Early Chest Tube Removal for Collapsed Lung

Overseen By Brian Louie, MD

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: Swedish Medical Center

Must not be taking: Immunosuppressants, Steroids, Chemotherapy, others

Disqualifiers: Chest radiation, Tuberculosis, COPD, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 2

Duration: 2 days

200 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial explores whether removing a chest tube one day after surgery for a collapsed lung is as effective as the usual two-day wait. The researchers aim to determine if earlier removal can reduce hospital stay, lower costs, and cause less discomfort without increasing the risk of the lung collapsing again within two years. The trial targets adults undergoing surgery to treat a primary spontaneous pneumothorax (a lung collapse occurring without trauma). Participants will have follow-up checks for two years to monitor their progress. As an unphased trial, this study offers participants the chance to contribute to medical knowledge that could enhance future treatment options.

Will I have to stop taking my current medications?

The trial does not specify if you need to stop taking your current medications. However, if you are taking immunosuppressive medications like chemotherapy or steroids, you may not be eligible to participate.

What prior data suggests that early chest tube removal is safe?

Research has shown that removing a chest tube soon after surgery is generally safe. Studies have found that taking out the chest tube shortly after video-assisted thoracoscopic surgery does not increase risks. In fact, it can help patients recover faster and reduce hospital stays. One study demonstrated that removing the chest tube on the same day as surgery is safe and often allows patients to go home the next day. Another analysis confirmed that early chest tube removal is safe, even with significant fluid drainage. Overall, the evidence supports that early chest tube removal is well-tolerated and does not lead to more complications. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about the Early Chest Tube Removal protocol because it could significantly shorten recovery times for patients with a collapsed lung. Unlike the standard approach, where the chest tube is left in until the second day after surgery, this protocol explores removing the tube within just 24 hours. This quicker removal could reduce discomfort and hospital stays, making recovery much more efficient and comfortable for patients.

What evidence suggests that early chest tube removal could be effective for primary spontaneous pneumothorax?

This trial will compare Early Chest Tube Removal with Standard Chest Tube Removal. Research has shown that removing chest tubes early, even within 6 hours after surgery, can be safe for many patients. One study found that up to 90% of patients had their chest tubes removed early without major problems, and only 2% required additional procedures later. Another study noted that early removal might slightly increase the risk of lung collapse, but the overall difference is small. Patients experienced better lung function after early removal. Although there is a small risk of recurrence, early removal could result in shorter hospital stays and less discomfort. ^{6 7 8 9 10}

Are You a Good Fit for This Trial?

This trial is for individuals who have had a lung collapse, known as primary spontaneous pneumothorax, and are undergoing surgery. Participants should be fit for the study before their operation and willing to follow up for 2 years with visits and phone calls.

Inclusion Criteria

I am having surgery for a collapsed lung using a camera and small cuts.

I am over 18 years old.

Exclusion Criteria

I have had chest radiation or surgery on the same side before.

Pregnant women

Prisoners

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

1-2 weeks

Treatment

Participants undergo VATS with blebectomy/wedge resection and pleurodesis, followed by randomization to early or standard chest tube removal

2 days

Inpatient stay

Follow-up

Participants are monitored for safety and effectiveness after treatment with scheduled follow-ups

2 years

In clinic with chest x-ray at 2 weeks, 1 year, and 2 years; phone call at 3 months

What Are the Treatments Tested in This Trial?

Interventions

• Early Chest Tube Removal
• Standard Chest Tube Removal

Trial Overview The study tests if removing the chest tube early (1 day after surgery) is as effective as the standard practice of removal on day 2. It looks at recurrence rates over two years, patient comfort, hospital stay duration, and any complications or additional treatments needed.

How Is the Trial Designed?

Group I: Early Chest Tube Removal Experimental Treatment 2 Interventions

Subjects within the "Early Removal" group will have their chest tube removed on POD#1 within 24 hours from the end of the surgery.

Group II: Standard Chest Tube Removal Active Control 2 Interventions

Subjects in the "Standard Removal" group will have their chest tube kept to suction on POD#1 with removal on POD#2.

Who Is Running the Clinical Trial?

