Key Points

• Thoracic surgeons must be familiar with insertion of both pigtail catheters using the Seldinger technique under ultrasound guidance and traditional large bore chest tubes.
• Multiple randomized controlled trials and meta-analyses have produced contradictory results regarding the use of applied external suction to chest drains after pulmonary resections.
• Digital drain technology holds promise in leading to a deeper understanding of pleural space mechanics after pulmonary resection and for the refinement of evidence-based practice in chest tube management.
• The liquid drainage threshold for removal of a chest drain should take into account body weight and whole-body lymphatic flow to establish a patient-specific threshold.
• There are several recognized factors and models that can identify patients at higher risk of prolonged air leak after pulmonary resection.
• Patients with a prolonged air leak can be safely managed in the outpatient setting.