Management of chest tubes after pulmonary resection: a systematic review and meta-analysis

Background: We performed a systematic review and meta-analysis to determine the effect of suction with water seal, compared with water seal alone, applied to intra pleural chest tubes on the duration of air leaks in patients undergoing pulmonary surgery. Methods: We searched MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials to find randomized controlled trials (RCTs) comparing the effect of the 2 methods on the duration of air leaks. Trials were systematically assessed for eligibility and validity. Data were extracted in duplicate and pooled across studies using a random-effects model. Results: The search yielded 7 RCTs that met the eligibility criteria. No difference was identified between the 2 methods in duration of air leak (weighted mean difference [WMD] 1.15 days, favours water seal; 95% confidence interval [CI]-0.64 to 2.94), time to discharge (WMD 2.19 d, favours water seal; 95% CI-0.63 to 5.01), duration of chest tubes (WMD 0.96 d, favours water seal; 95% CI-0.12 to 2.05) or incidence of prolonged air leaks (absolute risk reduction [ARR] 0.04, favours water seal; 95% CI-0.01 to 0.09). Water seal was associated with a significantly increased incidence of postoperative pneumothorax (ARR-0.14, 95% CI-0.21 to -0.07). Conclusion: No differences were identified in terms of duration of air leak, incidence of prolonged air leak, duration of chest tubes and duration of hospital stay when chest tubes were placed to suction rather than water seal. Chest tube suction appears to be superior to water seal in reducing the incidence of pneumothorax; however, the clinical significance of this finding is unclear.