Comparative effectiveness of suction versus water seal following tube thoracostomy in traumatic pneumothorax and hemothorax: An updated systematic review and meta-analysis.

Shaban A, Zaki HA, Ponappan B, Malik WA, Shaban EE, Shaban A, Abosamak MF.

Systematic ReviewAbstract only — full text under license

AI summary — for doctors, generated from the abstract only

In five small, high-risk-of-bias RCTs, suction after tube thoracostomy for traumatic pneumothorax or hemothorax shortened chest tube duration by about 3 days and hospital stay by about 4 days versus water seal.

What was studied

An updated systematic review and meta-analysis (to May 2026) of 5 RCTs (404 patients) comparing suction with water seal after tube thoracostomy in chest trauma.

Key findings

Chest tube duration MD -2.95 days (95% CI -4.58 to -1.31).
Hospital LOS MD -3.98 days (95% CI -5.70 to -2.27).
Improved lung expansion with suction; specific statistic not fully captured in the abstract.

Clinical relevance

This suggests suction may shorten chest tube and hospital duration after traumatic tube thoracostomy, but all trials were unblinded and at high risk of bias, so the evidence is weak.

Who should care

Emergency Medicine

Limitations

Few small trials, all at high risk of bias due to lack of blinding affecting subjective outcomes like tube removal and discharge.

Suction after a trauma chest tube may get it out sooner, but the trials behind this are weak.

This is an AI-generated summary of the published abstract, not a clinical recommendation. It may not reflect the full text or subsequent updates — verify against the original source before acting on it.

Abstract

Background

Tube thoracostomy is commonly used in patients with chest trauma. However, optimal management after chest tube insertion remains controversial, particularly regarding the use of suction versus water seal systems. This updated meta-analysis evaluated the comparative effectiveness of suction and water seal management in traumatic pneumothorax and hemothorax patients.

Methods

A systematic search of PubMed, Embase, Web of Science, and Cochrane CENTRAL databases was performed from database inception to May 2026. Randomized controlled trials comparing suction with water seal after tube thoracostomy were included. Risk of bias was assessed using the Cochrane RoB-2 tool, while certainty of evidence was evaluated using the GRADE approach. Clinical significance was determined using minimal clinically important difference (MCID) thresholds based on Cohen's d.

Results

Five randomized controlled trials involving 404 patients were analyzed. Suction significantly reduced chest tube duration (MD: -2.95 days; 95% CI: -4.58 to -1.31; p = 0.0004) and hospital length of stay (MD: -3.98 days; 95% CI: -5.70 to -2.27; p < 0.00001) compared with water seal management. Suction also improved rates of full lung expansion (OR: 4.86; 95% CI: 1.70-13.88; p = 0.003). MCID analysis demonstrated clinically meaningful benefits for hospital stay, chest tube duration, and lung expansion. No significant differences were found in recurrent pneumothorax, re-intervention rates, or retained/clotted hemothorax between groups; however, these findings remain inconclusive due to the small number of studies, which may have lowered the statistical power to detect any meaningful differences.

Conclusion

Suction appears to improve hospital stay, chest tube duration, and lung expansion following tube thoracostomy in traumatic chest injuries. However, these findings should be interpreted cautiously as all the included trials were at high risk of bias, primarily due to the lack of clinicians, participants, and outcome assessors blinding, which may have influenced subjective outcomes such as chest tube removal and hospital discharge. Therefore, well-designed randomized trials are required to strengthen the certainty of evidence.

DOI

10.1016/j.ajem.2026.07.055

PMID

42537523

Research metadata (titles, abstracts, authors, publication dates) is sourced from Europe PMC, which aggregates content from PubMed/MEDLINE, PubMed Central, and other providers under the U.S. National Library of Medicine (NLM/NCBI). NLM does not claim copyright on abstracts; the original journal publishers or authors may hold rights to the full articles. AI-generated summaries are derived only from the abstract, never the full text, and are always labeled as AI-generated.

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