Thoracostomy tube withdrawal during latter phases of expiration or inspiration: a systematic review and meta-analysis

Eur J Trauma Emerg Surg. 2023 Dec;49(6):2389-2400. doi: 10.1007/s00068-023-02306-9. Epub 2023 Jun 22.


Purpose: In patients with thoracic injuries, tube thoracostomy is routinely employed. There is disagreement over which manner of tube withdrawal is best, the latter phases of expiration or inspiration. Considering several earlier investigations' inconsistent findings, their comparative effectiveness is still up for debate. In light of this, we carried out a systematic analysis of studies contrasting the withdrawal of thoracostomy tubes during the latter stages of expiration versus inspiration for traumatic chest injuries. Analyzed outcomes are recurrent pneumothoraces, reinsertion of the thoracostomy tube, and hospital stay.

Methods: We looked for papers comparing the withdrawal of the thoracostomy tube during the last stages of expiration and inspiration for the management of thoracic injuries on Embase, Pubmed, Cochrane Library and Google Scholar. Review Manager was used to determine mean differences (MD) and risk ratios (RR) using a 95% confidence interval (CI).

Results: The primary outcomes showed no significant difference between the inspiration and expiration groups: recurrent pneumothorax (RR 1.27, 95% CI 0.83-1.93, P 0.28) and thoracostomy tube reinsertion (OR: 1.84, CI 0.50-6.86, P 0.36, I2 5%). However, the duration of hospital stay was significantly lower in patients in whom the thoracostomy tube was removed at the end of inspiration (RR 1.8, 95% CI 1.49-2.11, P < 0.00001, I2 0%). The implications of these findings warrant cautious interpretation, accounting for potential confounding factors and inherent limitations that may shape their significance.

Conclusion: The thoracostomy tube can be removed during both the end-expiratory and end-inspiratory stages of respiration with no appreciable difference. Nevertheless, caution should be exercised when ascertaining the implications of these findings, taking into account the potential limitations and confounding variables that may exert influence upon the outcomes.

Keywords: Chest tube withdrawal; End-expiration; End-inspiration; Thoracic trauma; Thoracostomy tube; Trauma.

Publication types

  • Meta-Analysis
  • Systematic Review
  • Review

MeSH terms

  • Chest Tubes
  • Humans
  • Pneumothorax* / etiology
  • Pneumothorax* / surgery
  • Retrospective Studies
  • Thoracic Injuries* / surgery
  • Thoracostomy
  • Thoracotomy