Background: Small-bore chest drains are now the most common drains for treating pleural effusion (PE), but knowledge on complications is limited especially in malignant PE and empyema. We aimed to evaluate rate of complications of ultrasound guided small bore chest drains [6-10 French (F)] by PE etiology.
Methods: Retrospective cohort study of 484 chest drains inserted in 330 adults in a Swedish department 2018-2020. Rate of complications (blockage, dislocation, infection, or misplacement) and repeat intervention (new drain within 2 weeks or surgery) was analyzed by effusion type (organ failure, parapneumonic, malignant, empyema, other, unknown), age, sex, seniority of radiologist, and bore size using multivariable logistic regression.
Results: Most inserted drains (73.3%) were 6 F. The rate of repeat intervention was substantially higher in malignant PE [25.5%; adjusted odds ratio (aOR) 3.3; 95% confidence interval (CI): 1.6-6.8] and empyema (56.4%; aOR 11.9; 95% CI: 4.8-29.4) compared to other aetiologies (range, 9.5-17.8%). Surgery as complication occurred in empyema in 23.0% of cases (aOR 10.6; 95% CI: 1.4-79.4). The rate of repeat intervention in simple PE (parapneumonic or due to organ failure) was low (range, 9.5-12.5%).
Conclusions: A single small-bore chest drain (6-10 F) was successful in the vast majority of simple PEs, but had high complication rates in empyema with frequent need of additional drains or surgery. These findings support use of larger drains and early consultation with a thoracic surgeon in empyema.
Keywords: Pleural effusion (PE); haemothorax; hydrothorax; malignant pleural effusions (malignant PEs); pleural empyema.
2024 Journal of Thoracic Disease. All rights reserved.