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Chest Tubes: Indications, Sizing, Placement, and Management

Ritchie, Michael MD; Brown, Craig MD; Bowling, Mark MD

doi: 10.1097/CPM.0000000000000188
Clinical Myths & Evidence-Based Medicine

Despite a significant array of published literature on chest tubes, there are few definitive data, making evidence-based recommendations challenging. In 2010, the British Thoracic Society came up with a definitive set of guidelines on many topics involving chest tubes, but a follow-up on the guidelines showed a <50% compliance with their recommendations. Other issues that come up are the differences between societies. The British Thoracic Society and the American College of Chest Physicians have differences in the definition of small versus large pneumothoraces and the overall management of pneumothoraces. Another possible resistance to conformity is the changing literature with respect to tube size, placement, and indication. The goal of this review is to provide a straightforward layout to educate those new to tube thoracostomy placement and enough nuance to improve the practice of some of those experienced in tube thoracostomy.

Division of Pulmonary and Critical Care Medicine, Brody School of Medicine, East Carolina University, Greenville, NC

Disclosures: M.B. is a compensated speaker for Medtronic. The remaining authors declare that they have no conflicts of interest.

Address correspondence to: Michael Ritchie, MD, East Carolina University Division of Pulmonary and Critical Care Medicine Brody School of Medicine, 600 Moye Blvd Room 3E-149, Greenville, NC 27834. E-mail:

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