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Novoa NM, Fuentes MG. Digital chest drainage vs. water seal chest drainage in the robotic era. J Thorac Dis 2020; 12:3004-3006. [PMID: 32642219 PMCID: PMC7330785 DOI: 10.21037/jtd.2020.03.86] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Nuria M Novoa
- Thoracic Surgery Department, Salamanca University Hospital, Salamanca, Spain.,Salamanca Institute of Biomedical Research (IBSAL), Salamanca, Spain
| | - Marta G Fuentes
- Thoracic Surgery Department, Salamanca University Hospital, Salamanca, Spain.,Salamanca Institute of Biomedical Research (IBSAL), Salamanca, Spain
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Quantitative measurement of air leak in patients with chest drains. TURK GOGUS KALP DAMAR CERRAHISI DERGISI-TURKISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2020; 27:80-87. [PMID: 32082831 DOI: 10.5606/tgkdc.dergisi.2019.16735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 08/09/2018] [Indexed: 11/21/2022]
Abstract
Background This study aims to evaluate a new method that detects peak air leak speed and peak air leak flow, investigate the correlation between the amount of air leak and development of prolonged air leak, and identify patients who are at risk of developing prolonged air leak after lung resection. Methods In this prospective trial, the amount of air leak was measured with the assistance of an anemometer connected to the top of a standard underwater drainage system, and a mobile phone with android operating system. Patients who underwent tube thoracostomy for spontaneous pneumothorax were assigned to group 1 (18 males, 1 female; mean age 31.6±10.9 years; range, 18 to 70 years), whereas patients who underwent lung resection for benign or malignant lung diseases were assigned to group 2 (37 males; 16 females; mean age 56.9±15.6 years; range, 18 to 80 years). The receiver operating characteristics analysis was performed for the statistical analysis of the data. Results Prolonged air leak was observed in five patients (26.3%) in group 1 and in six patients (11.3%) in group 2. In group 1, first measurement on postoperative day zero could detect prolonged air leak development with 100% sensitivity and 92.9% specificity. Similarly, in group 2, measurements on day zero could detect prolonged air leak development with 100% sensitivity and 87.2% specificity. Conclusion Compared to similar products, this newly developed measuring device may be widely used in clinics with its low cost and ease of use. Measured peak air leak flow values can predict patients who may develop prolonged air leak. Patent work for the device is ongoing.
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Moon Y. Treatment of postoperative air leak with fresh frozen plasma. J Thorac Dis 2020; 11:5655-5657. [PMID: 32030292 DOI: 10.21037/jtd.2019.12.77] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Youngkyu Moon
- Department of Thoracic & Cardiovascular Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Aldaghlawi F, Kurman JS, Lilly JA, Hogarth DK, Donington J, Ferguson MK, Murgu SD. A Systematic Review of Digital vs Analog Drainage for Air Leak After Surgical Resection or Spontaneous Pneumothorax. Chest 2020; 157:1346-1353. [PMID: 31958444 DOI: 10.1016/j.chest.2019.11.046] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Revised: 10/27/2019] [Accepted: 11/21/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The concerns regarding air leak after lung surgery or spontaneous pneumothorax include detection and duration. Prior studies have suggested that digital drainage systems permit shorter chest tube duration and hospital length of stay (LOS) by earlier detection of air leak cessation. We conducted a systematic review to assess the impact of digital drainage on chest tube duration and hospital LOS after pulmonary surgery and spontaneous pneumothorax. METHODS Ovid MEDLINE, PubMed, Embase, the Cochrane Library, Scopus, and Google Scholar were searched from inception through January 2019. We included randomized controlled trials, cohort studies, and case series of adult patients, using digital or traditional drainage devices for air leaks of either postsurgical or spontaneous pneumothorax origin. RESULTS Of 1,272 references reviewed, 23 articles were included. Nineteen articles addressed postoperative air leak, and four articles pertained to air leak after spontaneous pneumothorax. Thirteen studies were randomized controlled trials. Digital drainage resulted in significantly shorter chest tube duration in eight of 18 studies and shorter hospital LOS in six of 14 studies for postoperative air leak. For postpneumothorax air leak, digital drainage resulted in significantly shorter chest tube duration in two of three studies and hospital LOS in one of two studies with an analog control group. CONCLUSIONS Most studies show no significant differences in chest tube duration and hospital LOS with digital vs analog drainage systems for patients with air leak after pulmonary resection. For post-spontaneous pneumothorax air leak, the limited published evidence suggests shorter chest tube duration and hospital LOS with digital drainage systems.
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Affiliation(s)
- Fadi Aldaghlawi
- Department of Medicine, Indiana University Goshen Health, Goshen, IN
| | - Jonathan S Kurman
- Division of Pulmonary and Critical Care, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Jason A Lilly
- Ruth Lilly Medical Library, Indiana University School of Medicine, Indianapolis, IN
| | - D Kyle Hogarth
- Section of Pulmonary and Critical Care, Department of Medicine, University of Chicago, Chicago, IL
| | - Jessica Donington
- Section of Thoracic Surgery, Department of Surgery, University of Chicago, Chicago, IL
| | - Mark K Ferguson
- Section of Thoracic Surgery, Department of Surgery, University of Chicago, Chicago, IL
| | - Septimiu D Murgu
- Section of Pulmonary and Critical Care, Department of Medicine, University of Chicago, Chicago, IL.
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Marulli G, Comacchio GM, Nosotti M, Rosso L, Mendogni P, Natale G, Andriolo L, Imbriglio G, Larocca V, Brascia D, Rea F. Multicenter randomized study on the comparison between electronic and traditional chest drainage systems. Trials 2019; 20:730. [PMID: 31842974 PMCID: PMC6915964 DOI: 10.1186/s13063-019-3811-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 10/22/2019] [Indexed: 11/13/2022] Open
Abstract
Background In patients submitted to major pulmonary resection, the postoperative length of stay is mainly influenced by the duration of air leaks and chest tube removal. The measurement of air leaks largely relies on traditional chest drainage systems which are prone to subjective interpretation. Difficulty in differentiating between active air leaks and bubbles due to a pleural space effect may also lead to tentative drain clamping and prolonged time for chest drain removal. New digital systems allow continuous monitoring of air leaks, identifying subtle leakage that may be not visible during daily patient evaluation. Moreover, an objective assessment of air leaks may lead to a reduced interobserver variability and to an optimized timing for chest tube removal. Methods This study is a prospective randomized, interventional, multicenter trial designed to compare an electronic chest drainage system (Drentech™ Palm Evo) with a traditional system (Drentech™ Compact) in a cohort of patients undergoing pulmonary lobectomy through a standard three-port video-assisted thoracic surgery approach for both benign and malignant disease. The study will enroll 382 patients in three Italian centers. The duration of chest drainage and the length of hospital stay will be evaluated in the two groups. Moreover, the study will evaluate whether the use of a digital chest system compared with a traditional system reduces the interobserver variability. Finally, it will evaluate whether the digital drain system may help in distinguishing an active air leak from a pleural space effect, by the digital assessment of intrapleural differential pressure, and in identifying potential predictors of prolonged air leaks. Discussion To date, few studies have been performed to evaluate the clinical impact of digital drainage systems. The proposed prospective randomized trial will provide new knowledge to this research area by investigating and comparing the difference between digital and traditional chest drain systems. In particular, the objectives of this project are to evaluate the feasibility and usefulness of digital chest drainages and to provide new tools to identify patients at higher risk of developing prolonged air leaks. Trial registration ClinicalTrials.gov, NCT03536130. Retrospectively registered on 24 May 2018.
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Affiliation(s)
- Giuseppe Marulli
- Thoracic Surgery Unit, Department of Organ Transplantation and Emergency, University Hospital of Bari, Piazza Giulio Cesare, 11, 70124, Bari, Italy.
| | - Giovanni M Comacchio
- Thoracic Surgery Unit, Department of Cardiologic, Thoracic and Vascular Sciences, University Hospital of Padova, Padova, Italy
| | - Mario Nosotti
- Thoracic Surgery Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Lorenzo Rosso
- Thoracic Surgery Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Paolo Mendogni
- Thoracic Surgery Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Giuseppe Natale
- Thoracic Surgery Unit, Department of Cardiologic, Thoracic and Vascular Sciences, University Hospital of Padova, Padova, Italy
| | | | | | | | - Debora Brascia
- Thoracic Surgery Unit, Department of Organ Transplantation and Emergency, University Hospital of Bari, Piazza Giulio Cesare, 11, 70124, Bari, Italy
| | - Federico Rea
- Thoracic Surgery Unit, Department of Cardiologic, Thoracic and Vascular Sciences, University Hospital of Padova, Padova, Italy
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Lee YY, Hsu PK, Huang CS, Wu YC, Hsu HS. Complications after Chest Tube Removal and Reinterventions in Patients with Digital Drainage Systems. J Clin Med 2019; 8:jcm8122092. [PMID: 31805705 PMCID: PMC6947439 DOI: 10.3390/jcm8122092] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Revised: 11/17/2019] [Accepted: 11/26/2019] [Indexed: 11/25/2022] Open
Abstract
Introduction: Digital thoracic drainage systems are a new technology in minimally invasive thoracic surgery. However, the criteria for chest tube removal in digital thoracic drainage systems have never been evaluated. We aim to investigate the incidence and predictive factors of complications and reinterventions after drainage tube removal in patients with a digital drainage system. Method: Patients who received lung resection surgery and had their chest drainage tubes connected with a digital drainage system were retrospectively reviewed. Results: A total of 497 patients were monitored with digital drainage systems after lung resection surgery. A total of 175 (35.2%) patients had air leak-related complications after drainage tube removals, whereas 25 patients (5.0%) required reintervention. We identified that chest drainage duration of five days was an optimal cut-off value in predicting air leak-related complications and reinterventions. In multiple logistic regression analysis, previous chest surgery history; small size (16 Fr.) drainage tubes; the presence of initial air leaks, defined as air leaks recorded by the digital drainage system immediately after operation; and duration of chest drainage ≥5 days were independent factors of air leak-related complications, whereas the presence of initial air leaks and duration of chest drainage ≥5 days were independent predictive factors of reintervention after drainage tube removal. Conclusion: Air leak-related complications and reinterventions after drainage tube removals happened in 35.2% and 5.0% of patients with digital thoracic drainage systems. The management of chest drainage tubes in patients with predictive factors, i.e., the presence of initial air leaks and duration of chest drainage of more than five days, should be treated with caution.
