Single versus double chest tube after anatomical pulmonary resections - randomized trial

Pleural drainage is the standard procedure after different thoracic procedures. The drainage rules used in various centers vary considerably. Although many centers use now single chest tube instead of the classical double-tube system, high-level evidence supporting this approach is scant.

The aim of this trial was to compare effectiveness of single chest tube versus the double-tube system and factors influencing this effectiveness.

A prospective randomized trial including patients treated between 2016 and 2017. The primary endpoint was drainage time and the secondary endpoints were drainage volume and air leak time.

There were 312 patients: 153 finally analyzed in the single-tube group (ST) and 145 patients in the double-tube group (DT). Both groups were comparable regarding patients' characteristics (p = 0.11-0.60). There was no significant difference in drainage time (p = 0.084). Single chest tube was associated with significantly lower drainage volume (1515 ml vs 1998 mL, p = 0.001), mean air leak intensity (26.5 vs 64.2 mL/min, p = 0.005) and mean air leak time (59.9 vs 89.0 hours, p = 0.002). On the multivariate analysis only fused fissure (p = 0.027) was associated with total drainage time. Drainage volume was associated with double-tube (p = 0.039) and VC (p = 0.049), air leak intensity with double-tube (p = 0.032) and BMI (p = 0.048) and air leak time with double-tube (p = 0.008) and BMI (p = 0.043). Complications occurred more often in the DT group (p = 0.04).

in patients who underwent anatomical pulmonary resections single chest tube is associated with lower chest tube output, air leak intensity and air leak time.