Chest tubes

Chest tube placement is indicated when there's an abnormal accumulation of fluid or air in the pleural space that necessitates drainage and is not resolving with conservative management or is causing significant respiratory or hemodynamic compromise. The specific indications vary depending on the nature of the pleural abnormality.

Pneumothorax

Chest tubes are essential for tension pneumothorax, which requires immediate intervention to prevent hemodynamic collapse. In cases of spontaneous pneumothorax, whether primary or secondary, a chest tube may be indicated if the pneumothorax is large (typically >2 cm rim width on imaging) or if the patient is symptomatic (e.g., significant dyspnea). Observation with supplemental oxygen might suffice for smaller, asymptomatic pneumothoraces.

Pleural Effusion

While small pleural effusions may resolve on their own, larger effusions or those causing respiratory distress necessitate chest tube drainage. Empyema, a pus-filled pleural effusion, also typically requires chest tube drainage alongside antibiotic therapy due to the difficulty in eradicating the infection with conservative measures alone.

Following confirmation of empyema (+leukocyte count, a Gram stain showing bacterial organisms, a glucose concentration <40 mg/dL, or a pH <7.2) by thoracentisis to sample the pleural fluid, a chest tube is placed in order to drain the pus. This is because treatment with abx alone almost always results in failure.

Pleurodesis is when the lung is glued to the chest wall. This is typically done in recurrent malignant pleural effusions or for patients with recurrent pneumothoraces.