How long should a chest tube remain in place after parapneumonic effusion?

From the Guidelines

The chest tube should remain in place until the pleural fluid drainage is less than 1 mL/kg/24 h or 25-60 mL total in a 24-hour period, usually within 48-72 hours after the operation or completion of fibrinolysis, as recommended by the pediatric infectious diseases society and the infectious diseases society of America 1.

Key Considerations for Chest Tube Removal

• The decision to remove the chest tube should be based on the absence of an air leak and minimal pleural fluid drainage, as well as clinical improvement and resolution of the underlying pneumonia.
• The tube can be removed once the lung has fully re-expanded and there is minimal fluid output.
• For complicated parapneumonic effusions or empyema, longer duration may be necessary, sometimes up to 2 weeks.

Important Factors to Consider

• Premature removal of the chest tube can lead to reaccumulation of fluid, while unnecessarily prolonged placement increases the risk of infection, pain, and restricted mobility.
• Throughout the chest tube placement, appropriate pain management should be provided, and the insertion site should be monitored for signs of infection.
• A trial of clamping the tube for 4-6 hours followed by a chest X-ray can help ensure no reaccumulation of fluid occurs before removing the tube.

Clinical Guidelines

• The pediatric infectious diseases society and the infectious diseases society of America recommend that patients with a chest tube can be discharged after the tube has been removed for 12-24 hours, with no clinical evidence of deterioration or significant reaccumulation of a parapneumonic effusion or pneumothorax 1.

From the Research

Duration of Chest Tube Placement

The duration of chest tube placement after para-pneumonic effusion is not explicitly stated in the provided studies. However, the management of pleural infections and the use of chest tubes are discussed in several studies:

• The study by 2 discusses the management of pleural infections, including the use of chest tubes, but does not provide specific guidance on the duration of chest tube placement.
• The study by 3 mentions the use of small-bore chest tubes for pleural drainage, but also does not provide information on the duration of chest tube placement.
• The study by 4 recommends inserting a chest tube if the effusion is more than 10 mm in thickness and the characteristics of the pleural fluid indicate a poor prognosis, but does not specify how long the chest tube should remain in place.
• The study by 5 discusses the approach to patients with parapneumonic effusions, including the use of chest tube drainage, but does not provide guidance on the duration of chest tube placement.

Key Considerations

Some key considerations for the management of parapneumonic effusions include:

• The need for prompt antibiotic therapy and pleural drainage in cases of complicated parapneumonic effusions and empyema 2, 3, 4, 5
• The use of small-bore chest tubes for pleural drainage 3
• The potential need for intrapleural fibrinolytics or thoracoscopy in cases of loculated effusions 4
• The importance of monitoring patients for signs of complications, such as failure of drainage or development of empyema 2, 3, 4, 5

Additional Therapies

Additional therapies that may be considered in the management of parapneumonic effusions include:

• Intrapleural deoxyribonuclease (DNase) and tissue plasminogen activator (t-PA) to aid fluid drainage 2, 5
• Surgery, including video-assisted thoracoscopic surgery (VATS) or open decortication, in cases of complicated parapneumonic effusions or empyema 2, 3, 4
• Nutritional support to optimize patient outcomes 3