An initial experience with a digital drainage system during the postoperative period of pediatric thoracic surgery

Abstract

Objective:To report an initial experience with a digital drainage system during the postoperative period of pediatric thoracic surgery. Methods:This was a prospective observational study involving consecutive patients, ≤ 14 years of age, treated at a pediatric thoracic surgery outpatient clinic, for whom pulmonary resection (lobectomy or segmentectomy via muscle-sparing thoracotomy) was indicated. The parameters evaluated were air leak (as quantified with the digital system), biosafety, duration of drainage, length of hospital stay, and complications. The digital system was used in 11 children (mean age, 5.9 ± 3.3 years). The mean length of hospital stay was 4.9 ± 2.6 days, the mean duration of drainage was 2.5 ± 0.7 days, and the mean drainage volume was 270.4 ± 166.7 mL. The mean maximum air leak flow was 92.78 ± 95.83 mL/min (range, 18-338 mL/min). Two patients developed postoperative complications (atelectasis and pneumonia, respectively). The use of this digital system facilitated the decision-making process during the postoperative period, reducing the risk of errors in the interpretation and management of air leaks.

Thopaz+ Portable Digital System for Managing Chest Drains: A NICE Medical Technology Guidance

“…Of the 13 included studies, there were six RCTs [ 7 , 12 , 14 – 16 , 18 ], three observational comparative studies that used propensity matching for their analysis [ 20 – 22 ], three observational studies with no comparative element [ 9 , 13 , 17 ] and one prospective comparative study [ 19 ]. The comparators in almost all of the RCTs and comparative observational studies were traditional analogue chest drainage systems that used wall-mounted suction.…”

“…Cedar did not find comparative evidence on the use of Thopaz for fluid loss measurement, an outcome in the scope. One identified paper looked at the use of Thopaz in a paediatric cohort [ 13 ]. Although non-comparative, this study was included to provide evidence for use in children in line with the sub-groups defined in the scope.…”

“…Of the complications, pulmonary complications were the most common (Digital: 32%, Analogue, 40%; p = 0.01) Pompili et al (2011) [ 21 ] Comparative with propensity matched controls Single-centre (Italy) Thopaz (Electronic, n = 51), traditional suction drainage (traditional, n = 51) Pulmonary lobectomy Mean days: Electronic: 2.5, Traditional: 4.4; p < 0.0001 Mean days: Electronic: 4.5, Traditional 6; p = 0.0003 No drain reinsertions required in either group No complications observed in either group Shoji et al (2016) [ 22 ] Comparative study with propensity matched controls Single-centre (Japan) Thopaz ( n = 86), Analogue chest drainage system (ACS, n = 86) Pulmonary lobectomy Mean days (range): Thopaz: 2.7 (1–9), ACS: 3.7 (1–20); p = 0.031 Not a study outcome Thopaz: 0, ACS: 2, p = 0.094 Not a study outcome Mier et al (2010) [ 19 ] Prospective, non-randomised, comparative study Single-centre (Spain) Thopaz (Group A, n = 26), DigiVent (Group B, n = 24), Pleur-Evac (Group C, n = 25) Pulmonary resection Mean days (SD): Group A: 2.4 (± 1.0), Group B: 3.3 (± 1.0) Group C: 4.5 (± 3.6). A vs B, p = 0.01; A vs C, p < 0.001; B vs C, p = 0.47 Not a study outcome Not a study outcome Not a study outcome Linder et al 2012 [ 17 ] Non-comparative case series Multicentre (4 centres in Germany) Thopaz ( n = 80) Pulmonary resection Mean days (SD): 4.9 (± 2.8); p = 0.0348 across all centres Highest mean duration (SD): 5.5 (± 3.2) Lowest mean duration (SD): 3.6 (± 1.9) Mean days (SD): 7.7 (± 3.7); p = 0.379 across all centres Highest mean length of stay, days(SD): 10.8 (± 3.1) Lowest mean length of stay, days (SD): 7.2 (± 3.1) Not a study outcome Not a study outcome Costa Jr et al (2016) [ 13 ] Prospective, non-compar...…”