This systematic review and meta-analysis compared suction versus water seal management after tube thoracostomy in adults with traumatic pneumothorax or hemothorax, pooling 5 RCTs (n=404) identified from inception to May 2026.
Suction significantly reduced chest tube duration (MD: −2.95 days; 95% CI: −4.58 to −1.31) and hospital length of stay (MD: −3.98 days; 95% CI: −5.70 to −2.27), and improved full lung expansion rates (OR: 4.86; 95% CI: 1.70–13.88); no significant differences in recurrent pneumothorax, re-intervention, or retained hemothorax were detected.
All 5 included trials were rated high risk of bias, primarily due to inability to blind clinicians, participants, and outcome assessors — which may have directly influenced subjective endpoints like chest tube removal timing and discharge decisions. The small number of studies (and total patients) likely underpowered comparisons for complications such as recurrent pneumothorax and retained hemothorax.
Suction after chest tube insertion for traumatic pneumothorax or hemothorax may meaningfully shorten tube duration and hospital stay, but clinicians should weigh this against a uniformly high-bias evidence base before changing practice. Larger, well-blinded RCTs are needed before firm recommendations can be made.
