Chest Drain Suction

The routine use of suction is not recommended.

Chest drain suction (high volume, low pressure) should be considered when lung re-expansion has not occurred 48 hours after chest drain insertion.

Failure of the lung to re-expand after chest drain insertion is suggestive of an ongoing air leak. Earlier application of suction is not recommended because of concerns over precipitating re-expansion pulmonary oedema, which conveys a significant mortality risk. The lung capillaries become ‘leaky’ following a pneumothorax and application of additional mechanical stresses can result in oedema.

There is often no ongoing air leak in spontaneous pneumothoraces and lower mechanical stresses will be caused by aspiration or thoracostomy tube insertion without suction. Re-expansion pulmonary oedema is more common in patients under 30 years old, those with late presentation of a pneumothorax and those with large pneumothoraces.