Table 1. Clinical scenarios in which to avoid chest tube placement.

Clinical scenarios	Alternate therapy	Potential reasons to place a chest tube
Pleural effusion secondary to congestive heart failure	• Diuresis • Additional medical therapy to treat heart failure	Facilitate weaning off the mechanical ventilator
Hepatic hydrothorax	• Thoracentesis • TIPS • Liver transplantation	Symptomatic, large pleural effusion with immediate plans for TIPS or liver transplantation
Pneumothorax ex vacuo	• Conservative, patients are typically asymptomatic • Allow pleural fluid to reaccumulate and air will be reabsorbed	Enlarging pneumothorax as seen on serial chest radiographs
Trapped lung and pleural effusion	• Conservative • Decortication	Indwelling pleural catheter for palliation with symptomatic malignant effusions associated with trapped lung
Endobronchial obstruction and pleural effusion	• Treat endobronchial tumor • Palliative care
Mediastinal emphysema	• Increase inspired oxygen concentration • Mechanical ventilator changes • Antitussive medications	Decompress a pneumothorax

Abbreviation: TIPS, transjugular intravascular portosystemic shunt.