Chest tube removal: End-inspiration or end-expiration?

Background: Recurrent pneumothorax is the mast significant complication aft er discontinuation of thoracostomy tubes. The primary objective of the pres ent study was to determine which method of tube removal, at the end of insp iration or at the end of expiration, is associated with a lesser risk of de veloping a recurrent pneumothorax. A secondary objective was to identify po tential risk factors for developing recurrence. Methods: A. prospective study. of 102 chest tubes in 69 trauma patients (1. 5 tubes per patient! randomly assigned to removal at the end of inspiration (n = 52) or the end of expiration (n = 50). Results: Recurrent pneumothorax or enlargement of a small but stable pneumo thorax was observed after the removal of four chest tubes in the end-inspir ation group (8%) and after discontinuation of three chest tubes (6%) in the end-expiration group (p = 1.0). Of those, only two tubes in the end-inspir ation group and 1 tube in the end-expiration group required repeat closed t horacostomy. Multiple factors were analyzed that did not adversely affect o utcome. These included patient age, Injury Severity Score, Revised Trauma S core, mechanism of injury, hemothorax, thoracotomy, thoracostomy, previous lung disease, chest tube duration, the presence of more than one thoracosto my tube in the same hemithorax, or a small (but stable) pneumothorax at the time of tube removal. Conclusions: Discontinuation of chest tubes at the end of inspiration or at the end of expiration has a similar rate of post-removal pneumothorax. Bot h methods are equally safe.