Water-seal duration and chest tube removal outcomes after traumatic pneumothorax: a retrospective cohort study

Thoracic trauma may result in pneumothorax or hemothorax requiring chest tube (CT) insertion. CTs can be managed with active suction and/or a water-seal (WS) system, but the optimal WS duration before safe removal remains unclear. We evaluated the association between WS duration and tube thoracostomy failure in traumatic pneumothorax.

We performed a retrospective cohort study of patients who underwent tube thoracostomy for traumatic pneumothorax at an urban Level 1 trauma center from January 2016 to October 2022. Two multivariable logistic regression models were used to assess factors associated with WS outcomes (failure vs. success). The primary model examined the association between WS duration and outcome after a single water-seal (SWS) trial, adjusting for clinical and demographic covariates. The secondary model evaluated total CT duration using the same covariates, excluding time to first suction.

Fifty-four patients underwent tube thoracostomy; 33 (61.1%) had successful CT removal after a SWS course, whereas 21 (38.9%) required repeat suction and/or CT reinsertion after the initial WS trial. WS duration was not significantly associated with failure (p = 0.21). Longer total CT duration was associated with failure, with each additional 12-hour period increasing the odds by 39% (OR = 1.39, 95% CI: 1.09-1.78, p = 0.008).

In this single-center retrospective cohort, WS duration was not significantly associated with thoracostomy failure, though longer total CT duration was.

While WS duration did not demonstrate a relationship with outcome in our cohort, larger prospective studies are needed before duration recommendations can be made.