title: When should a chest radiograph be obtained after chest tube removal in mechanically ventilated patients? A prospective study.
abstract: BACKGROUND
  The purpose of this study was to determine the appropriate time interval between the removal of a chest tube and the chest radiograph (CXR). We hypothesized that a CXR obtained 1 hour after chest tube removal would exclude the presence of a recurrent pneumothorax.
  
  
  METHODS
  Of 214 trauma intensive care unit patients with a chest tube during a 1-year period, 75 met entry criteria and underwent chest tube removal according to an institutional review board-approved prospective study protocol. Patients were undergoing positive-pressure ventilation, with an existing solitary chest tube, and had less than 150 mL of drainage on water seal over the previous day. After chest tube removal, serial CXRs were obtained at approximately 1, 10, and 36 hours. Demographic, chest tube, and ventilator data were collected.
  
  
  RESULTS
  None of the patients experienced hemodynamic or respiratory deterioration after chest tube removal. There were nine pneumothoraces (12%). All pneumothoraces were present on the initial CXR after chest tube removal. Two patients (3%) required intervention for pneumothorax. Of the remaining seven small pneumothoraces, three resolved and four were unchanged on the third CXR.
  
  
  CONCLUSIONS
  A CXR obtained within 1 to 3 hours after chest tube removal effectively identifies pneumothorax in mechanically ventilated patients.
authors.affiliation: DeWitt Daughtry Family Department of Surgery, University of Miami School of Medicine, Florida 33101, USA.
authors.forename: Louis R
authors.initials: LR
authors.lastname: Pizano
authors.forename: Douglas E
authors.initials: DE
authors.lastname: Houghton
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Cohn
authors.forename: Mark S
authors.initials: MS
authors.lastname: Frisch
authors.forename: Ramon H
authors.initials: RH
authors.lastname: Grogan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D015505:Chest Tubes; D015331:Cohort Studies; D003422:Critical Care; D020878:Device Removal / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011030:Pneumothorax / Q000000981:diagnostic imaging* / Q000628:therapy; D011336:Probability; D011446:Prospective Studies; D013902:Radiography, Thoracic / Q000379:methods*; D012121:Respiration, Artificial / Q000379:methods; D012307:Risk Factors; D055502:Secondary Prevention; D012680:Sensitivity and Specificity; D013898:Thoracic Injuries / Q000000981:diagnostic imaging* / Q000628:therapy; D013997:Time Factors; D014193:Trauma Centers; D016896:Treatment Outcome