From the Guidelines
Chest tubes should be placed on continuous suction at -20 cm H2O (approximately -15 to -20 millimeters of mercury) for optimal management of spontaneous pneumothorax, as recommended by the British Thoracic Society guidelines 1. The use of high volume, low pressure suction systems is preferred, as they can effectively evacuate air and fluid from the pleural space without causing damage to lung tissue or perpetuating persistent air leaks. Key considerations for chest tube management include:
- Avoiding the application of suction directly after tube insertion to prevent re-expansion pulmonary oedema (RPO) 1
- Adding suction after 48 hours for persistent air leak or failure of a pneumothorax to re-expand 1
- Using high volume, low pressure systems such as a Vernon-Thompson pump or wall suction with an adaptor to reduce pressure 1
- Situating patients in an area with specialist nursing experience when suction is applied 1 It is essential to note that the optimal suction pressure and duration may vary depending on individual patient factors, such as underlying lung disease or the presence of a large persistent air leak. However, based on the available evidence, continuous suction at -20 cm H2O is the recommended initial approach for managing spontaneous pneumothorax with chest tubes 1.
From the Research
Chest Tube Suction Management
- The optimal suction management for chest tubes is not explicitly stated in the provided studies 2, 3, 4, 5, 6.
- However, a study on initial chest tube management after pulmonary resection suggests that water seal may be preferred over suction in patients without air leak, as it results in significantly shorter chest tube duration and hospital length of stay 5.
- The study does not specify the exact millimeters of mercury for suction, but it implies that water seal may be a suitable alternative to suction in certain cases.
- Another study on traumatic pneumothorax mentions the use of tube thoracostomy, but does not provide details on suction management 6.
- The remaining studies provide general information on chest tube placement and management, but do not address the specific question of suction management 2, 3, 4.