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Affiliation(s)
| | - Po-Kuei Hsu
- Correspondence: ; Tel.: +886-2-2875-7546; Fax: +886-2-7723-2151
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Van Linden A, Hecker F, Courvoisier DS, Arsalan M, Köhne J, Brei C, Holubec T, Walther T. Reduction of drainage-associated complications in cardiac surgery with a digital drainage system: a randomized controlled trial. J Thorac Dis 2019; 11:5177-5186. [PMID: 32030235 DOI: 10.21037/jtd.2019.12.20] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Background Thoracic chest drains are placed after cardiac surgery allowing for the clearance of blood, fluid, and air to prevent post-operative complications. Despite its importance, there is little data on the application of digital chest drainage systems in cardiac surgery. Therefore, the differences between an analog and a digital chest drainage system in cardiac surgery patients were investigated in a randomized controlled trial. Methods A total of 354 elective cardiac surgery patients were preoperatively randomized 1:1 between September 2016 and September 2017 to either an analog (Ocean) or a digital (Thopaz+) chest drainage system aiming to compare drainage-associated postoperative outcome parameters. Results A total of 340 patients were included in the analysis (analog: 188; digital: 152) with no significant differences in preoperative baseline parameters. Incidence of X-rays to detect air leaks was significantly lower in the digital group (analog: 20.2%; digital: 8.6%; P<0.01). Patients treated with the digital system showed a 3.3% reduction of re-thoracotomies, however, not statistically significant (analog: 5.3%; digital: 2.0%; P=0.19). Median total fluid amount did not significantly differ between study groups [median (P25; P75); analog: 705 (400; 1,333) mL; digital: 686 (404; 1,229) mL; P=0.83]; however, the use of the digital drainage system resulted in a quicker removal with a reduced median drainage duration of 16 hours (analog: 65 hours; digital: 49 hours; P≤0.01). Conclusions The study provides evidence that digital drainage systems can be safely applied in cardiac surgery patients. The use of the digital management system led to a decreased incidence of drainage-associated complications as well as to shortened chest tube duration. Findings require confirmation by additional studies.
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Affiliation(s)
- Arnaud Van Linden
- Department of Cardiothoracic and Vascular Surgery, Goethe University Hospital Frankfurt, Frankfurt, Germany
| | - Florian Hecker
- Department of Cardiothoracic and Vascular Surgery, Goethe University Hospital Frankfurt, Frankfurt, Germany
| | | | - Mani Arsalan
- Department of Cardiothoracic and Vascular Surgery, Goethe University Hospital Frankfurt, Frankfurt, Germany
| | - Josepha Köhne
- Department of Cardiac Surgery, Kerckhoff Clinic, Bad Nauheim, Germany
| | - Christina Brei
- Medela Medizintechnik GmbH & Co. Handels KG, Dietersheim, Germany
| | - Tomas Holubec
- Department of Cardiothoracic and Vascular Surgery, Goethe University Hospital Frankfurt, Frankfurt, Germany
| | - Thomas Walther
- Department of Cardiothoracic and Vascular Surgery, Goethe University Hospital Frankfurt, Frankfurt, Germany
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Jacobsen K, Talbert S, Boyer JH. The benefits of digital drainage system versus traditional drainage system after robotic-assisted pulmonary lobectomy. J Thorac Dis 2019; 11:5328-5335. [PMID: 32030250 PMCID: PMC6988061 DOI: 10.21037/jtd.2019.11.69] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Accepted: 11/12/2019] [Indexed: 11/06/2022]
Abstract
BACKGROUND Postoperative air leaks are the most common complication after a pulmonary resection. There is no data in the literature comparing the traditional and digital chest drainage system after a robotic-assisted pulmonary lobectomy. METHODS This was a retrospective, correlational study. Medical records from 182 eligible robotic-assisted lobectomy patients were evaluated to determine the association between digital and traditional chest tube drainage systems (CTDS) with postoperative chest tube days, hospital LOS, chest tube reinsertion during hospitalization, and 30-day readmission for pneumothorax. Multiple regression was used to determine the association between CTDS while controlling for confounding variables. RESULTS No differences were noted between groups for age, gender, BMI, smoking, adhesions or neoadjuvant therapy. Patients with digital drainage systems had significantly shorter chest tube duration than those with traditional drainage systems (2.07 vs. 2.73 days, P=0.003). After controlling for age and BMI, CTDS was not found to be a significant predictor of CT duration. Digital drainage system were also associated with significantly shorter hospital LOS (4.02 vs. 5.06 days, P=0.01) After controlling for age, BMI, and presence of post-op a-fib, use of a digital CTDS was significantly associated with 1 day shorter hospital LOS. Chest tube reinsertion occurred four times more frequently with traditional drainage systems, but the difference did not achieve the level of statistical significance (P=0.059). The frequency of readmission due to pneumothorax was very low (1 patient per group), which prevented comparative statistical analysis. CONCLUSIONS In the digital drainage system there are shorter chest tube days and hospital length of stay after a robotic-assisted lobectomy. The decision to remove chest tubes in the traditional drainage system is burdened with uncertainty. The digital drainage system reduces intraobserver variability allowing for improved decision making in chest tube removal. Both CT duration and hospital LOS were shorter using unadjusted analyses. Type of CTDS was not significantly associated with CT duration after controlling for age and BMI. However, after controlling for age, BMI, and post-op atrial fibrillation, use of the digital CTDS was associated with a 1 day reduction in hospital LOS.
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Affiliation(s)
| | - Steven Talbert
- UCF College of Nursing, University of Central Florida, Orlando, FL, USA
| | - Joseph H. Boyer
- Division of Cardiothoracic Surgery, Director, AdventHealth Cardiovascular Institute Robotics and Minimally Invasive Cardiothoracic Surgery, Orlando, FL, USA
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Raymond DP. Are we ready for the Digital Age? J Thorac Cardiovasc Surg 2019; 155:1841-1842. [PMID: 29554792 DOI: 10.1016/j.jtcvs.2017.10.043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 10/13/2017] [Indexed: 10/17/2022]
Affiliation(s)
- Daniel P Raymond
- Thoracic Surgery, Cleveland Clinic Health System, Cleveland, Ohio.
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Motono N, Iwai S, Funasaki A, Sekimura A, Usuda K, Uramoto H. What is the allowed volume threshold for chest tube removal after lobectomy: A randomized controlled trial. Ann Med Surg (Lond) 2019; 43:29-32. [PMID: 31194145 PMCID: PMC6551566 DOI: 10.1016/j.amsu.2019.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Revised: 05/18/2019] [Accepted: 05/24/2019] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION The management of chest tubes and the volume threshold for chest tube removal after pulmonary resection remain controversial. Several studies have reported the volume threshold for chest tube removal following pulmonary resection to range from 200 to 450 mL/24 h. METHODS A prospective randomized single-blind clinical study was performed with data collected from patients who had undergone lobectomy and lymph node dissection at our hospital between June 2014 and April 2018. The patients were randomly assigned to the High group (removal of chest tube when drainage was <450 mL/24 h) or Low group (removal of chest tube when drainage was <200 mL/24 h) at postoperative day (POD) 2. The primary end point was drainage time. The secondary end point were complications and rate of thoracentesis. RESULTS Seventy patients met the inclusion criteria and were randomized, with 35 patients assigned to the High group and 35 patients to the Low group. The average duration of chest tube placement was 2.05 days in the High group and 2.31 days in the Low group. The duration of chest tube placement in the High group was significantly shorter than that in the Low group (p = 0.02). There were no major postoperative complications in either group. Thoracentesis was not necessary in either group. CONCLUSION Pleural effusion of 450 mL/day is tolerable as the volume threshold for the removal of a chest tube after pulmonary resection.
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Affiliation(s)
- Nozomu Motono
- Department of Thoracic Surgery, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Ishikawa, 920-0293, Japan
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Shigeeda W, Deguchi H, Tomoyasu M, Kaneko Y, Kanno H, Tanita T, Saito H. The utility of the Stapler with PGA sheet for pulmonary wedge resection: a propensity score-matched analysis. J Thorac Dis 2019; 11:1546-1553. [PMID: 31179098 DOI: 10.21037/jtd.2019.03.05] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Air leakage is a common complication after pulmonary wedge resection. The aim of this study was to evaluate the effect of staple line reinforcement in reducing air leakage after pulmonary wedge resection. Methods A retrospective analysis was performed on patients who underwent pulmonary wedge resection. The patients were classified into 2 groups; the Stapler with polyglycolic acid sheet was used for the reinforced and the Stapler without polyglycolic acid sheet was used for the non-reinforced group. The patients were matched one-to-one based on a propensity score that comprised several patient characteristics. A propensity score-matched analysis was performed to compare patient outcomes. Results A total of 291 patients who met the inclusion criteria were investigated. There were 165 in the reinforced group and 126 patients in the non-reinforced group. Propensity score analysis generated 104 matched pairs of patients in both the reinforced and the non-reinforced groups. The rate of non-placement of chest tube was significantly higher in the reinforced group than in the non-reinforced group (61.5% vs. 36.5%; P<0.001). The rate of postoperative air leakage was higher in the non-reinforced group than in the reinforced group (13.5% vs. 1.9%, P<0.001). On logistic regression analysis, not using the reinforcement device was one of the independent factors related to pulmonary air leakage after pulmonary wedge resection (OR: 8.58, P<0.001). Conclusions The use of the Stapler with polyglycolic acid sheet during pulmonary wedge resection increased the rate of intraoperative chest tube removal and reduced the rate of postoperative air leakage.
