Postoperative chest tube management: measuring air leak using an electronic device decreases variability in the clinical practice☆☆☆

Varela, Gonzálo; Jiménez, Marcelo F.; Novoa, Nuria; Aranda, José Luis

doi:10.1016/j.ejcts.2008.09.005

Cited by 126 publications

(91 citation statements)

References 15 publications

(13 reference statements)

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“…Previously published reports have demonstrated that digital drainage systems are superior in reducing the incidence of post-operative prolonged air leak (12)(13)(14). Several articles describe the advantage of a digital system in eliminating the inter-observer differences related to air leak grading, as the system quantifies the precise amount of air leak (13)(14)(15). Moreover, the effect of continuous vs. intermittent suction on postoperative air leak may also account for differences in air leak duration.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Does the usage of digital chest drainage systems reduce pleural inflammation and volume of pleural effusion following oncologic pulmonary resection?—A prospective randomized trial

Waele¹,

Agzarian²,

Hanna³

et al. 2017

J. Thorac. Dis.

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Background: Prolonged air leak and high-volume pleural drainage are the most common causes for delays in chest tube removal following lung resection. While digital pleural drainage systems have been successfully used in the management of post-operative air leak, their effect on pleural drainage and inflammation has not been studied before. We hypothesized that digital drainage systems (as compared to traditional analog continuous suction), using intermittent balanced suction, are associated with decreased pleural inflammation and postoperative drainage volumes, thus leading to earlier chest tube removal. Methods: One hundred and three [103] patients were enrolled and randomized to either analog (n=50) or digital (n=53) drainage systems following oncologic lung resection. Chest tubes were removed according to standardized, pre-defined protocol. Inflammatory mediators [interleukin-1B (IL-1B), 6, 8, tumour necrosis factor-alpha (TNF-α)] in pleural fluid and serum were measured and analysed. The primary outcome of interest was the difference in total volume of postoperative fluid drainage. Secondary outcome measures included duration of chest tube in-situ, prolonged air-leak incidence, length of hospital stay and the correlation between pleural effusion formation, degree of inflammation and type of drainage system used.Results: There was no significant difference in total amount of fluid drained or length of hospital stay between the two groups. A trend for shorter chest tube duration was found with the digital system when compared to the analog (P=0.055). Comparison of inflammatory mediator levels revealed no significant differences between digital and analog drainage systems. The incidence of prolonged post-operative air leak was significantly higher when using the analog system (9 versus 2 patients; P=0.025). Lobectomy was associated with longer chest tube duration (P=0.001) and increased fluid drainage when compared to sublobar resection (P<0.001), regardless of drainage system. Conclusions: Use of post-lung resection digital drainage does not appear to decrease pleural fluid formation, but is associated with decreased prolonged air leaks. Total pleural effusion volumes did not differ with the type of drainage system used. These findings support previously established benefits of the digital system in decreasing prolonged air leaks, but the advantages do not appear to extend to decreased pleural fluid formation.

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Section: Discussionmentioning

confidence: 99%

“…To date, drainage systems have only been compared with relation to postoperative air leak (11)(12)(13)(14)(15). Whilst this is an important aspect of the decision to remove chest tubes, the volume of fluid extracted is another major determinant, that continues to garner increased attention amongst research circles (2,(16)(17)(18).…”

Section: Discussionmentioning

confidence: 99%

Does the usage of digital chest drainage systems reduce pleural inflammation and volume of pleural effusion following oncologic pulmonary resection?—A prospective randomized trial

Waele¹,

Agzarian²,

Hanna³

et al. 2017

J. Thorac. Dis.

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“…An initial survey of patients and nurses on the use of the portable device has already produced preliminary confirmation that chest drain handling and patient mobility are improved compared to conventional water seal systems . Perhaps more importantly, it has also been shown that use of the digital air flow monitor on a digital system such as the Thopaz can accurately and objectively measure post-operative air leaks after lung surgery (Varela et al, 2009). A study from Hong Kong has already demonstrated that the greater consistency in monitoring air leaks can be translated into more decisive, confident post-operative chest drain management resulting in shortened chest drain durations and lengths of hospital stay (Yeung & Sihoe, 2010).…”

Section: Future Directionsmentioning

confidence: 99%

The Evolution of VATS Lobectomy

Sihoe¹

2012

Topics in Thoracic Surgery

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“…It objectifies much of the subjective information and can be replicated among several observers (9). The level of agreement significantly increased in nurses, surgeons and residents (11,(13)(14)(15). This system enables the health care team, regardless of their experience or level of education, to accurately report the status a patient's air leak (9,14).…”

Section: Interobserver Variabilitymentioning

confidence: 99%

Chest drainage systems and management of air leaks after a pulmonary resection

Baringer¹,

Talbert²

2017

J. Thorac. Dis.

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Air leaks after a pulmonary resection continue to be the most common postoperative complication. The presence of an air leak occurs in approximately 30-50% of patients immediately after surgery. Prolonged air leaks (PALs) predict an increased hospital length of stay, additional chest tube days and increased pain. The two types of systems used after surgery are digital and traditional chest drainage devices. Eighteen articles from four databases were evaluated for this analysis in chest drainage systems and managing air leaks after thoracic surgery. The digital and traditional drainage devices were evaluated.PALs were examined with interobserver variability of air leak assessment and differences in the two systems were addressed. The research gaps in the digital system are examining what flow thresholds should be used to safely remove a chest tube after surgery and for what length of time. In future research, the next step is standardizing chest tube management to decrease individual surgeon preference. Treatment of air leaks implementing scientific data instead of personal preference and opinion by a surgeon can lead to earlier chest tube removal, decreased morbidity and a shorter hospital stay.

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Postoperative chest tube management: measuring air leak using an electronic device decreases variability in the clinical practice☆☆☆

Abstract: We have demonstrated a high rate of disagreement related to the indication to remove chest tubes after lung resection and the improvement of the agreement rate with the use of an electronic device to measure postoperative air leak and pleural pressures.

Cited by 126 publications

References 15 publications

Does the usage of digital chest drainage systems reduce pleural inflammation and volume of pleural effusion following oncologic pulmonary resection?—A prospective randomized trial

Does the usage of digital chest drainage systems reduce pleural inflammation and volume of pleural effusion following oncologic pulmonary resection?—A prospective randomized trial

The Evolution of VATS Lobectomy

Chest drainage systems and management of air leaks after a pulmonary resection

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