Pleural Drain Management in a Tertiary Hospital: Gaps between Evidence and Clinical Practice

Abstract

Objective: To characterize local clinical practices in pleural drain management at a tertiary hospital and assess their concordance with contemporary evidence.

Materials and Methods: A descriptive cross-sectional observational study was conducted, including 46 general surgeons and surgical residents from a Chilean tertiary center. Practices related to chest tube size, trocar use, drainage system, management of hemodynamically and respiratory stable laminar traumatic pneumothorax, and chest tube removal strategies were evaluated.

Results: The most frequently reported practices were use of 24 Fr chest tubes (63.1%), insertion without trocar (65.2%), suction drainage followed by transition to water seal (41.3%), and hospitalization for observation in stable laminar traumatic pneumothorax (89.1%). Regarding chest tube removal, removal during expiration was the most frequently selected option (76.1%). Heterogeneity was observed in drainage management and chest tube removal strategies.

Discussion: The findings show variability in institutional pleural drain management and identify areas amenable to standardization. Recent evidence supports less invasive strategies in selected patients; however, part of this evidence was published after the data collection period and should therefore be interpreted as an updated framework rather than as a standard available when participants completed the survey.

Conclusion: Pleural drain management at this center showed relevant variability across different stages of care. Implementing contextualized protocols may help reduce variability and optimize clinical decision-making.