Swedish Medical Center

Lead Sponsor

Trials

55

Recruited

8,500+

Published Research Related to This Trial

A study involving 50 patients who were discharged with a portable chest tube device showed that 89% had successful outpatient management, allowing for earlier discharge after thoracic surgery.

The use of the portable chest tube system led to no major complications and only minor complications in four patients, indicating a safe and effective alternative to prolonged hospital stays.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Postoperative outpatient chest tube management: initial experience with a new portable system. Rieger, KM., Wroblewski, HA., Brooks, JA., et al.[2007]

In a study of 83 patients who underwent coronary artery bypass grafting, removing chest tubes 24 hours post-surgery led to improved postoperative outcomes, including lower analgesic requirements and earlier mobilization compared to those with tubes removed after 48 hours.

Early chest tube removal (24 hours) did not result in significant complications such as pleural effusion or atelectasis, suggesting it is a safe practice that can enhance recovery without increasing the risk of adverse effects.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Timing of chest tube removal after coronary artery bypass surgery. Abramov, D., Yeshayahu, M., Tsodikov, V., et al.[2011]

In a study of 207 nonventilated blunt chest trauma patients, routine postremoval chest radiographs after chest tube removal showed increased or recurrent intrathoracic issues in 31% of cases, but only 3% required immediate reintervention based on these findings.

The results suggest that it may be safe to skip routine postremoval chest X-rays in these patients, recommending selective imaging only for those showing clinical signs or symptoms after the procedure.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The value of chest radiography after chest tube removal in nonventilated trauma patients: a post-hoc analysis of a multicenter prospective cohort study. Sweet, AAR., Kobes, T., Houwert, RM., et al.[2023]

Premature removal of chest tubes in trauma patients can lead to increased complications and higher hospital costs, highlighting the importance of careful timing in chest tube management.

The review discusses critical factors for chest tube removal, including the need for chest radiography and monitoring drainage rates, which are essential for ensuring patient safety and effective treatment.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Tube Thoracostomy (Chest Tube) Removal in Traumatic Patients: What Do We Know? What Can We Do? Paydar, S., Ghahramani, Z., Ghoddusi Johari, H., et al.[2020]

In a study of 100 patients undergoing thoracoscopic lung surgery, early chest tube removal on postoperative day 0 was found to be safe, with no cases of pneumothorax requiring reinsertion and only one readmission for delayed pleural effusion.

Patients who had their chest tubes removed on POD 0 experienced a shorter hospital stay (median of 1 day) and higher compliance with an opioid-free pain management protocol (75%) compared to those who had tubes removed later, indicating potential benefits for recovery.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Early postoperative day 0 chest tube removal using a digital drainage device protocol after thoracoscopic major pulmonary resection. Pfeuty, K., Lenot, B.[2021]

In a study of 1232 patients who underwent cardiac surgery, early removal of chest tubes (around midnight) was linked to a higher risk of developing postoperative pleural and/or pericardial effusions requiring invasive treatment, with a relative risk of 1.70.

Patients who had their chest tubes removed early had a 20% incidence of complications compared to 13% in those who had tubes removed the following morning, suggesting that delaying removal may enhance patient safety.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Early chest tube removal following cardiac surgery is associated with pleural and/or pericardial effusions requiring invasive treatment. Andreasen, JJ., Sørensen, GV., Abrahamsen, ER., et al.[2015]

In a study of 126 patients with stage I lung cancer undergoing uniportal video-assisted thoracic surgery, early removal of the pigtail catheter within 24 hours post-surgery was found to be safe and feasible, with no significant complications requiring tube reinsertion for pneumothorax during the 30-day follow-up.

Patients who had their chest tubes removed within 24 hours experienced significantly less pain on the third postoperative day compared to those who had their tubes removed after 24 hours, suggesting that early removal may enhance recovery comfort.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The short-term outcomes for the early removal of pigtail catheter drainage within 24 hours of uniportal video-assisted anatomic surgery in patients with lung cancer. Zheng, S., Shi, Q., Ma, Q., et al.[2022]

A study involving 70 patients who underwent lobectomies found that early removal of chest tubes (when drainage was less than 300 ml/24 h) is feasible and safe, leading to a shorter chest tube duration (44 hours vs. 67 hours) and reduced hospital stay (5.0 days vs. 6.0 days).