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Affiliation(s)
- Wataru Shigeeda
- Department of Thoracic Surgery, School of Medicine, Iwate Medical University, Iwate, Japan
| | - Hiroyuki Deguchi
- Department of Thoracic Surgery, School of Medicine, Iwate Medical University, Iwate, Japan
| | - Makoto Tomoyasu
- Department of Thoracic Surgery, School of Medicine, Iwate Medical University, Iwate, Japan
| | - Yuka Kaneko
- Department of Thoracic Surgery, School of Medicine, Iwate Medical University, Iwate, Japan
| | - Hironaga Kanno
- Department of Thoracic Surgery, School of Medicine, Iwate Medical University, Iwate, Japan
| | - Tatsuo Tanita
- Natori Mori Hospital, Tohoku Medical and Pharmaceutical University, Miyagi, Japan
| | - Hajime Saito
- Department of Thoracic Surgery, School of Medicine, Iwate Medical University, Iwate, Japan
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Evans JM, Ray A, Dale M, Morgan H, Dimmock P, Carolan-Rees G. Thopaz+ Portable Digital System for Managing Chest Drains: A NICE Medical Technology Guidance. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2019; 17:285-294. [PMID: 30671917 PMCID: PMC6535154 DOI: 10.1007/s40258-019-00461-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
The Thopaz+ portable digital system was evaluated by the Medical Technologies Advisory Committee (MTAC) of the National Institute for Health and Care Excellence (NICE). The manufacturer, Medela, submitted a case for the adoption of Thopaz+ that was critiqued by Cedar, on behalf of NICE. Due to a lack of clinical evidence submitted by the manufacturer, Cedar carried out its own literature search. Clinical evidence showed that the use of Thopaz+ led to shorter drainage times, a shorter hospital stay, lower rates of chest drain re-insertion and higher patient satisfaction compared to conventional chest drainage when used in patients following pulmonary resection. One comparative study of the use of Thopaz+ in patients with spontaneous pneumothorax was identified and showed shorter drainage times and a shorter length of hospital stay compared to conventional drainage. No economic evidence was submitted by the manufacturer, but a simple decision tree model was included. The model was improved by Cedar and showed a cost saving of £111.33 per patient when Thopaz+ was used instead of conventional chest drainage in patients following pulmonary resection. Cedar also carried out a sub-group analysis of the use of Thopaz+ instead of conventional drainage in patients with pneumothorax where a cost saving of £550.90 was observed. The main cost driver for the model and sub-group analysis was length of stay. The sub-group analysis was based on a single comparative study. However, the MTAC received details of an unpublished audit of Thopaz+ which confirmed its efficacy in treating patients with pneumothorax. Thopaz+ received a positive recommendation in Medical Technologies Guidance 37.
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Affiliation(s)
| | | | - Megan Dale
- Cedar, Cardiff and Vale University Health Board, Cardiff, Wales, UK.
| | | | - Paul Dimmock
- National Institute for Health and Care Excellence, Manchester, UK
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The Influence of Suction on Chest Drain Duration After Lobectomy Using Electronic Chest Drainage. Ann Thorac Surg 2019; 107:1621-1625. [DOI: 10.1016/j.athoracsur.2018.12.059] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 11/18/2018] [Accepted: 12/10/2018] [Indexed: 11/23/2022]
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Vinck EE, Martínez SI, Barrios RV, Téllez LJ, Garzón JC, García-Herreros L. Facing the challenges of perioperative air leaks using water seal in Colombia. Asian Cardiovasc Thorac Ann 2019; 27:436-442. [PMID: 31126190 DOI: 10.1177/0218492319853991] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Air leaks following thoracic surgery continue to be a significant cause of morbidity and mortality. In contemporary thoracic surgery, many aspects of post-surgical air leaks are still controversial. In developing countries like Colombia, state-of-the-art technology such as newer digital drainage systems are not always available, and surgeons rely primarily on water seal systems for air leak management. Although efforts are being made to increase the use of newer digital systems, being a third-world country has its challenges, and we emphasize the importance of following international guidelines as much as possible, especially when facing complex situations such as perioperative air leaks with limited resources.
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Affiliation(s)
- Eric E Vinck
- 1 Department of Surgery, El Bosque University, Associated with Dr. Horacio Oduber Hospital, Oranjestad, Aruba
| | - Stella I Martínez
- 2 Department of Thoracic Surgery, El Bosque University, Bogotá, Colombia
| | - Rodolfo V Barrios
- 2 Department of Thoracic Surgery, El Bosque University, Bogotá, Colombia
| | - Luis J Téllez
- 4 Department of Thoracic Surgery & Lung Transplant, Fundación Cardioinfantil, Bogotá, Colombia
| | - Juan C Garzón
- 4 Department of Thoracic Surgery & Lung Transplant, Fundación Cardioinfantil, Bogotá, Colombia
| | - Luis García-Herreros
- 4 Department of Thoracic Surgery & Lung Transplant, Fundación Cardioinfantil, Bogotá, Colombia
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Bowman JA, Utter GH. Electronic chest tube drainage devices and low suction following video-assisted thoracoscopic pulmonary lobectomy. J Thorac Dis 2019; 11:1738-1741. [PMID: 31285862 PMCID: PMC6588738 DOI: 10.21037/jtd.2019.05.26] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 05/06/2019] [Indexed: 11/06/2022]
Affiliation(s)
- Jessica A. Bowman
- Department of Surgery, Division of Trauma and Acute Care Surgery, University of California, Davis, CA, USA
| | - Garth H. Utter
- Department of Surgery, Division of Trauma and Acute Care Surgery, University of California, Davis, CA, USA
- Department of Surgery Outcomes Research Group, University of California, Davis, CA, USA
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Prediction of prolonged air leak after lung resection using continuous log data of flow by digital drainage system. Gen Thorac Cardiovasc Surg 2019; 67:684-689. [DOI: 10.1007/s11748-019-01073-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 01/11/2019] [Indexed: 11/25/2022]
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Comacchio GM, Monaci N, Verderi E, Schiavon M, Rea F. Enhanced recovery after elective surgery for lung cancer patients: analysis of current pathways and perspectives. J Thorac Dis 2019; 11:S515-S522. [PMID: 31032070 DOI: 10.21037/jtd.2019.01.99] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The concept of enhanced recovery after surgery (ERAS), initially introduced in the field of colorectal surgery, has been developed in order to optimize the postoperative course. In recent years the number of authors analyzing the role of ERAS in lung cancer surgery is increasing, highlighting several interventions with positive effects on the postoperative course. Yet it is still difficult to draw definite conclusions and specific guidelines, as most of these studies largely differ for their methodological aspects and study populations. Herein we focus on the key elements of each single intervention, trying to identify what we can apply in a common pathway, and which aspects are still to be evaluated for the validation of an ERAS program.
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Affiliation(s)
- Giovanni Maria Comacchio
- Thoracic Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Nicola Monaci
- Thoracic Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Enrico Verderi
- Thoracic Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Marco Schiavon
- Thoracic Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Federico Rea
- Thoracic Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
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69
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Wang H, Hu W, Ma L, Zhang Y. Digital chest drainage system versus traditional chest drainage system after pulmonary resection: a systematic review and meta-analysis. J Cardiothorac Surg 2019; 14:13. [PMID: 30658680 PMCID: PMC6339372 DOI: 10.1186/s13019-019-0842-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 01/14/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Several randomized controlled trials (RCTs) and observational studies have compared the efficacy of digital chest drainage system versus traditional chest drainage system. However, the results were inconsistent. METHODS We searched the Web of Science and Pubmed for observational studies and RCTs that compared the effect of digital chest drainage system with traditional chest drainage system after pulmonary resection. Eight studies (5 randomized control trails and 3 observational studies) comprising 1487 patients met the eligibility criteria. RESULTS Compared with the traditional chest drainage system, digital chest drainage system reduced the risk of prolonged air leak (PAL) (RR = 0.54, 95%CI 0.40-0.73, p < 0.0001), and shortened the duration of chest drainage (SMD = - 0.35, 95%CI -0.60 - -0.09, p = 0.008) and length of hospital stay (SMD = - 0.35, 95%CI -0.61 - -0.09, p = 0.007) in patients after pulmonary resection. CONCLUSIONS Digital chest drainage system is expected to benefit patients to attain faster recovery and higher life quality as well as to reduce the risk of postoperative complications. Further RCTs with larger sample size are still needed to more clearly elucidate the advantages of digital chest drainage system.
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Affiliation(s)
- Hong Wang
- Department of Surgery, Zhejiang University Hospital, Zhejiang University, Hangzhou, China
| | - Wenbin Hu
- Department of Cardiothoracic Surgery, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China
| | - Liang Ma
- Department of Cardiothoracic Surgery, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China
| | - Yiran Zhang
- Department of Cardiothoracic Surgery, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China.
