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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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Last updated: July 21, 2026