Does External Pleural Suction Reduce Prolonged Air Leak After Lung Resection? Results From the AirINTrial After 500 Randomized Cases

Leo, Francesco; Duranti, Leonardo; Girelli, Lara; Furia, Simone; Billè, Andrea; Garofalo, Giuseppe; Scanagatta, Paolo; Giovannetti, Riccardo; Pastorino, Ugo

doi:10.1016/j.athoracsur.2013.04.079

Cited by 30 publications

(10 citation statements)

References 12 publications

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Section: Discussionmentioning

confidence: 99%

“…This indicated that the addition of negative suction to simple water seal might aggravate air leak. The association of suction drainage with incidence of PAL is still controversial ( 3 , 22 ), which might attribute to different surgery types, population selection, and PAL definition. Various definitions of PAL have been proposed as lasting postoperative air leak ranged from over 3 to 10 days ( 23 ), while the most widely acknowledged is over 5 days mainly according to the mean postoperative hospital stays nowadays ( 24 ).…”

Section: Discussionmentioning

confidence: 99%

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Suction Versus Nonsuction Drainage After Uniportal Video-Assisted Thoracoscopic Surgery: A Propensity Score-Matched Study

Zhou

Zheng

et al. 2021

Front. Oncol.

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BackgroundUniportal video-assisted thoracoscopic surgery (UniVATS) was utilized with a rapid growth. The evidence is sparse, however, on whether to add external suction to water-seal drainage for chest drainage after UniVATS. This retrospective propensity score-matched study aimed to identify the necessity of adding external suction to chest drainage after UniVATS.MethodsPatients with lung cancer who underwent UniVATS were included from our prospectively maintained database. Patients were divided into two cohorts based on the addition of external suction to postoperative water-seal drainage or not. Propensity score-matched analysis was performed to identify the impact of suction on chest tube duration, incidence of persistent air leak, hospital stay, and hospitalization cost. Multivariable model with interaction terms was constructed to identify impact of covariables on effect of suction.ResultsThe two cohorts matched well on baseline characteristics (nonsuction: 173; suction: 96). Compared with nonsuction group, suction group showed longer median chest tube duration (3 vs. 2 days, p = 0.003), higher incidences of persistent air leak (9.4% vs. 1.2%, p = 0.003), persistent drainage (16.8% vs. 5.8%, p = 0.007), and reduced drainage volume within first 3 postoperative days (386.90 vs. 504.78 ml, p = 0.011). Resection extent was identified to mediate the relationship between suction and chest tube drainage.ConclusionsThese findings discouraged adding external suction to water-seal drainage after UniVATS regarding longer chest tube duration and more persistent air leak. Patients undergoing lobectomy would benefit more from water-seal drainage without external suction compared with those doing sublobectomy.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Suction Versus Nonsuction Drainage After Uniportal Video-Assisted Thoracoscopic Surgery: A Propensity Score-Matched Study

Zhou

Zheng

et al. 2021

Front. Oncol.

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“…Alphonso et al and Brunelli et al described no differences between suction groups and non-suction groups in duration of air leaks in their randomized studies of the patients that underwent pulmonary resection [9,10]. Meanwhile, Leo et al suggested the routine use of external suction reduces the rate of prolonged air leaks after anatomic lung resection [11], Gocyk et al reported in their prospective randomized study that nonsuction drainage is more effective than suction drainage regarding drainage volume, drainage duration, and the rate of prolonged air leak [5]. In recent meta-analysis of randomized controlled trials on the effect of the addition of suction to water-seals on the postoperative outcomes in patients undergoing pulmonary resection, there were no significant differences between the suction and nonsuction groups concerning duration of air leaks, hospitalization, or in occurrence of prolonged air leaks [12].…”

Section: Discussionmentioning

confidence: 99%

Low suction on digital drainage devices promptly improves post-operative air leaks following lung resection operations: a retrospective study