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70
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Yeung C, Gilbert S. Digital pleural drainage technology is here to stay-time to realize its potential. J Thorac Dis 2019; 10:S3882-S3883. [PMID: 30631505 DOI: 10.21037/jtd.2018.09.71] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Ching Yeung
- Division of Thoracic Surgery, University of Ottawa, Ottawa, Ontario, Canada
| | - Sebastien Gilbert
- Division of Thoracic Surgery, University of Ottawa, Ottawa, Ontario, Canada.,The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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71
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Jiménez M, Novoa N, Varela G. Digital pleural drainages-what is the real value for patients? J Thorac Dis 2019; 10:S3867-S3869. [PMID: 30631501 DOI: 10.21037/jtd.2018.09.79] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Marcelo Jiménez
- Service of Thoracic Surgery, Salamanca University Hospital, Salamanca, Spain.,Department of Surgery, School of Medicine, Salamanca University, Salamanca, Spain
| | - Nuria Novoa
- Service of Thoracic Surgery, Salamanca University Hospital, Salamanca, Spain.,Department of Surgery, School of Medicine, Salamanca University, Salamanca, Spain
| | - Gonzalo Varela
- Department of Surgery, School of Medicine, Salamanca University, Salamanca, Spain
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72
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Yeung C, Ghazel M, French D, Japkowicz N, Gottlieb B, Maziak D, Seely AJE, Shamji F, Sundaresan S, Villeneuve PJ, Gilbert S. Forecasting pulmonary air leak duration following lung surgery using transpleural airflow data from a digital pleural drainage device. J Thorac Dis 2018; 10:S3747-S3754. [PMID: 30505561 DOI: 10.21037/jtd.2018.08.11] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background Prolonged air leak (PAL) is often the limiting factor for hospital discharge after lung surgery. Our goal was to develop a statistical model that reliably predicts pulmonary air leak resolution by applying statistical time series modeling and forecasting techniques to digital drainage data. Methods Autoregressive Integrated Moving Average (ARIMA) modeling was used to forecast air leak flow from transplural air flow data. The results from ARIMA were retrospectively internally validated with a group of 100 patients who underwent lung resection between December 2012 and March 2017, for whom digital pleural drainage data was available for analysis and a persistent air leak was the limiting factor for chest tube removal. Results The ARIMA model correctly identified 82% (82/100) of patients as to whether or not the last chest tube removal was appropriate. The performance characteristics of the model in properly identifying patients whose air leak would resolve and who would therefore be candidates for safe chest tube removal were: sensitivity 80% (95% CI, 69-88%), specificity 88% (95% CI, 68-97%), positive predictive value 95% (95% CI, 86-99%), and negative predictive value 59% (95% CI, 42-79%). The false positive and false negative rate was 12% (95% CI, 12-31%) and 20% (95% CI, 12-31%). Conclusions We were able to validate a statistical model that that reliably predicted resolution of pulmonary air leak resolution over a 24-hour period. This information may improve the care of patients with chest tube by optimizing duration of pleural drainage.
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Affiliation(s)
- Ching Yeung
- Division of Thoracic Surgery, University of Ottawa, Ottawa, Ontario, Canada
| | - Mohsen Ghazel
- School of Electrical Engineering and Computer Science, University of Ottawa, Ottawa, Ontario, Canada
| | - Daniel French
- Division of Thoracic Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Nathalie Japkowicz
- Division of Thoracic Surgery, University of Ottawa, Ottawa, Ontario, Canada.,Department of Computer Science, American University, Washington, DC, USA
| | - Bram Gottlieb
- Division of Thoracic Surgery, University of Ottawa, Ottawa, Ontario, Canada
| | - Donna Maziak
- Division of Thoracic Surgery, University of Ottawa, Ottawa, Ontario, Canada.,The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Andrew J E Seely
- Division of Thoracic Surgery, University of Ottawa, Ottawa, Ontario, Canada.,The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Farid Shamji
- Division of Thoracic Surgery, University of Ottawa, Ottawa, Ontario, Canada.,The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Sudhir Sundaresan
- Division of Thoracic Surgery, University of Ottawa, Ottawa, Ontario, Canada.,The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Patrick James Villeneuve
- Division of Thoracic Surgery, University of Ottawa, Ottawa, Ontario, Canada.,The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Sebastien Gilbert
- Division of Thoracic Surgery, University of Ottawa, Ottawa, Ontario, Canada.,The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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73
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Shintani Y, Funaki S, Ose N, Kanou T, Kanzaki R, Minami M, Okumura M. Chest tube management in patients undergoing lobectomy. J Thorac Dis 2018; 10:6432-6435. [PMID: 30746183 DOI: 10.21037/jtd.2018.11.47] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Yasushi Shintani
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Soichiro Funaki
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Naoko Ose
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Takashi Kanou
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Ryu Kanzaki
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Masato Minami
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Meinoshin Okumura
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
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74
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French DG, Gilbert S. Technology and evidence-based care enhance postoperative management of chest drains. J Thorac Dis 2018; 10:6399-6403. [PMID: 30746174 DOI: 10.21037/jtd.2018.11.99] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Daniel G French
- Division of Thoracic Surgery, Dalhousie University, Queen Elizabeth II Hospital-Victoria Campus, Halifax, NS, Canada
| | - Sebastien Gilbert
- Division of Thoracic Surgery, University of Ottawa, The Ottawa Hospital-General Campus, Ottawa, ON, Canada
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75
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Altree TJ, Jersmann H, Nguyen P. Persistent air leak successfully treated with endobronchial valves and digital drainage system. Respirol Case Rep 2018; 6:e00368. [PMID: 30237889 PMCID: PMC6138541 DOI: 10.1002/rcr2.368] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Revised: 08/22/2018] [Accepted: 08/26/2018] [Indexed: 11/23/2022] Open
Abstract
A 62-year old man with severe chronic obstructive pulmonary disease developed a persistent air leak from an iatrogenic pneumothorax following Computed Tomography-guided core biopsy of a pulmonary nodule. The pneumothorax was treated with an 8.5F intercostal catheter, which was then replaced by a 28F thoracostomy tube after development of significant subcutaneous emphysema and a tension pneumothorax. The air leak showed no improvement until endobronchial valve (EBV) insertion guided by objective flow data from a digital drainage system (DDS). The air leak subsequently reduced with -20 cmH2O suction from the DDS, and the thoracostomy tube was removed once the objective measured flow rate had sufficiently diminished. The combination of EBV insertion and suction from the DDS successfully treated the persistent air leak, with timing of thoracostomy tube removal guided by DDS flow data.
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Affiliation(s)
- Thomas James Altree
- Department of Thoracic MedicineRoyal Adelaide HospitalAdelaideSouth AustraliaAustralia
| | - Hubertus Jersmann
- Department of Thoracic MedicineRoyal Adelaide HospitalAdelaideSouth AustraliaAustralia
| | - Phan Nguyen
- Department of Thoracic MedicineRoyal Adelaide HospitalAdelaideSouth AustraliaAustralia
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76
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French DG, Plourde M, Henteleff H, Mujoomdar A, Bethune D. Optimal management of postoperative parenchymal air leaks. J Thorac Dis 2018; 10:S3789-S3798. [PMID: 30505566 DOI: 10.21037/jtd.2018.10.05] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Air leaks are the most common complication after pulmonary resection. Enhanced recovery after surgery (ERAS) programs must be designed to manage parenchymal air leaks. ERAS programs should consider two components when creating protocols for air leaks: assessment and management. Accurate assessment of air leaks using traditional analogues devices, newer digital drainage systems, portable devices and chest X-rays (CXR) are reviewed. Published data suggests that digital drainage systems result in a more confident assessment of air leaks. The literature regarding the management of postoperative air leaks, including the number of chest tubes, the role of applied external suction, invasive maneuvers and discharge with a portable device is reviewed. The key findings are that a single chest drain is adequate in the majority of cases to manage an air leak, the use of applied external suction is unlikely to prevent or prolong an air leak, autologous blood patch pleurodesis may potentially shorten postoperative air leaks and there is sufficient data to support that patients can safely be discharged with a portable drainage system. There is also literature to support the design of protocols for management of postoperative air leaks. Standardization of postoperative care through ERAS programs will allow for the design of larger RCTs to better understand some of the controversies around the management of postoperative air leaks.
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Affiliation(s)
- Daniel G French
- Division of Thoracic Surgery, Department of Surgery, Queen Elizabeth II Hospital - Victoria Campus, Dalhousie University, Halifax, NS, Canada
| | - Madelaine Plourde
- Division of Thoracic Surgery, Department of Surgery, Queen Elizabeth II Hospital - Victoria Campus, Dalhousie University, Halifax, NS, Canada
| | - Harry Henteleff
- Division of Thoracic Surgery, Department of Surgery, Queen Elizabeth II Hospital - Victoria Campus, Dalhousie University, Halifax, NS, Canada
| | - Aneil Mujoomdar
- Division of Thoracic Surgery, Department of Surgery, Queen Elizabeth II Hospital - Victoria Campus, Dalhousie University, Halifax, NS, Canada
| | - Drew Bethune
- Division of Thoracic Surgery, Department of Surgery, Queen Elizabeth II Hospital - Victoria Campus, Dalhousie University, Halifax, NS, Canada
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Abstract
This review of the development of a specialist nursing service within a thoracic surgery centre looks at the implementation of a specialist nursing role. An analysis of the needs of the service allowed identification of areas where specialist nursing input could have a positive impact on the patient pathway: (I) a nurse-led clinic for review of patients who require early review after discharge, in particular those discharged home with chest drains, was developed; (II) improvements to the patient pathway such as day of surgery admission were introduced along with a reduction in the number of patients who require admission to intensive care after surgery; (III) the specialist nurse leads on the introduction of new technology such as electronic chest drains. The specialist nurse works in the follow-up clinic, seeing patients autonomously, with a particular emphasis on patients under long-term follow-up after thoracic surgery. A telephone clinic has been introduced for patients on long-term CT follow-up. These are well received by patients; (IV) specialist nurses also work on in-patient wards, providing specialist input to the patient pathway, and can also take on work traditionally undertaken by junior medical staff. To be successful the specialist nursing role needs to be supported by the multidisciplinary team (MDT). These roles are developed to meet the needs of each unit and can have a very positive impact on the patient pathway.
