What is the normal amount of chest tube drainage per kilogram for an adult?

From the Guidelines

The normal amount of chest tube output for an adult is typically less than 1 ml/kg/24 h, as indicated by the most recent evidence. For a 70 kg adult, this would translate to approximately less than 70 mL per 24 hours. This guideline is based on the recommendation that a chest tube can be removed in the absence of an intrathoracic air leak and when pleural fluid drainage is less than 1 ml/kg/24 h, usually calculated over the last 12 hours 1. It's essential to note that chest tube output varies based on the underlying condition being treated, and the output should gradually decrease over time as the pleural space resolves the condition that necessitated chest tube placement.

Key Considerations

• The initial amount of chest tube output can be higher, especially in post-surgical patients or those with pneumothorax or hemothorax, but it should rapidly decrease over time.
• Persistent high output (>200 mL/hour for several hours) or sudden increases in previously decreasing output warrant immediate clinical attention as they may indicate active bleeding.
• The color and consistency of the drainage are also important clinical indicators, with initially bloody drainage expected to transition to serous or serosanguinous fluid over time.
• Excessive ultrafiltration (>30 ml kg−1) during cardiopulmonary bypass should be avoided, as it may be associated with an increased risk of postoperative acute kidney injury (AKI) 1.

Clinical Implications

• Monitoring chest tube output is crucial for assessing the patient's condition and guiding clinical decisions.
• The output should be evaluated in conjunction with other clinical indicators, such as the patient's vital signs, chest X-ray, and overall clinical status.
• Deviations from the expected output or changes in the character of the drainage should prompt further investigation and potential intervention.

From the Research

Normal Chest Tube Output

• The normal amount of chest tube output per kg for an adult is not explicitly stated in the provided studies.
• However, study 2 mentions that the fluid criteria for chest drain management was increased from 3 mL/kg to 7 mL/kg, suggesting that a chest tube output of up to 7 mL/kg may be considered normal.
• Study 3 reports that the mean chest tube output for patients with pneumothorax or hemothorax was 1558 ± 1919 cc for non-occult injuries and 1123 ± 1076 cc for occult injuries, but does not provide a specific value per kg.

Chest Tube Management

• Study 4 suggests that chest tubes may be removed successfully when the fluid output is ≤200 mL/day.
• Study 2 found that chest drains can be safely removed without fluid criteria and with an air leak of less than 20 mL/min, resulting in a reduced length of hospital stay.
• Study 5 highlights the importance of standardizing chest tube management to decrease individual surgeon preference and notes that the research gaps in digital chest drainage systems include examining what flow thresholds should be used to safely remove a chest tube after surgery.
• Study 6 demonstrates that chest tubes can be safely removed in patients with an air leak or a pneumothorax, as long as certain criteria are met, such as the patient being asymptomatic and having no subcutaneous emphysema after 14 days on a portable device at home.