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Najib M. Rahman, BMBCh; Robert J. O. Davies, DM
Author and Funding Information

From the Oxford Centre for Respiratory Medicine and Oxford Respiratory Trials Unit, University of Oxford.

Correspondence to: Najib M. Rahman, BMBCh, Oxford Respiratory Trials Unit, Oxford Centre for Respiratory Medicine, Churchill Hospital Site, Oxford Radcliffe Hospital, Old Road, Headington, Oxford OX3 7LJ, England; e-mail: naj_rahman@yahoo.co.uk


Financial/nonfinancial disclosures: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2010 American College of Chest Physicians


Chest. 2010;138(3):760-761. doi:10.1378/chest.10-0967
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To the Editor:

We share the interest and concern of Drs Atchabahian, Laplace, and Tazarourte in the quality of care patients receive with chest tube drainage. We agree that there is a compelling need for randomized trials to accurately define efficacy and safety of different tube sizes and insertion techniques. Until such trials are completed, it is not possible to know with certainty which tube types are in the best interests of patients, and we must rely on nonrandomized data sets. Against this background, our cohort represents the largest comparative study to date and so helps to inform the debate about this important treatment.

Although it seems intuitive that smaller tubes become blocked during the drainage of infected purulent fluid, there is extensive observational (nonrandomized) literature suggesting that this is not the case in practice, particularly with regular flushing.1,2 The lack of therapeutic advantage in our large series3 supports the conclusion that there is no clear disadvantage to smaller bore tubes. Within our study, the rate of malposition or occlusion requiring reinsertion of a second tube is captured within the results and discussed in the article. We continue to believe that our data provide preliminary encouraging evidence that smaller bore tubes may achieve as good a clinical outcome with less pain for patients, and we eagerly anticipate the results of well-designed randomized trials to definitively assess whether this is true.

Gobien RP, Stanley JH, Schabel SI, et al. The effect of drainage tube size on adequacy of percutaneous abscess drainage. Cardiovasc Intervent Radiol. 1985;82:100-102. [CrossRef] [PubMed]
 
Röthlin MA, Schöb O, Klotz H, Candinas D, Largiadèr F. Percutaneous drainage of abdominal abscesses: are large-bore catheters necessary? Eur J Surg. 1998;1646:419-424. [CrossRef] [PubMed]
 
Rahman NM, Maskell NA, Davies CWH, et al. The relationship between chest tube size and clinical outcome in pleural infection. Chest. 2010;1373:536-543. [CrossRef] [PubMed]
 

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References

Gobien RP, Stanley JH, Schabel SI, et al. The effect of drainage tube size on adequacy of percutaneous abscess drainage. Cardiovasc Intervent Radiol. 1985;82:100-102. [CrossRef] [PubMed]
 
Röthlin MA, Schöb O, Klotz H, Candinas D, Largiadèr F. Percutaneous drainage of abdominal abscesses: are large-bore catheters necessary? Eur J Surg. 1998;1646:419-424. [CrossRef] [PubMed]
 
Rahman NM, Maskell NA, Davies CWH, et al. The relationship between chest tube size and clinical outcome in pleural infection. Chest. 2010;1373:536-543. [CrossRef] [PubMed]
 
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