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78
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Batchelor TJP, Rasburn NJ, Abdelnour-Berchtold E, Brunelli A, Cerfolio RJ, Gonzalez M, Ljungqvist O, Petersen RH, Popescu WM, Slinger PD, Naidu B. Guidelines for enhanced recovery after lung surgery: recommendations of the Enhanced Recovery After Surgery (ERAS®) Society and the European Society of Thoracic Surgeons (ESTS). Eur J Cardiothorac Surg 2018; 55:91-115. [DOI: 10.1093/ejcts/ezy301] [Citation(s) in RCA: 461] [Impact Index Per Article: 76.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 07/31/2018] [Indexed: 02/06/2023] Open
Affiliation(s)
- Timothy J P Batchelor
- Department of Thoracic Surgery, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Neil J Rasburn
- Department of Anaesthesia, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | | | | | - Robert J Cerfolio
- Department of Cardiothoracic Surgery, New York University Langone Health, New York, NY, USA
| | - Michel Gonzalez
- Division of Thoracic Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Olle Ljungqvist
- Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - René H Petersen
- Department of Thoracic Surgery, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Wanda M Popescu
- Department of Anesthesiology, Yale University School of Medicine, New Haven, CT, USA
| | - Peter D Slinger
- Department of Anesthesia, University Health Network – Toronto General Hospital, Toronto, ON, Canada
| | - Babu Naidu
- Department of Thoracic Surgery, Heart of England NHS Foundation Trust, Birmingham, UK
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Kumar A, Asaf BB, Puri HV, Sharma MK, Lingaraju VC, Rajput VS. Video-assisted thoracoscopic surgery lobectomy: The first Indian report. J Minim Access Surg 2018; 14:291-297. [PMID: 29319014 PMCID: PMC6130190 DOI: 10.4103/jmas.jmas_148_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 09/11/2017] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION The fear of pleural adhesions and densely stuck lymph nodes in India, a country where tuberculosis is endemic, is one major factor keeping our surgeons away from video-assisted thoracoscopic surgery (VATS) lobectomy. In this paper, we aim to report our experience with performing VATS lobectomy in 102 cases using a standardised three-port anterior approach. MATERIALS AND METHODS Between March 2012 and September 2016, we performed 102 VATS lobectomies. Sixty patients (58.8%) were males and 42 females (41.2%), with a mean age of 42.02 years. Diagnoses were as follows: benign disease (72), lung cancer (27) and pulmonary metastases (3). Among the cases with primary lung cancer, twenty out of 27 (74%) were adenocarcinoma and 7 cases of squamous carcinoma (25.92%). All patients underwent lobectomy by a standardised three-port anterior approach. RESULTS The overall conversion rate was 8.82% (n = 9). We observed no postoperative complications in 82 (80.4%) patients. The average blood loss was 211.37 ml. Mean operative time was 173 min. Median length of hospital stay was 5 with median chest tube duration of 4.9 days. There was no in hospital or 30-day mortality. The most common complication was prolonged air leak. CONCLUSION From this first Indian series, it is clear that VATS lobectomy is feasible in both benign and malignant cases. It also shows that the fear of adhesions is unwarranted and properly selected benign cases can also undergo VATS lobectomy safely.
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Affiliation(s)
- Arvind Kumar
- Centre for Chest Surgery, Sir Ganga Ram Hospital, New Delhi, India
| | - Belal Bin Asaf
- Centre for Chest Surgery, Sir Ganga Ram Hospital, New Delhi, India
| | | | | | | | - Vimesh S. Rajput
- Centre for Chest Surgery, Sir Ganga Ram Hospital, New Delhi, India
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80
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Varela G, Jiménez MF. Re: Digital chest drainage is better than traditional chest drainage following pulmonary surgery: a meta-analysis. Eur J Cardiothorac Surg 2018; 54:642-643. [PMID: 29668867 DOI: 10.1093/ejcts/ezy162] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Gonzalo Varela
- Thoracic Surgery Service, Salamanca University Hospital, Salamanca, Spain
| | - Marcelo F Jiménez
- Thoracic Surgery Service, Salamanca University Hospital, Salamanca, Spain
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81
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Plourde M, Jad A, Dorn P, Harris K, Mujoomdar A, Henteleff H, French D, Bethune D. Digital Air Leak Monitoring for Lung Resection Patients: A Randomized Controlled Clinical Trial. Ann Thorac Surg 2018; 106:1628-1632. [PMID: 30170011 DOI: 10.1016/j.athoracsur.2018.06.080] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 06/18/2018] [Accepted: 06/25/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Digital chest drainage devices objectively measure airflow to guide chest tube management. There are contradictory results regarding their utility in reducing length of stay and chest tube duration. The objective of this study was to compare digital and analog devices in patients undergoing anatomic lung resection. METHODS A single-institution randomized trial was conducted. Patients undergoing anatomic lung resection between November 2013 and July 2016 were randomized to digital or analog devices. Chest tubes were managed using a standardized protocol. Hospital length of stay and chest tube duration were primary outcomes. Chest tube clamping, number of chest roentgenograms, and chest tube reinsertion were secondary outcomes. RESULTS The study randomized 215 patients, with 107 in the digital group and 108 in the analog group. There was no significant difference in outcomes for length of stay (p = 1), chest tube duration (p = 0.71), number of chest roentgenograms performed (p = 0.78) or need for chest tube reinsertion (p = 0.21). The only significant finding was a higher number of patients who had their chest tubes clamped before removal, with 47% in the analog group and 19% in the digital group (p < 0.0001). CONCLUSIONS Digital devices did not result in reduced chest tube duration or hospital length of stay. Approximately one half of the patients in the analog group had their chest tubes clamped before removal because of uncertainty in air leak assessment. Digital devices provided objective quantification of air leaks that decreased chest tube clamping.
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Affiliation(s)
- Madelaine Plourde
- Division of Thoracic Surgery, Department of Surgery, Dalhousie University, Queen Elizabeth II Hospital - Victoria Campus, Halifax, Canada.
| | - Ahmed Jad
- Division of General Surgery, Department of Surgery, Dalhousie University, Queen Elizabeth II Hospital - Victoria Campus, Halifax, Canada
| | - Patrick Dorn
- Division of Thoracic Surgery, Department of Surgery, Dalhousie University, Queen Elizabeth II Hospital - Victoria Campus, Halifax, Canada
| | - Kyla Harris
- Division of Thoracic Surgery, Department of Surgery, Dalhousie University, Queen Elizabeth II Hospital - Victoria Campus, Halifax, Canada
| | - Aneil Mujoomdar
- Division of Thoracic Surgery, Department of Surgery, Dalhousie University, Queen Elizabeth II Hospital - Victoria Campus, Halifax, Canada
| | - Harry Henteleff
- Division of Thoracic Surgery, Department of Surgery, Dalhousie University, Queen Elizabeth II Hospital - Victoria Campus, Halifax, Canada
| | - Daniel French
- Division of Thoracic Surgery, Department of Surgery, Dalhousie University, Queen Elizabeth II Hospital - Victoria Campus, Halifax, Canada
| | - Drew Bethune
- Division of Thoracic Surgery, Department of Surgery, Dalhousie University, Queen Elizabeth II Hospital - Victoria Campus, Halifax, Canada
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82
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Shintani Y, Funaki S, Ose N, Kawamura T, Kanzaki R, Minami M, Okumura M. Air leak pattern shown by digital chest drainage system predict prolonged air leakage after pulmonary resection for patients with lung cancer. J Thorac Dis 2018; 10:3714-3721. [PMID: 30069369 DOI: 10.21037/jtd.2018.05.150] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background A common cause of complications after a pulmonary resection procedure is prolonged air leakage. Recently introduced digital drainage systems provide accurate recording of air leak data for later review. We investigated the clinical usefulness of the continuous stream of data recorded by such a device. Methods We analyzed data obtained from 299 patients with pulmonary malignancy who underwent a pulmonary resection procedure for lung cancer patients with use of a digital chest drainage system. Postoperative air leak patterns were divided into 4 groups and their correlation with prolonged air leakage after pulmonary resection was evaluated. Results The incidence of prolonged air leak was 10% (30/299). The postoperative air leak patterns noted in the present patients were divided into none (n=217, 73%), intermittent (n=21, 7%), decrease (n=40, 13%), and variable (n=21, 7%). The incidence of prolonged air leak in each group was 0.5% (1/217) in the none group, 24% (5/21) in the intermittent group, 20% (8/40) in the decrease group, and 76% (16/21) in the variable group. The amount of air leakage immediately after surgery was highest in the variable group. Patients in the intermittent and variable groups had longer durations of air leakage and chest tube placement. The frequency of postoperative interventional treatment was significantly higher in the variable group as compared to the others. Chest tube reinsertion for pneumothorax and increased subcutaneous emphysema after the initial chest tube removal was only seen in the intermittent group. Conclusions Advantages of digital drainage system use are continuous monitoring and recording capabilities, which show the detailed air leak pattern after pulmonary resection. That pattern can be used to predict the durations of air leakage and chest tube drainage, as well as for producing an air leak management algorithm.
