Emergency conditions

• Pneumothorax
• In all patients on mechanical ventilation
• When pneumothorax is large
• In a clinically unstable patient
• For tension pneumothorax after needle decompression
• When pneumothorax is recurrent or persistent
• Esophageal rupture with gastric leak into pleural space
• When pneumothorax is secondary to chest trauma
• When pneumothorax is iatrogenic, if large and clinically significant

Non-Emergency conditions

• Malignant pleural effusion
• Treatment with sclerosing agents or pleurodesis
• Recurrent pleural effusion
• Parapneumonic effusion or empyema
• Chylothorax
• Postoperative care (e.g., after coronary bypass, thoracotomy, or lobectomy)

• The need for emergent thoracotomy is an absolute contraindication to tube thoracotomy.
• Coagulopathy
• Pulmonary bullae
• Pulmonary, pleural, or thoracic adhesions
• Skin infection over the chest tube insertion site
• Loculated pleural effusion or empyema

• Bleeding and hemothorax due to intercostal artery perforation
• Perforation of visceral organs (lung, heart, diaphragm, or intraabdominal organs)
• Perforation of major vascular structures such as the aorta or subclavian vessels
• Intercostal neuralgia due to trauma of neurovascular bundles
• Subcutaneous emphysema
• Reexpansion pulmonary edema
• Infection of the drainage site, pneumonia, and empyema.
• There may be technical problems such as intermittent tube blockage from clotted blood, pus, lines for the insertion of a chest drain or debris, or incorrect positioning of the tube, which causes ineffective drainage.