Treatment most importantly targets the underlying condition. For example, the inflammatory pleural effusions of SLE may be treated with systemic corticosteroids or other anti-inflammatory agents. Antibiotics treat pneumonia and para-pneumonic effusions, although purulent fluid or abscess in the pleural space can require chest tube drainage in addition to antibiotics.

Other indications for chest tube placement include pneumothorax compromising ventilation, exceeding 25%, or recurring after initial needle thoracostomy. Trauma with hemorrhage into the pleural space can also require a chest tube, or even open-chest surgery to identify and treat the source of bleeding. Some pleural effusions may be treated with therapeutic pleural tap rather than chest tube. In these cases, up to 1 L of fluid may be drained through a pleural needle and catheter. For these therapeutic taps, attaching the thoracostomy needle to a tube and vacuum bottle may be more efficient and cause less risk of bleeding or pleural injury from movement of the needle during the procedure than the traditional technique of using a large syringe and stopcock to remove 30 to 50 mL at a time. Rapid drainage of large pleural effusions or pneumothorax can result in reexpansion pulmonary edema.

Patients with recurrent pneumothorax may require surgery to repair a specific defect. Patients with malignant pleural effusion that has recurred after complete reexpansion may benefit from pleural sclerosis, instilling agents such as bleomycin or tetracycline. Pleural stripping is rarely used because of the high rate of complications.

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