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Affiliation(s)
- Yasushi Shintani
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Yamadaoka, Suita, Osaka, Japan
| | - Soichiro Funaki
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Yamadaoka, Suita, Osaka, Japan
| | - Naoko Ose
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Yamadaoka, Suita, Osaka, Japan
| | - Tomohiro Kawamura
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Yamadaoka, Suita, Osaka, Japan
| | - Ryu Kanzaki
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Yamadaoka, Suita, Osaka, Japan
| | - Masato Minami
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Yamadaoka, Suita, Osaka, Japan
| | - Meinoshin Okumura
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Yamadaoka, Suita, Osaka, Japan
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83
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Liu J, Li J, Cui F, Li S, He J. One-week recovery from bronchopleural fistula by combined techniques. J Thorac Dis 2018; 10:E431-E434. [PMID: 30069398 DOI: 10.21037/jtd.2018.05.99] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Jun Liu
- Department of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.,State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Diseases, Guangzhou 510120, China.,Guangzhou Institute of Respiratory Health (GIRH), Guangzhou 510120, China
| | - Jingpei Li
- Department of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.,State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Diseases, Guangzhou 510120, China.,Guangzhou Institute of Respiratory Health (GIRH), Guangzhou 510120, China
| | - Fei Cui
- Department of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.,State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Diseases, Guangzhou 510120, China.,Guangzhou Institute of Respiratory Health (GIRH), Guangzhou 510120, China
| | - Shiyue Li
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Diseases, Guangzhou 510120, China.,Guangzhou Institute of Respiratory Health (GIRH), Guangzhou 510120, China
| | - Jianxing He
- Department of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.,State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Diseases, Guangzhou 510120, China.,Guangzhou Institute of Respiratory Health (GIRH), Guangzhou 510120, China
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Zhou J, Lyu M, Chen N, Wang Z, Hai Y, Hao J, Liu L. Digital chest drainage is better than traditional chest drainage following pulmonary surgery: a meta-analysis. Eur J Cardiothorac Surg 2018; 54:635-643. [PMID: 29659768 DOI: 10.1093/ejcts/ezy141] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Accepted: 03/06/2018] [Indexed: 02/05/2023] Open
Affiliation(s)
- Jian Zhou
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Mengyuan Lyu
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Nan Chen
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Zihuai Wang
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Yang Hai
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Jianqi Hao
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Lunxu Liu
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
- Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung Cancer, Sichuan University, Chengdu, China
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85
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The impact of enhanced recovery after surgery (ERAS) protocol compliance on morbidity from resection for primary lung cancer. J Thorac Cardiovasc Surg 2018; 155:1843-1852. [DOI: 10.1016/j.jtcvs.2017.10.151] [Citation(s) in RCA: 89] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 10/12/2017] [Accepted: 10/24/2017] [Indexed: 02/07/2023]
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86
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Takamochi K, Nojiri S, Oh S, Matsunaga T, Imashimizu K, Fukui M, Suzuki K. Comparison of digital and traditional thoracic drainage systems for postoperative chest tube management after pulmonary resection: A prospective randomized trial. J Thorac Cardiovasc Surg 2018; 155:1834-1840. [DOI: 10.1016/j.jtcvs.2017.09.145] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 08/28/2017] [Accepted: 09/30/2017] [Indexed: 11/28/2022]
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87
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Sakata KK, Reisenauer JS, Kern RM, Mullon JJ. Persistent air leak - review. Respir Med 2018; 137:213-218. [DOI: 10.1016/j.rmed.2018.03.017] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Revised: 03/06/2018] [Accepted: 03/13/2018] [Indexed: 10/17/2022]
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88
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Affiliation(s)
- David Feller-Kopman
- From the Division of Pulmonary, Critical Care, and Sleep Medicine, Johns Hopkins University, Baltimore (D.F.-K.); and the Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University, Nashville (R.L.)
| | - Richard Light
- From the Division of Pulmonary, Critical Care, and Sleep Medicine, Johns Hopkins University, Baltimore (D.F.-K.); and the Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University, Nashville (R.L.)
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89
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External Suction and Fluid Output in Chest Drains After Lobectomy: A Randomized Clinical Trial. Ann Thorac Surg 2018; 105:393-398. [DOI: 10.1016/j.athoracsur.2017.08.048] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 07/27/2017] [Accepted: 08/24/2017] [Indexed: 11/17/2022]
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90
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Patella M, Saporito A, Puligheddu C, Mongelli F, La Regina D, Pini R, Inderbitzi R, Cafarotti S. Lung Ultrasound to Detect Residual Pneumothorax After Chest Drain Removal in Lung Resections. Ann Thorac Surg 2018; 105:1537-1542. [PMID: 29331648 DOI: 10.1016/j.athoracsur.2017.12.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 11/30/2017] [Accepted: 12/06/2017] [Indexed: 02/04/2023]
Abstract
BACKGROUND Indication for postdrain removal imaging after lung resection is debated. Chest roentgenogram (CR) is widely used to confirm lung expansion but not evidence based. We propose to introduce lung ultrasound (LUS) as alternative to exclude significant pneumothorax (PTx) in this setting. METHODS The study enrolled 50 patients undergoing lung resections. Inclusion criteria were complete expansion of the lung at postoperative CR, pleural effusion of less than 300 mL/24 h, air leak of 10 to 20 mL/min for 6 hours. Two hours after chest drain removal, LUS was performed at the second and third intercostal spaces to assess pleural sliding. Patients with no detected PTx or with apical PTx were considered for discharge. The same patients were blindly evaluated with CR by a second operator, and a comparison between the two methods was performed. Clinical decisions were taken based on CR results. RESULTS LUS confirmed large PTxs in 7 patients, apical PTxs in 10 patients, and no PTx in 33 patients. CR confirmed 5 of 7 significant PTxs (1 chest drain reinserted, 4 patients observed), and 2 of 7 PTx were considered irrelevant. Apical PTxs were confirmed in 8 of 10 patients, and in 2 patients there was no PTx at CR. The 33 patients with no PTx at LUS had full lung expansion at CR. LUS has a negative predictive value of 100% in excluding large PTxs and a positive predictive value of 71%. CONCLUSIONS In this subgroup of patients with air leak of 10 to 20 mL/min, performing an imaging study to verify the absence of PTx is desirable; however, when LUS confirms lung expansion or the presence of apical PTx, CR does not seem to be needed.
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Affiliation(s)
- Miriam Patella
- Department of Thoracic Surgery, San Giovanni Hospital, Bellinzona, Switzerland.
| | - Andrea Saporito
- Perioperative Medicine Research Group, San Giovanni Hospital, Bellinzona, Switzerland
| | - Carla Puligheddu
- Department of Radiology, San Giovanni Hospital, Bellinzona, Switzerland
| | - Francesco Mongelli
- Department of Thoracic Surgery, San Giovanni Hospital, Bellinzona, Switzerland
| | - Davide La Regina
- Perioperative Medicine Research Group, San Giovanni Hospital, Bellinzona, Switzerland
| | - Ramon Pini
- Department of Thoracic Surgery, San Giovanni Hospital, Bellinzona, Switzerland
| | - Rolf Inderbitzi
- Department of Thoracic Surgery, San Giovanni Hospital, Bellinzona, Switzerland
| | - Stefano Cafarotti
- Department of Thoracic Surgery, San Giovanni Hospital, Bellinzona, Switzerland
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91
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Yan S, Wang X, Wang Y, Lv C, Wang Y, Wang J, Yang Y, Wu N. Intermittent chest tube clamping may shorten chest tube drainage and postoperative hospital stay after lung cancer surgery: a propensity score matching analysis. J Thorac Dis 2017; 9:5061-5067. [PMID: 29312711 DOI: 10.21037/jtd.2017.11.08] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background Postoperative pleural drainage markedly influences the length of hospital stay and the financial costs of medical care. The safety of chest tube clamping before removal has been documented. This study aims to determine if intermittent chest tube clamping shortens the duration of chest tube drainage and hospital stay after lung cancer surgery. Methods We retrospectively analyzed 285 consecutive patients with operable lung cancer treated using lobectomy and systematic mediastinal lymphadenectomy. The chest tube management protocol in our institution was changed in January 2014, and thus, 222 patients (clamping group) were managed with intermittent chest tube clamping, while 63 patients (control group) were managed with a traditional protocol. Propensity score matching at a 1:1 ratio was applied to balance variables potentially affecting the duration of chest tube drainage. Analyses were performed to compare drainage duration and postoperative hospital stay between the two groups in the matched cohort. Multivariate logistic regression analyses were performed to predict the factors associated with chest tube drainage duration. Results The rates of thoracocentesis after chest tube removal were similar between the clamping and control groups in the whole cohort (0.5% vs. 1.6%, P=0.386). The rates of pyrexia were also comparable in the two groups (2.3% vs. 3.2%, P=0.685). After propensity score matching, 61 cases remained in each group. Both chest tube drainage duration (3.9 vs. 4.8 days, P=0.001) and postoperative stay (5.7 vs. 6.4 days, P=0.025) were significantly shorter in the clamping group than in the control group. Factors significantly associated with shorter chest tube drainage duration were female sex, chest tube clamping, left lobectomy, and video-assisted thoracoscopic surgery (VATS) (P<0.05). Conclusions Intermittent postoperative chest tube clamping may decrease the duration of chest tube drainage and postoperative hospital stay while maintaining patient safety.
