That is, apparently, the question being asked by the trauma folks at Los Angeles County Hospital. Traditionally, traumatic pneumothorax with accompanying hemothorax is routinely treated by the largest chest tube possible. Theoretically, smaller chest tubes will clog with debris or blood clot, requiring additional thoracostomy tubes or interventions.
However, these authors note several simulations of chest tube drainage indicating tubes as small as 14 French may be adequate. They also hypothesize these larger chest tubes are as painful as tragically possible, and the tradition of large chest tubes results in undue suffering.
The answer...remains unsettled. There was no difference observed in their analysis of chest tubes of maximum size versus smaller-than-maxiumum size. But, a 28-32 Fr chest tube is still a pretty darn large tube. I'm not surprised that pain and drainage characteristics were not different. If they really wanted to push the envelope, they ought to look at the truly small tubes – at least, if their goal is clinically relevant pain reduction.
"Does size matter? A prospective analysis of 28–32 versus 36–40
French chest tube size in trauma"