[Thoracic drainage. What is evidence based?].

Pleural drainage becomes a vital measure to restore physiological conditions in cases of loss of pleural negative pressure, regardless its etiology. Therefore, it is not surprising that hardly any evidence based publications on this topic are available. For the treatment of pleural empyema,the history of pleural drainage goes back to antiquity.Nowadays, quite a number of synonymously used terms are wrongly employed instead of the correct terms of thoracic or pleural drainage. Indications for placing a pleural drainage are: pneumothorax, pleural effusion, pleural empyema,hemothorax and chylothorax. As a standard method, it is recommended that the pleural drainage be placed in the fifth or sixth intercostal space in the anterior axillary line. It is not advisable to use a closed insertion with the help of a trocar due to the significantly increased risk of injury. The insertion of a pleural drainage when correctly placed is a safe procedure; rare typical complications involve the wrong placement of the drainage, hemorrhage or infection like pleural empyema. The complication rate, however, does not exceed 3%.