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Affiliation(s)
- Shi Yan
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Thoracic Surgery II, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Xing Wang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Thoracic Surgery II, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Yaqi Wang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Thoracic Surgery II, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Chao Lv
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Thoracic Surgery II, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Yuzhao Wang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Thoracic Surgery II, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Jia Wang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Thoracic Surgery II, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Yue Yang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Thoracic Surgery II, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Nan Wu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Thoracic Surgery II, Peking University Cancer Hospital & Institute, Beijing 100142, China
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92
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Baringer K, Talbert S. Chest drainage systems and management of air leaks after a pulmonary resection. J Thorac Dis 2017; 9:5399-5403. [PMID: 29312751 DOI: 10.21037/jtd.2017.11.15] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
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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Affiliation(s)
- Kristina Baringer
- Division of Cardiothoracic Surgery, Florida Hospital, University of Central Florida, Orlando, FL, USA
| | - Steve Talbert
- UCF College of Nursing, University of Central Florida, Orlando, FL, USA
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93
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Mori R, Yamazaki K, Shoji F, Kouso H, Ushijima C, Miura N, Takenaka T, Takeo S. Assessment of pleural air leakage using digital chest drainage system after surgical pulmonary resection: Comparison of visible alveolar air leakage with the digital value measured by a digital chest drainage system. PLoS One 2017; 12:e0187705. [PMID: 29107948 PMCID: PMC5673177 DOI: 10.1371/journal.pone.0187705] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 10/24/2017] [Indexed: 11/24/2022] Open
Abstract
Background The sensitivity of postoperative pleural air leakage (PAL) after pulmonary resection is evaluated by a simple subjective grading method in clinical practice. A new electronic digital chest drainage evaluation system (DCS) recently became clinically available. This study was designed to evaluate the clinical application of the DCS in monitoring the airflow volume and managing postoperative PAL. Methods We prospectively enrolled 25 patients who underwent pulmonary resection. Postoperative PAL was evaluated using both conventional PAL grading based on the physician’s visual judgment (analog chest drainage evaluation system [ACS]: Level 0 = no leakage to 4 = continuous leakage) and the DCS. The DCS digital measurement was recorded as the flow volume (ml/min), which was taken once daily from postoperative day 1 to the day of chest drainage tube removal. Results In total, 45 measurements were performed on 25 patients during the evaluation period. Postoperative PAL was observed in five patients (20.0%) and judged as ACS Level >1. The mean DCS values corresponding to ACS Levels 0, 1, 2, and 3 were 2.42 (0.0–11.3), 48.6 (35.4–67.9), 95.6 (79.7–111.5), and 405.3 (150.3–715.6), respectively. The Spearman correlation test showed a significant positive correlation between the ACS PAL level and DCS flow volume (R = 0.8477, p < 0.001). Conclusions A relationship between the visual PAL level by the ACS and the digital value by the DCS was identified in this study. The numeric volume obtained by the DCS has been successful in information-sharing with all staff. The digital PAL value evaluated by the DCS is appropriate, and the use of the DCS is promising in the treatment of postoperative PAL after pulmonary resection.
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Affiliation(s)
- Ryo Mori
- Department of Thoracic Surgery, Clinical Research Institute, National Hospital Organization, Kyusyu Medical Center, Fukuoka, Japan
| | - Koji Yamazaki
- Department of Thoracic Surgery, Clinical Research Institute, National Hospital Organization, Kyusyu Medical Center, Fukuoka, Japan
- * E-mail:
| | - Fumihiro Shoji
- Department of Thoracic Surgery, Clinical Research Institute, National Hospital Organization, Kyusyu Medical Center, Fukuoka, Japan
| | - Hidenori Kouso
- Department of Thoracic Surgery, Clinical Research Institute, National Hospital Organization, Kyusyu Medical Center, Fukuoka, Japan
| | - Chie Ushijima
- Department of Thoracic Surgery, Clinical Research Institute, National Hospital Organization, Kyusyu Medical Center, Fukuoka, Japan
| | - Naoko Miura
- Department of Thoracic Surgery, Clinical Research Institute, National Hospital Organization, Kyusyu Medical Center, Fukuoka, Japan
| | - Tomoyoshi Takenaka
- Department of Thoracic Surgery, Clinical Research Institute, National Hospital Organization, Kyusyu Medical Center, Fukuoka, Japan
| | - Sadanori Takeo
- Department of Thoracic Surgery, Clinical Research Institute, National Hospital Organization, Kyusyu Medical Center, Fukuoka, Japan
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94
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Ding M, Gao YD, Zeng XT, Guo Y, Yang J. Endobronchial one-way valves for treatment of persistent air leaks: a systematic review. Respir Res 2017; 18:186. [PMID: 29110704 PMCID: PMC5674238 DOI: 10.1186/s12931-017-0666-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2017] [Accepted: 10/18/2017] [Indexed: 11/10/2022] Open
Abstract
Persistent air leak (PAL) is associated with significant morbidity and mortality, prolonged hospitalization and increased health-care costs. It can arise from a number of conditions, including pneumothorax, necrotizing infection, trauma, malignancies, procedural interventions and complications after thoracic surgery. Numerous therapeutic options, including noninvasive and invasive techniques, are available to treat PALs. Recently, endobronchial one-way valves have been used to treat PAL. We conducted a systematic review based on studies retrieved from PubMed, EMbase and Cochrane library. We also did a hand-search in the bibliographies of relevant articles for additional studies. 34 case reports and 10 case series comprising 208 patients were included in our review. Only 4 patients were children, most of the patients were males. The most common underlying disease was COPD, emphysema and cancer. The most remarkable cause was pneumothorax. The upper lobes were the most frequent locations of air leaks. Complete resolution was gained within less than 24 h in majority of patients. Complications were migration or expectoration of valves, moderate oxygen desaturation and infection of related lung. No death related to endobronchial one-way valves implantation has been found. The use of endobronchial one-way valve adds to the armamentarium for non-invasive treatments of challenging PAL, especially those with difficulties of anesthesia, poor condition and high morbidity. Nevertheless, prospective randomized control trials with large sample should be needed to further evaluate the effects and safety of endobronchial one-way valve implantation in the treatment of PAL.
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Affiliation(s)
- Mei Ding
- Department of Respiratory Medicine, Zhongnan Hospital of Wuhan University, Donghu Road 169, Wuhan, 430071, People's Republic of China
| | - Ya-Dong Gao
- Department of Respiratory Medicine, Zhongnan Hospital of Wuhan University, Donghu Road 169, Wuhan, 430071, People's Republic of China.
| | - Xian-Tao Zeng
- Center for Evidence-based and Translational Medicine, Zhongnan Hospital of Wuhan University, Donghu Road 169, Wuhan, 430071, People's Republic of China
| | - Yi Guo
- Center for Evidence-based and Translational Medicine, Zhongnan Hospital of Wuhan University, Donghu Road 169, Wuhan, 430071, People's Republic of China
| | - Jiong Yang
- Department of Respiratory Medicine, Zhongnan Hospital of Wuhan University, Donghu Road 169, Wuhan, 430071, People's Republic of China
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95
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Abstract
PURPOSE OF REVIEW The method for identification of alveolopleural fistulae (APF) by visual inspection of air bubbles in the chest drainage system has several limitations and suffers from poor accuracy. Here we discuss the use of a novel technique of pleural gas analysis in the identification and management of APF. RECENT FINDINGS We found that pleural gas analysis has higher sensitivity and specificity than visual inspection in identifying APF. Additionally, we demonstrated that intrapleural gas milieu impacts lung healing and reduction of intrapleural carbon dioxide can promote resolution of APF. SUMMARY Pleural gas analysis is a novel technique to identify and manage APF. Integration of gas analysis in chest drainage systems would provide a more objective method for managing chest tubes and providing a favorable pleural gas environment for lung healing.
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96
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Gao S, Zhang Z, Aragón J, Brunelli A, Cassivi S, Chai Y, Chen C, Chen C, Chen G, Chen H, Chen JS, Cooke DT, Downs JB, Falcoz PE, Fang W, Filosso PL, Fu X, Force SD, Garutti MI, Gonzalez-Rivas D, Gossot D, Hansen HJ, He J, He J, Holbek BL, Hu J, Huang Y, Ibrahim M, Imperatori A, Ismail M, Jiang G, Jiang H, Jiang Z, Kim HK, Li D, Li G, Li H, Li Q, Li X, Li Y, Li Z, Lim E, Liu CC, Liu D, Liu L, Liu Y, Lobdell KW, Ma H, Mao W, Mao Y, Mou J, Ng CSH, Novoa NM, Petersen RH, Oizumi H, Papagiannopoulos K, Pompili C, Qiao G, Refai M, Rocco G, Ruffini E, Salati M, Seguin-Givelet A, Sihoe ADL, Tan L, Tan Q, Tong T, Tsakiridis K, Venuta F, Veronesi G, Villamizar N, Wang H, Wang Q, Wang R, Wang S, Wright GM, Xie D, Xue Q, Xue T, Xu L, Xu S, Xu S, Yan T, Yu F, Yu Z, Zhang C, Zhang L, Zhang T, Zhang X, Zhao X, Zhao X, Zhi X, Zhou Q. The Society for Translational Medicine: clinical practice guidelines for the postoperative management of chest tube for patients undergoing lobectomy. J Thorac Dis 2017; 9:3255-3264. [PMID: 29221303 PMCID: PMC5708414 DOI: 10.21037/jtd.2017.08.165] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The Society for Translational Medicine and The Chinese Society for Thoracic and Cardiovascular Surgery conducted a systematic review of the literature in an attempt to improve our understanding in the postoperative management of chest tubes of patients undergoing pulmonary lobectomy. Recommendations were produced and classified based on an internationally accepted GRADE system. The following recommendations were extracted in the present review: (I) chest tubes can be removed safely with daily pleural fluid of up to 450 mL (non-chylous and non-sanguinous), which may reduce chest tube duration and hospital length of stay (2B); (II) in rare instances, e.g., persistent abundant fluid production, the use of PrRP/B <0.5 when evaluating fluid output to determine chest tube removal might be beneficial (2B); (III) it is recommended that one chest tube is adequate following pulmonary lobectomy, except for hemorrhage and space problems (2A); (IV) chest tube clearance by milking and stripping is not recommended after lung resection (2B); (V) chest tube suction is not necessary for patients undergoing lobectomy after first postoperative day (2A); (VI) regulated chest tube suction [-11 (-1.08 kPa) to -20 (1.96 kPa) cmH2O depending upon the type of lobectomy] is not superior to regulated seal [-2 (0.196 kPa) cmH2O] when electronic drainage systems are used after lobectomy by thoracotomy (2B); (VII) chest tube removal recommended at the end of expiration and may be slightly superior to removal at the end of inspiration (2A); (VIII) electronic drainage systems are recommended in the management of chest tube in patients undergoing lobectomy (2B).
