INTRODUCTION: There is an ongoing discussion about whether clamping a chest tube (ChT) before its removal is the ideal way to avoid complications. As a pending research question recently posed by the BTS in a Public Consultation Draft, and as the first prospective study and first randomized controlled trial (RCT) to ever answer this question, this study aimed to compare the incidence of 24-hour post-removal pneumothorax with and without ChT clamping in patients with pleural disease.

METHODS: Adult patients hospitalized in a single centre requiring a ChT because of pleural effusion, pneumothorax or thoracic surgery were block-randomized into two arms: 6 hours clamping vs. not clamping before ChT removal. The primary outcome was the appearance of pneumothorax within the first 24 hours as seen in a chest X-ray.

RESULTS: A total of 93 patients were included, of which 41 patients had ChT clamping (44%) while 52  (56%) had not. ChT insertion diagnosis was pleural effusion in 43 patients (46%), pneumothorax in 35 patients (38%) and surgery in 15 patients (16%). Only 4 patients in each group developed post-removal pneumothorax in the first 24 hours (7.7% vs. 9.8%) with no differences between them (p=0.72) and only 1 patient required ChT reinsertion. No differences were observed in days with a ChT between both groups (p=0.44), nor in the days of hospital stay after its withdrawal (p=0.86). A subgroup analysis according to ChT insertion diagnosis also revealed no differences in post-removal pneumothorax between clamping and non-clamping arms.

CONCLUSION: There were no differences in the incidence of 24-hour post-removal pneumothorax between both techniques in this RCT.