The Clinical Effectiveness of Suction Versus Water Seal for Optimal Management of Pleural Chest Tubes in Adult Patients: A Systematic Review

Abstract

The objective of this comprehensive systematic review was to identify and synthesize the best available evidence on effectiveness of suction versus water seal for optimal management of pleural chest tubes in adult patients. A thorough literature search across fifteen databases was conducted to identify relevant articles. Twenty-three articles were appraised for methodological quality with five studies being included in the final meta-analysis. This analysis indicated use of water seal alone decreases: duration of air leak by 1.16 days (p=0.20), chest tube dwell time by 1.24 days (p=0.001), and length of hospital stay by 2.45 days (p=0.04). Water seal alone also decreases the incidence of prolonged air leak greater than seven days (p=0.90) and incidence of complications (p=0.07). The results of this systematic review and meta-analysis demonstrate that the use of suction is an unnecessary intervention. Water seal alone provides for optimal management of a pleural chest tube in adult patients. Use of water seal alone is less nursing time intensive and appears to be more cost-effective as a shorter duration of air leak and chest tube dwell time shortens the length of hospital stay- all of which would lower expenditures.