Mitsui

Tauchi

Uchida

et al. 2021

J Cardiothorac Surg

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Background We investigated the most effective suction pressure for preventing or promptly improving postoperative air leaks on digital drainage devices after lung resection. Methods We retrospectively analyzed the postoperative data of 242 patients who were monitored with a digital drainage system after pulmonary resection in our institution between December 2017 and June 2020. We divided the patients into three groups according to the suction pressure used: A (low-pressure suction group: − 5 cm H2O), B (intermediate-pressure group: − 10 cm H2O), and C (high-pressure suction group: − 20 cm H2O). We evaluated the duration of air leaks, timing of chest tube replacement, the amount of postoperative air leak, volume of fluid drained before chest tube removal, and the total number of air leaks during drainage. Results In total, 217 patients were included in this study. The duration of air leaks gradually decreased with significant difference between the groups, the highest decrease in A, the lowest decrease in C (P = 0.019). Timing of chest tube replacement, on the other hand, did not significantly differ between the three groups (P = 0.126). The number of postoperative air leaks just after surgery did not significantly differ between the three groups (P = 0.175), but the number of air leaks on postoperative day 1 were fewest in group A, then B, and greatest in group C (P = 0.033). The maximum amount of air leaks during drainage was lowest in A, then B, and highest in C (P = 0.036). Volume of fluid drained before chest tube removal did not significantly differ between the three groups (P = 0.986). Conclusion Low-pressure suction after pulmonary resection seems to avoid or promptly improve postoperative air leaks in digital drainage devices after lung resection. Trial registration This is a single-institution, retrospective analysis-based study of data from an electronic database. Study protocol was approved by the Akashi Medical Center Institutional Research Ethics Board (approval number: 2020–9).

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“…провели крупное рандомизированное исследование, включившее 500 пациентов, которое показало, что применение активной аспирации достоверно уменьшает риск продленного сброса воздуха, но только в группе анатомических резекций. В группе неанатомических резекций не было выявлено достоверной разницы [12].…”

Section: Discussionunclassified

Influence of suction on prolonged air leak after VATS lobectomies: a prospective randomized study

Maslak

Пищик²,

Obornev³

et al. 2020

Innovacionnaâ medicina Kubani

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Background. Prolonged air leak is the most common postoperative complication following lung resection. Despite the huge number of researches concerning this problem, no consensus exists regarding the choice of the appropriate method of pleural space drainage after thoracoscopic surgery.Objective. To compare suction and water-seal regarding their influence on the incidence of prolonged air leak.Material and Methods. This prospective randomized trial included sixty patients who underwent VATS lobectomies on different diagnoses in the Center for Thoracic Surgery, Clinical Hospital no. 122 (St. Petersburg) from September 2018 until May 2020. The open-label randomized controlled trial involved two groups: control group (water-seal drainage) and suction group. Each group consisted of thirty patients. Ten patients were discharged with a Heimlich valve.Results. The incidence of prolonged air leak was 23%. Patients in the suction group had a higher duration of air leak than those in the control group (5.3 ± 1.3 vs 3.7 ± 0.9 days, р = 0.04). The number of air leak cases was slightly higher in the suction group (8 and 6 patients); however, the difference was not significant (р = 0.57). Both groups had no difference in the number of complications (р = 0.2). There were no cases of reoperation.Discussion. The advantage of water-seal is a lower risk of parenchymal defects. Suction may increase holes in visceral pleura, cause hyperexudation, leading to prolonged duration of drainage. At the same time, the use of suction may decrease residual pleural spaces, match visceral and parietal pleura, which may decrease the duration of air leak. A lot of studies on this issue was performed, however, their results are contradictory.Conclusion. Drainage of pleural space after VATS lobectomies may be safely performed with water-seal. In the case of increasing surgical emphysema or appearance of progressive dyspnea, suction should be applied

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Does External Pleural Suction Reduce Prolonged Air Leak After Lung Resection? Results From the AirINTrial After 500 Randomized Cases

Cited by 30 publications

References 12 publications

Suction Versus Nonsuction Drainage After Uniportal Video-Assisted Thoracoscopic Surgery: A Propensity Score-Matched Study

Suction Versus Nonsuction Drainage After Uniportal Video-Assisted Thoracoscopic Surgery: A Propensity Score-Matched Study

Low suction on digital drainage devices promptly improves post-operative air leaks following lung resection operations: a retrospective study

Influence of suction on prolonged air leak after VATS lobectomies: a prospective randomized study

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