Volume Threshold for Chest Tube Removal: A Randomized Controlled Trial

BACKGROUND Despite importance of chest tube insertion in chest trauma, there is no general agreement on the level of daily volume drainage from chest tube. This study was conducted to compare the effectiveness and safety of chest tube removal at the levels of 150 ml/day and 200 ml/day. METHODS Eligible patients (138) who needed replacement of chest tube (because of trauma or malignancy) were randomized into two groups; control (removal of chest tube when drainage reached to 150 ml/day) and trial (removal of chest tube at the level of 200 ml/day). All patients received standard care during hospital admission and a follow-up visit after 7 days of discharge from hospital. Patients were then compared in terms of major clinical outcomes using chi-squared and t-test. RESULTS From the total of 138 patients, 70 and 68 patients were randomized to control (G150) and trial (G200) group, respectively. Baseline characteristics were comparable between the two groups. Although the trial group had a shorter mean for length of hospital stay (LOS) (4.1 compared to 4.8, p=0.04), their differences in drainage time did not reach to the level of statistical significance (p=0.1). Analysis of data showed no statistically significant differences between the rate of radiological reaccumulation, thoracentesis and decrease in pulmonary sounds (auscultatory), one week after discharge from hospital. CONCLUSIONS Compared to a daily volume drainage of 150 ml, removal of chest tube when there is 200 ml/day is safe and will even result in a shorter hospital stay. This in turn leads to a lower cost.