The clinical effectiveness of suction versus water seal for optimal management of pleural chest tubes in adult patients: A systematic review protocol

Abstract

Review question/objective The objective of this review is to identify and synthesize the best available evidence on effectiveness of suction versus water seal for optimal management of pleural chest tubes in adult patients. The review questions are: Among adult patients with pleural chest tubes, does primarily suction added or water seal reduce time to resolution of any air leak/pneumothorax? Does use of primarily suction added or water seal reduce length of chest tube dwell time? Does one method versus the other result in complications such as a prolonged air leak for seven days or greater or a recurrence of a pneumothorax? Does use of primarily added suction or water seal result in reduced length of hospital stay? Inclusion criteria Types of participants This review will consider studies that included patients 18 years and older with a need to restore negative intrathoracic pressure in the pleural space thus requiring a conventional pleural chest tube insertion. Subjects will be those having had lung surgeries such as a lobectomy or resection. Also, we hope to capture studies of trauma patients who developed a pneumothorax and likely needed a pleural chest tube. Other patients needing a chest tube are anticipated to include individuals who had developed a spontaneous pneumothorax. Patients less than 18 years of age may not require a conventional pleural chest tube insertion and are typically treated with smaller tubes or needle aspiration. Therefore, studies that focused on patients less than 18 years will be excluded from this review. Types of intervention(s) Studies that examined the management of the chest tube and specifically the use of added suction applied to the pleural chest tube versus primarily water seal will be considered for inclusion in the review. Any chest tube that was treated with approximately equal amounts of suction and water seal will be excluded, as will studies that only focused on suction or water seal as a chest tube removal protocol. Any studies that use alternative interventions for a pneumothorax independently or in association with conventional chest tubes such as small bore chest tubes, Heimlich valve, pleuradesis, or needle aspiration are outside the scope of this review and will therefore be excluded. Types of outcomes Studies will be considered if they include one or more of the following outcome measures: Chest tube dwell time, time to resolution of any air leak/pneumothorax, length of hospital stay, and complications with the chest tube intervention such as prolonged air leak or recurrence of a pneumothorax.