There were no significant differences in complications or pleural effusions between the early removal group and the traditional management group, indicating that early chest tube removal does not increase the risk of postoperative issues.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[Early removal of the chest tube after lobectomies: a prospective randomized control study]. Zhang, Y., Li, H., Hu, B., et al.[2013]

In a study of 178 patients who underwent thoracic esophagectomy, early chest tube removal was found to be as safe as late removal, with no significant differences in postoperative pulmonary complications or the need for thoracocentesis.

Patients who had their chest tubes removed early were able to mobilize significantly faster post-surgery, with 89.8% achieving first mobilization within 15 hours compared to only 52% in the late removal group.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Postoperative pulmonary complications and thoracocentesis associated with early versus late chest tube removal after thoracic esophagectomy with three-field dissection: a propensity score matching analysis. Sato, T., Fujita, T., Okada, N., et al.[2018]

In a study of 93 patients undergoing video-assisted thoracoscopic surgery (VATS), early chest tube removal within 2 hours post-surgery significantly reduced pain intensity and analgesic requirements compared to conventional management.

Early chest tube removal did not lead to any postoperative complications, while complications were observed in patients with conventional management, suggesting that this approach may enhance patient safety and comfort.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[Early chest tube removal after video-assisted thoracoscopic surgery. Results of a prospective randomized study]. Sienel, W., Mueller, J., Eggeling, S., et al.[2022]

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC12093158/

Early versus late chest tube removal after surgery for ... The best available evidence suggests that early chest tube removal may be associated with a slightly higher recurrence rate after surgical pleurodesis for ...

2. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC11170371/

Early chest tube removal within 6 hours after thoracic ... Of the 942 patient charts reviewed, 244 (25.9%) met the criteria for chest tube removal within 6 hours postoperatively. This patient group did ...

3. sciencedirect.com sciencedirect.com/science/article/pii/S1110578X16300189

Influence of timing of chest tube removal on early outcome ... The mean value of FEV1/Liters and FEV1% of predicted also showed statistically significant improvement after chest tube removal. 8 (9%) of patients developed ...

4. jtcvsopen.org jtcvsopen.org/article/S2666-2736(23)00300-5/fulltext

The process and safety of removing chest tubes 4 to 12 ... Chest tubes can be removed within 4 to 12 hours after robotic lobectomy and segmentectomy in up to 90% of patients, with only 2% requiring thoracentesis within ...

5. cdn.amegroups.cn cdn.amegroups.cn/journals/pbpc/files/journals/2/articles/99321/public/99321-PB1-9944-R1.pdf?filename=JTD-24-1802-final.pdf&t=1745658472

Early versus late chest tube removal after surgery for ... Our meta-analysis comprised 6,156 patients with PSP and 10 patients with secondary spontaneous pneumothorax, who underwent bullectomy followed ...

6. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC7049017/

Early removal of chest tubes leads to better short-term ... Some studies have shown that early removal of a chest tube after video-assisted thoracoscopic surgery (VATS) lobectomy is safe and can shorten the length of ...

7. sciencedirect.com sciencedirect.com/science/article/pii/S2666273623003005

The process and safety of removing chest tubes 4 to 12 ... In 2017, Murakami and colleagues showed that early chest tube removal was feasible and safe after thoracoscopic major pulmonary resection. In 2013, Ueda ...

8. jtd.amegroups.org jtd.amegroups.org/article/view/99321/html

Early versus late chest tube removal after surgery for primary ... Recent studies showed that chest tube removal on the same day of surgery is safe with a mean postoperative LOS of one day in patients operated for PSP (9,10).

9. journals.lww.com journals.lww.com/md-journal/fulltext/2023/03240/efficacy_and_safety_of_early_chest_tube_removal.50.aspx

Efficacy and safety of early chest tube removal after... This meta-analysis revealed that it is feasible and safe to remove a chest tube with high-output drainage after pulmonary resection for selected patients.

10. academic.oup.com academic.oup.com/ejcts/article/67/Supplement_1/i27/8099262

How soon should we remove a chest drain following anatomic ... ... safe early drain removal protocol. Outcomes of very early chest drain removal has been reported by McCormack and colleagues with chest drain ...