Chest drain size: Does it matter?

Abstract

Pleural disease is common with an increasing incidence and so represents a significant proportion ofthe workload for respiratory physicians. Chest drain insertion continues to be considered a mainstay ofpleural disease management however the optimum drain size required for various pleural conditionsremains unclear. Traditionally large‑bore chest drains were inserted through a surgical techniqueof blunt dissection however smaller bore Seldinger (guidewire) drains have dramatically increasedin popularity in recent times most likely due to ease of insertion and perceived increased patienttolerability. Despite British Thoracic Society Guidelines advocating a preference for small‑bore chestdrains, their use remains controversial. We aim to review the literature in each category of pleuraldisease including pneumothorax, malignant pleural effusion and pleural infection, regarding chestdrain size, comparing the role, effectiveness and complications of each.