A national evaluation of intercostal chest drain removal strategies
Veale, Niki Martinelli, Anthony W Sethi, Dheeraj De Souza, Phillip Mon, Khaing Zar Cheng, Joyce Oi Suet Morrow, David Sam, May Saleem, Irfan Yip, Kay Por
Veale, Niki
Martinelli, Anthony W
Sethi, Dheeraj
De Souza, Phillip
Mon, Khaing Zar
Cheng, Joyce Oi Suet
Morrow, David
Sam, May
Saleem, Irfan
Yip, Kay Por
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 patients, 67 whose drains were not clamped (12.5% 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 of admission. 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.
MIDER Authors
Date
2025-11-04
Type
Article
Subject
Pneumothorax, Recurrence, Evaluation studies
Collections
Citation
Veale N, Martinelli AW, Sethi D, De Souza P, Mon KZ, Cheng JOS, Morrow D, Sam M, Saleem I, Yip KP, Kerks J, Henshall D, Smitherman-Cairns T, Smith K, Mitchell D, Jackson K, Pippard B, Paul S, Mohammad W, Hyman J, Rowlands B, Bosence S, Pearce C, Probyn B, Thorley R, Mitchell M, Griffiths A, Westley R, Huda AB, Mehmood A, Khan A, Tee V, Crooks R, Minnis P, Standing L, Ong WH, Rashid MS, Salih A, Koh EL, Ho CK, Soo Y, Hayes M, Holmes C, Al-Arrayed F, Saad A, Iqbal B, Trewick S, Goodley P, Oldershaw J, Thompson E, Hodge A, Gadallah M, Bhat R, Barton E, Sundaralingam A, Kankam O, Quinn J, Corcoran JP, Walker SP, Aujayeb A, Herre J, Jha A, Marciniak SJ, Rahman NM, Hallifax RJ. A National Evaluation of Intercostal Chest Drain Removal Strategies. Chest. 2026 Mar;169(3):849-858. doi: 10.1016/j.chest.2025.10.027. Epub 2025 Nov 4.
Journal / Source Title
Chest
DOI
10.1016/j.chest.2025.10.027
PMID
41192553
Publisher
Elsevier
Publisher’s URL
https://www.sciencedirect.com/journal/chest
https://journal.chestnet.org/
https://journal.chestnet.org/