Closed Pleural Drainage and Suction Systems

Nikita Arora, MD, FRCSC, Daniel G. French, MD MASc FRCSC, Sebastien Gilbert, MD

Key Points

Thoracic surgeons must be familiar with insertion of both pigtail catheters using the Seldinger technique under ultrasound guidance and traditional large bore chest tubes. Multiple randomized controlled trials and meta-analyses have produced contradictory results regarding the use of applied external suction to chest drains after pulmonary resections. Digital drain technology holds promise in leading to a deeper understanding of pleural space mechanics after pulmonary resection and for the refinement of evidence-based practice in chest tube management. The liquid drainage threshold for removal of a chest drain should take into account body weight and whole-body lymphatic flow to establish a patient-specific threshold. There are several recognized factors and models that can identify patients at higher risk of prolonged air leak after pulmonary resection. Patients with a prolonged air leak can be safely managed in the outpatient setting.

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