Every year, around 3,000 young people in the UK are admitted to hospital with a collapsed lung, where a spontaneous hole leaks air into the chest cavity, and doctors disagree on whether applying suction to the chest drain helps or harms recovery. Current guidelines leave the use of suction—negative pressure applied through the drain—to individual clinical judgment. Some evidence suggests suction re-expands the lung faster, but it may also delay healing by keeping air flowing through the hole, or even damage lung tissue. This uncertainty means treatment varies wildly between hospitals, and patients typically spend 4–8 days in hospital with a drain in place. This trial will randomise 450 patients across 36 hospitals in England, Scotland, and Wales to receive either immediate suction or standard care (no suction). The primary measure is total treatment time—how long the drain stays in. Secondary outcomes include hospital stay length, pain, breathlessness, complication rates, and cost-effectiveness. If suction proves safe and effective, it could shorten hospital stays, reduce bed occupancy, and standardise care nationally. If it does not, the trial will provide evidence to stop an unnecessary, potentially harmful practice. The results will feed directly into international treatment guidelines.
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Research Question Is early use of thoracic suction superior to standard care (no suction) in patients with Primary Spontaneous Pneumothorax (PSP) requiring treatment, by reducing the duration of treatment and without excess adverse effects? Our rationale is that suction may achieve this by: 1) More quickly re-expand the lung (reducing the size of pneumothorax) by providing negative pressure in the pleural space. 2) Earlier cessation of air leak by creating apposition of the lung to the chest wall, which aids healing. Background Primary spontaneous Pneumothorax (PSP) typically affects young patients and is caused by a spontaneous hole occurring in the lung, thus leaking air into the pleural space. Contemporary guidelines focus on treating the pneumothorax either with short-term drainage (needle aspiration) or intercostal chest drain (ICD), which typically requires admission, resulting in 3,000 admissions/year in the UK. Once admitted to hospital with a chest drain, median hospital stay is 4-8 days, and management remains contentious. Suction, which is the application of negative pressure to the pleural space via the chest drain, is sometimes used to expand the lung more quickly. However, suction is not without risk; it may precipitate injury to the lung or delay healing by maintaining flow through the hole in the lung. The use of suction in PSP is thus controversial, highly variable, and inconsistent in current practice and has potential risks and benefits. We therefore propose a definitive study to evaluate whether early suction in admitted patients with PSP is safe and effective for outcomes important to patients and the NHS. Aims and objectives Aim: To evaluate whether use of early suction can reduce treatment duration for patients with PSP compared to usual care (no suction). Objectives: 1) To test whether use of suction is superior to usual care with respect to total treatment time (time with a drain in the thorax including post-surgery) 2) To estimate the difference between groups with respect to a range of patient-reported and clinical secondary outcomes up to 6 months 3) To estimate the cost-effectiveness of suction compared to standard management 4) To determine the risk profile of suction use compared with standard care Methods A multicentre, parallel, individually randomised controlled superiority trial in 36 hospitals in England, Scotland and Wales. 450 adult patients with PSP managed in hospital with chest drainage will be randomised between immediate use of suction (intervention) or usual care (control). The primary outcome measure is total treatment time. Secondary outcomes will assess length of hospitalisation, pain and breathless scores, patient-related health status, complications, in patient surgical rates, overall number of pleural procedures, recurrence rates, healthcare utilisation & costs, and cost-effectiveness. Timeline 48-month project: Set-up (6 months); pilot recruitment (12 months); further recruitment (23 months); follow-up (minimum 1 month follow-up), study close-down analysis and reporting (6 months). Anticipated impact and dissemination Findings from this trial will have a substantial impact on the current in-patient management of PSP by determining the role of suction and will be incorporated into international guidelines. Results will be submitted to major international meetings, for publication in a high impact medical journal and on social media platform
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