A Comparative Study Between-Small Bore and Large Bore Tubes for Therapeutic Pleural Drainage

Introduction: Pleural effusions due to various pulmonary and extra pulmonary causes are common clinical problems. Some pleural diseases require therapeutic pleurocentesis to decompress the pleural space like in malignant and benign pleural effusions, pyothorax, chylothorax, pneumothorax, complicated parapneumonic effusion and haemothoraces. Traditionally large bore tubes have been used with trocar or through blunt dissection. Nowadays small-bore catheters are gaining popularity, as they are less painful and believed to be equally efficacious as compared to large bore tubes. Aims & Objectives: To compare the success rate of small bore tubes with standard large bore chest tubes in therapeutic pleural drainage and to compare complications rate between small bore and large bore drains. Place and duration of study: The study was conducted at Department of Pulmonology of FPGMI, Shaikh Zayed Hospital, during one year (2015-2016). Material & Methods: Total 152 patients who required therapeutic evacuation of pleural space suffering from pneumothorax, empyema, parapneumonic and malignant effusion, were enrolled and underwent therapeutic drainage with small bore (< 20 F size) and large bore tubes (> 20 F size), randomized by lottery method. Results: The mean duration of drain placement for large bore drain was 7.9±3.8 days, which was significantly higher than small bore drains with a mean value of 3.0±1.6 days (p-value <0.001). The pain score was also quite high in large bore group with mean value 5.67±1.68 as compared to small bore 1.07±0.81(p-value<0.001). Similarly the mean bleeding during the procedure was significantly higher in large bore group as compared to small bore with mean values 11.9±7.8 and 0.1±0.2 ml respectively (p-value<0.001). The wound infection which is a significant complication was found only in large bore group with 14.5% cases as compared to none in small bore group (p-value 0.001). In large bore group surgery was required for 9(11.8%) cases while in small group there were 2(2.6%) patients referred for surgical intervention. Conclusion: Small bore thoracostomy drains are more effective than large bore tubes, for the treatment of pleural disorders requiring therapeutic drainage and they are associated with minimal pain and other complications.