Purpose of Review <p>Tube thoracostomy indications and management encompass several evolving practices and patient-specific considerations. This review provides an update on select topics relevant to emergency physicians involved in pleural drainage management.</p> Recent Findings <p>Recent studies have introduced updated recommendations for managing pleural drainage in the emergency setting. Alternatives to traditional large-bore chest tubes, such as conservative management and pigtail catheters, have been increasingly explored. The use of prophylactic antibiotics for tube thoracostomy and irrigation for hemothoraces has also been suggested to improve patient outcomes. Special populations including pediatric, pregnant, and anticoagulated patients require tailored approaches to tube thoracostomy placement. Given the growing body of literature, this review highlights key updates to inform clinical practice in the emergency department.</p> Summary <p>This article summarizes emerging evidence and practice considerations in tube thoracostomy management, with a focus on guiding emergency physicians through recent advancements and evolving standards of care for pleural drainage. </p>