Digital versus analogue chest drainage system in patients with primary spontaneous pneumothorax: a randomized controlled trial

Abstract

Background: Patients with a primary spontaneous pneumothorax (PSP) who are treated with chest tube drainage are traditionally connected to an analogue chest drainage system, containing a water seal and using a visual method of monitoring air leakage. Electronic systems with continuous digital monitoring of air leakage provide better insight into actual air leakage and changes in leakage over time, which may lead to a shorter length of hospital stay. Methods: We performed a randomized controlled trial comparing the digital with analogue system, with the aim of demonstrating that use of a digital drainage system in PSP leads to a shorter hospital stay. Results: In 102 patients enrolled with PSP we found no differences in total duration of chest tube drainage and hospital stay between the groups. However, in a post-hoc analysis, excluding 19 patients needing surgery due to prolonged air leakage, hospital stay was significantly shorter in the digital group (median 1 days, IQR 1-5 days) compared to the analogue group (median 3 days, IQR 2-5 days) (p 0.014). Treatment failure occurred in 3 patients in both groups; the rate of recurrence within 12 weeks was not significantly different between groups (16% in the digital group versus 8% in the analogue group, p 0.339). Conclusion: Length of hospital stay was not shorter in patients with PSP when applying a digital drainage system compared to an analogue drainage system. However, in the large subgroup of uncomplicated PSP, a significant reduction in duration of drainage and hospital stay was demonstrated with digital drainage. These findings suggest that digital drainage may be a practical alternative to manual aspiration in the management of PSP.

Combination of transbronchoscopic oxygen insufflation and a digital chest drainage system in endobronchial occlusion: a hybrid technique for localization of fistula in intractable pneumothorax

“…After thoracic drainage, a chest X-ray showed a mild pneumothorax cavity (arrowhead) (b), while chest computed tomography revealed collapse of the right middle and lower lobes against a background of ground-glass opacities and honeycombing in both lungs (c) insufflation, can be a more effective technique for locating fistulas. A DCDS can also graph the AAL over time and has been reported to facilitate the early removal of drainage tubes in cases of pneumothorax or videoassisted thoracoscopic lobectomy [9,10]. The application of DCDS immediately after chest drainage in patients with risk factors for persistent air leaks, such as interstitial lung disease, chronic obstructive pulmonary disease, or low body mass index, may enable early prediction of the development of intractable pneumothorax.…”

Benefits of using digital thoracic drainage systems for post-operative treatment in pediatric populations: personal experience and review of literature

“…The problem of low sensitivity and extreme interindividual variability resulting from this method has led to the need to develop more sophisticated digital systems that can ensure the maintenance of a regulated negative pressure, provide an objective and systematic assessment of air leaks, and standardize the timing of drainage removal (6)(7)(8)(9). The use of the latest digital drainage systems has already proven effective in postoperative chest surgery in adults (Table 4) (10-13); the National Institute for Health and Care Excellence (NICE), an independent British organization dedicated to promoting national and international guidelines for good clinical practice, recommends the adoption of Thopaz+ for the management of chest drainages in patients undergoing lung resection (14)(15)(16)(17)(18) and pneumothorax (19)(20)(21)(22). The NICE recommendations are based on evidence from studies, clinical experts, and local public and private authorities and are the result of rigorous, objective, and independent assessments.…”

The contemporary management of spontaneous pneumothorax in adults

“…The traditional underwater seal provides crude measurement by the rate of bubbles being produced, but more accurate measurement of the size of the air leak can be achieved by newer digital devices. Evidence from surgical patients suggests that these can reduce the length of hospital stay in patients presenting with post-surgical air leak, but there is currently limited evidence supporting their use in spontaneous pneumothorax [ 29 , 30 ].…”