Jennifer Kerks, David Henshall, Tobias Smitherman-Cairns, Katherine Smith, Daniel Mitchell, Karl Jackson, Benjamin Pippard, Seemab Paul, Waheed Mohammad, James Hyman, Benjamin Rowlands, Samantha Bosence, Catharine Pearce, Ben Probyn, Richard Thorley, Matthew Mitchell, Andrew Griffiths, Richard Westley, Abdullah Bin Huda, Asim Mehmood, Abid Khan, Vern Tee, Rachel Crooks, Paul Minnis, Lewis Standing, Wei Hann Ong, M. Salman Rashid, Ahmed Salih, Eve Lynn Koh, Ching Khai Ho, Yiwen Soo, Matthew Hayes, Clodagh Holmes, Fatima Al-Arrayed, Abeer Saad, Beenish Iqbal, Sam Trewick, Patrick Goodley, Jonathan Oldershaw, Elizabeth Thompson, Alexandra Hodge, Mohamed Gadallah, Rahul Bhat, Eleanor Barton, Anand Sundaralingam, Osei Kankam, James Quinn, John P. Corcoran, Steven P. Walker, Avinash Aujayeb, Jurgen Herre, Akhilesh Jha, Stefan J. Marciniak, Najib M. Rahman, Rob J. Hallifax
Institutions: Cambridge University Hospitals NHS Foundation Trust, Papworth Hospital NHS Foundation Trust, University of Cambridge, Norfolk and Norwich University Hospitals NHS Foundation Trust, University of Birmingham, University Hospitals Birmingham NHS Foundation Trust, Maidstone and Tunbridge Wells NHS Trust, University of Edinburgh, Newcastle upon Tyne Hospitals NHS Foundation Trust, Northumbria Healthcare NHS Foundation Trust, South Tyneside and Sunderland NHS Foundation Trust, County Durham and Darlington NHS Foundation Trust, Royal Devon University Healthcare NHS Foundation Trust, University Hospitals Plymouth NHS Trust, Aneurin Bevan University Health Board, Sheffield Teaching Hospitals NHS Foundation Trust, Mid Yorkshire Hospitals NHS Trust, Northern Health and Social Care Trust, North Tees and Hartlepool NHS Foundation Trust, Calderdale and Huddersfield NHS Foundation Trust, James Paget University Hospital, James Paget University Hospitals NHS Foundation Trust, North Cumbria Integrated Care NHS Foundation Trust, Oxford University Hospitals NHS Trust, Manchester University NHS Foundation Trust, Royal Free London NHS Foundation Trust, United Lincolnshire Hospitals NHS Trust, George Eliot Hospital NHS Trust, North Bristol NHS Trust, University of Oxford, East Sussex Healthcare NHS Trust, NIHR Oxford Biomedical Research Centre
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $4,160
Funders: Royal Free London NHS Foundation Trust, University Hospitals Plymouth NHS Trust, National Institute for Health and Care Research, Department of Health and Social Care, Inspire Foundation, Asthma and Lung UK, University of Oxford, North Bristol NHS Trust, Oxford University Hospitals NHS Foundation Trust, Sheffield Teaching Hospitals NHS Foundation Trust, NIHR Cambridge Biomedical Research Centre
OpenAlex ID: W4415830547