Document resource
Introduction and Objectives Recurrence of pneumothorax after intercostal chest drain (ICD) removal is a common complication, associated with the need for additional pleural procedures. In a large retrospective study, ICD clamping was not shown to be associated with a reduced risk of recurrence. 1 There is a need to determine whether ongoing variation in practice exists and whether a prospective study of this topic is feasible.Methods A survey was distributed via UK-based clinical and research networks between May and June 2025. Questions focused on preferred management strategies for two hypothetical clinical scenarios: a primary spontaneous pneumothorax (PSP) and a secondary spontaneous pneumothorax (SSP), both after cessation of air leak. Questions also assessed the use of air leak monitoring devices and clinician interest in participating in a prospective trial.Results 66 responses were received, of which 97% (n=64) were working in respiratory medicine, predominantly consultant physicians (41%, n=27) and specialist registrars (53%, n=35). Significant variation in practice was reported. For the PSP scenario, clinician preference was in favour of direct ICD removal without clamping compared with clamping (56% vs 41%) ( figure 1A). For SSP, the converse was true with a preference for ICD clamping (65% vs 29%) (figure 1B). Use of air leak monitoring devices was inconsistent, with respondents split between using them routinely (17%, n=11), sometimes (33%, n=22), and never (50%, n=33). A majority of clinicians would prioritise reduction in pneumothorax recurrence over a reduced length of stay (92% vs 8%). There was enthusiasm for future research with 86% of respondents (n=57) agreeing a need to develop strategies focused on reducing early recurrence, and 97% (n=64) confirming interest in participating in a prospective trial.Abstract P85 Figure 1Clinician approaches to intercostal chest drain removal. (A, B) Pie charts illustrating the distribution of clinician- reported approaches to ICD removal in (A) primary spontaneous pneumothorax and (B) secondary spontaneous pneumothorax scenarios (n=66)Conclusions Variation in ICD removal practice persists across the UK, with management strategies differing between primary and secondary pneumothorax. This inconsistency in practice and overwhelming support for a future study strongly justify the need for a prospective randomised controlled trial to establish an evidence-based, standardised approach.Reference N Veale, AW Martinelli, D Sethi, et al. S113 The CLAMP project: a National evaluation of intercostal chest drain removal. Thorax 79(Suppl 2):A79–A80.