Clamping trials prior to thoracostomy tube removal and the need for subsequent invasive pleural drainage

There is little evidence supporting or refuting clamping trials, a period of clamping thoracostomy tubes prior to removal. We sought to evaluate whether clamping trials reduce the need for subsequent pleural drainage procedures. We conducted a retrospective cohort study of trauma patients who underwent tube thoracostomy during 2009–2015. We compared patients who underwent clamping trials to those who did not, adjusting for confounders. The primary outcome was subsequent ipsilateral pleural drainage within 30 days. We evaluated 214 clamping trial and 285 control patients. Only two of 214 patients failed their clamping trial and none developed a tension pneumothorax [0.0% (95% CI 0.0–1.7%)]. Clamping trials were associated with fewer pleural drainage procedures [13 (6%) vs. 33 (12%); adjusted OR 0.41 (95% CI 0.20–0.84)]. A clamping trial prior to thoracostomy tube removal seems to be safe and was associated with less likelihood of a subsequent pleural drainage procedure. •Clamping trials were associated with fewer pleural drainage procedures.•Failure of clamping trials was rare, and no patients developed tension pneumothorax.•Clamping trials were also associated with fewer subsequent radiographic studies. Clamping trials—a brief period of clamping thoracostomy tubes prior to removal—may help reveal occult air leaks, minimizing the risk of needing a subsequent procedure to drain the pleural space. In this retrospective cohort study of patients with traumatic injury, clamping trials were associated with a reduced likelihood of a subsequent ipsilateral pleural drainage procedure within 30 days [adjusted OR 0.41 (95% CI 0.20–0.84)].