RecentRCT

SEAL IT

Suction vs Water Seal for Initial Treatment of Traumatic Pneumothorax Trial (SEAL IT): A Pragmatic Cluster-Randomized Study.

J Am Coll Surg, 2026 · Single-center pragmatic, alternating-month cluster allocation

Population: 72 selected adult trauma patients; excluded hemothorax >300 mL and tubes placed before CT
Intervention: Initial water seal
Comparator: Initial suction
Primary outcome: Initial chest tube duration
Result: Median 41 versus 51 hours favoring water seal; four deaths excluded from the primary analysis.

What the trial found

Median 41 versus 51 hours favoring water seal; four deaths excluded from the primary analysis.

Clinical interpretation

Small, unblinded study with post-allocation clinician discretion; no reliable proof of equivalent complications or mortality. Do not generalize to unstable patients or large hemothorax.

Limitations

Alternating calendar-month allocation, small sample and exclusion of deaths limit causal certainty.

Low certainty

Clinical Context & Relevant Topics (1)

Disease Reference

Pneumothorax & Barotrauma in Critical Care

Tension physiology, point-of-care ultrasound diagnosis, needle/finger/tube thoracostomy, and management of bronchopleural fistulas on mechanical ventilation.

View Topic Context →