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
Affiliation
Cambridge University Hospitals NHS Foundation Trust; Royal Papworth Hospital NHS Foundation Trust; University of Cambridge; Norfolk and Norwich University Hospitals NHS Foundation Trust; Mid and South Essex 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 Teaching NHS Trust; Northern Health and Social Care Trust; North Tees and Hartlepool NHS Foundation Trust; Calderdale and Huddersfield NHS Foundation Trust; James Paget University Hospitals NHS Foundation Trust; North Cumbria Integrated Care NHS Foundation Trust; North West Anglia NHS Foundation Trust; Oxford University Hospitals NHS Foundation 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; East Sussex NHS Trust; University of Oxford; Chinese Academy of Medicine Oxford Institute; Oxford NIHR Biomedical Research Centre
Other Contributors
Publication date
2025-11-04
Subject
Collections
Research Projects
Organizational Units
Journal Issue
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.
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. 2025 Nov 4:S0012-3692(25)05655-7. doi: 10.1016/j.chest.2025.10.027. Epub ahead of print.
Type
Article