Removal of chest tubes in children without water seal after elective thoracic procedures: A randomized prospective study

BACKGROUND: Chest tubes are often placed in children after elective thoracic surgical procedures. Depending on surgeon preference, tubes can be pulled directly from suction or after a trial of water seal. Removal of the tube without water seal potentially allows earlier removal, decreased postoperative pain, and earlier discharge from the hospital. No randomized, prospective study has been performed to compare the two methods to determine whether omission of the water seal period is safe after elective thoracic surgery in children. STUDY DESIGN: This is a single-blinded, randomized study conducted between June 1998 and June 2000. Children undergoing elective, noncardiac, nonesophageal thoracic operations were placed into water seal or a nonwater seal groups. Groups were compared for development of pneumothorax or pleural effusion after chest tube removal. RESULTS: Fifty-two children participated in the study, with 28 in group I (suction) and 24 in group II (water seal). Operations included both pulmonary and nonpulmonary thoracic operations performed both thoracoscopically and open. No child developed a major pleural effusion after chest tube removal. Three children (11%) in group I and eight (33%) in group II developed pneumothorax. No child required reinsertion of the chest tube and all were successfully treated with observation and oxygen. There was no marked difference between the groups regarding development of pneumothorax, but the power of the study is low. CONCLUSIONS: A water seal trial is not necessary for safe removal of chest tubes in children undergoing elective surgery. Chest tubes can be removed safely and earlier when pulled directly from suction for both pulmonary and nonpulmonary thoracic pediatric procedures.