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Affiliation(s)
- Shugeng Gao
- Department of Thoracic Surgical Oncology, Cancer Institute & Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College; National Cancer Center, Beijing 100021, China
| | - Zhongheng Zhang
- Department of Emergency Medicine, Sir Run-Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China
| | | | | | | | - Ying Chai
- Department of Thoracic Surgery, Second Affiliated Hospital, Medical College of Zhejiang University, Hangzhou 310009, China
| | - Chang Chen
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Shanghai 200433, China
| | - Chun Chen
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fujian 350001, China
| | - Gang Chen
- Department of Thoracic Surgery, Guangdong General Hospital, Guangzhou 510080, China
| | - Haiquan Chen
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai 200030, China
| | - Jin-Shing Chen
- Department of Anesthesiology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei 10002, Taiwan
| | - David Tom Cooke
- Section of General Thoracic Surgery, University of California, Davis Health System, Sacramento, CA, USA
| | - John B. Downs
- Department of Anesthesiology and Critical Care Medicine, University of Florida, Gainesville, FL, USA
| | | | - Wentao Fang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai 200030, China
| | | | - Xiangning Fu
- Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Seth D. Force
- Cardiothoracic Surgery, Emory University, The Emory Clinic, Atlanta, GA, USA
| | - Martínez I. Garutti
- Department of Anaesthesia and Postoperative Care, Hospital General Universitario Gregorio Marañon, Madrid, Spain
| | | | - Dominique Gossot
- Department of Thoracic Surgery, Institut Mutualiste Montsouris, Paris, France
| | - Henrik Jessen Hansen
- Department of Cardiothoracic Surgery, Rigshospitalet (National University Hospital), Copenhagen, Denmark
| | - Jianxing He
- Department of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510000, China
- Guangzhou Institute of Respiratory Disease & China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, Guangzhou 510000, China
| | - Jie He
- Department of Thoracic Surgical Oncology, Cancer Institute & Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College; National Cancer Center, Beijing 100021, China
| | - Bo Laksáfoss Holbek
- Department of Cardiothoracic Surgery and Section for Surgical Pathophysiology, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Jian Hu
- Department of Thoracic Surgery, First Affiliated Hospital, Medical College of Zhejiang University, Hangzhou 310003, China
| | - Yunchao Huang
- Department of Thoracic Surgery, Yunnan Cancer Hospital, Kunming 650100, China
| | - Mohsen Ibrahim
- Division of Thoracic Surgery, Faculty of Medicine and Psychology, Sant’Andrea Hospital, University of Rome ‘Sapienza’, Rome, Italy
| | - Andrea Imperatori
- Center for Thoracic Surgery, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Mahmoud Ismail
- Charité Kompetenzzentrum für Thoraxchirurgie, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Gening Jiang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Shanghai 200433, China
| | - Hongjing Jiang
- Department of Esophageal Oncology, Tianjin Medical University Cancer Institute and Hospital, Tianjin 300060, China
| | - Zhongmin Jiang
- Department of Thoracic Surgery, Shandong Qianfoshan Hospital, Jinan 250014, China
| | - Hyun Koo Kim
- Department of Thoracic and Cardiovascular Surgery, College of Medicine, Korea University Guro Hospital, Seoul, Korea
| | - Danqing Li
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Beijing 100032, China
| | - Gaofeng Li
- Department of Thoracic Surgery, Yunnan Cancer Hospital, Kunming 650100, China
| | - Hui Li
- Department of Thoracic Surgery, Beijing Chaoyang Hospital, Beijing 100049, China
| | - Qiang Li
- Department of Thoracic Surgery, Sichuan Cancer Hospital and Institute, Chengdu 610041, China
| | - Xiaofei Li
- Department of Thoracic Surgery, Tangdu Hospital Fourth Military Medical University, Xi’an 710038, China
| | - Yin Li
- Henan Cancer Hospital, Zhengzhou 450008, China
| | - Zhijun Li
- Department of Thoracic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China
| | - Eric Lim
- Imperial College and The Academic Division of Thoracic Surgery, Royal Brompton Hospital, Sydney Street, London, UK
| | - Chia-Chuan Liu
- Division of Thoracic Surgery, Department of Surgery, Sun Yat-Sen Cancer Center, Taipei, Taiwan
| | - Deruo Liu
- Department of Thoracic Surgery, China and Japan Friendship Hospital, Beijing 100029, China
| | - Lunxu Liu
- Department of Cardiovascular and Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Yongyi Liu
- Department of Thoracic Surgery, Liaoning Cancer Hospital and Institute, Shengyang 110042, China
| | - Kevin W. Lobdell
- Department of Thoracic and Cardiovascular Surgery, Sanger Heart and Vascular Institute, Carolinas Medical Center, Charlotte, NC, USA
| | - Haitao Ma
- Department of Thoracic Surgery, The First Hospital Affiliated to Soochow University, Suzhou 215000, China
| | - Weimin Mao
- Department of Thoracic Surgery, Zhejiang Cancer Hospital, Hangzhou 310000, China
| | - Yousheng Mao
- Department of Thoracic Surgical Oncology, Cancer Institute & Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College; National Cancer Center, Beijing 100021, China
| | - Juwei Mou
- Department of Thoracic Surgical Oncology, Cancer Institute & Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College; National Cancer Center, Beijing 100021, China
| | - Calvin Sze Hang Ng
- Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, N.T., Hong Kong, China
| | - Nuria M. Novoa
- Thoracic Surgery Service, University Hospital of Salamanca, Paseo de San Vicente 58-182, 37007 Salamanca, Spain
| | - René H. Petersen
- Department of Cardiothoracic Surgery, Rigshospitalet (National University Hospital), Copenhagen, Denmark
| | - Hiroyuki Oizumi
- Second Department of Surgery, Yamagata University Faculty of Medicine, Yamagata, Japan
| | | | - Cecilia Pompili
- Department of Thoracic Surgery, St. James’s University Hospital, Leeds, UK
- Leeds Institute of Cancer and Pathology, Leeds, UK
| | - Guibin Qiao
- Department of Thoracic Surgery, Guangzhou General Hospital of Guangzhou Military Area Command, Guangzhou 510000, China
| | - Majed Refai
- Thoracic Surgery Department, United Hospitals of Ancona, Via San Vincenzo 5/f Polverigi, Ancona, Italy
| | - Gaetano Rocco
- Department of Thoracic Surgery and Oncology, National Cancer Institute, Pascale Foundation, Naples, Italy
| | - Erico Ruffini
- Department of Thoracic Surgery, University of Torino, Torino, Italy
| | - Michele Salati
- Unit of Thoracic Surgery, Ospedali Riuniti Ancona, Ancona, Italy
| | | | - Alan Dart Loon Sihoe
- Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Lijie Tan
- Department of Thoracic Surgery, Shanghai Zhongshan Hospital of Fudan University, Shanghai 200032, China
| | - Qunyou Tan
- Department of Thoracic Surgery, Daping Hospital, Research Institute of Surgery Third Military Medical University, Chongqing 400042, China
| | - Tang Tong
- Department of Thoracic Surgery, Second Affiliated Hospital of Jilin University, Changchun 130041, China
| | - Kosmas Tsakiridis
- Cardiac and Thoracic Department, Private Hospital “St.Lukes”, Thessaloniki, Greece
| | - Federico Venuta
- Department of Surgery “Paride Stefanini” - Thoracic Surgery Unit, Policlinico Umberto I, University of Rome SAPIENZA, Rome, Italy
| | - Giulia Veronesi
- Robotic Surgery, Division of Thoracic Surgery, Humanitas Research Hospital, Via Manzoni 56, Rozzano, Italy
| | | | - Haidong Wang
- Department of Thoracic Surgery, Southwest Hospital, Third Military Medical University, Chongqing 400038, China
| | - Qun Wang
- Department of Thoracic Surgery, Shanghai Zhongshan Hospital of Fudan University, Shanghai 200032, China
| | - Ruwen Wang
- Department of Thoracic Surgery, Daping Hospital, Research Institute of Surgery Third Military Medical University, Chongqing 400042, China
| | - Shumin Wang
- Department of Thoracic Surgery, General Hospital of Shenyang Military Area, Shenyang 110015, China
| | - Gavin M. Wright
- Department of Surgical Oncology, St Vincent’s Hospital, Melbourne, Australia
- Department of Surgery, St Vincent’s Hospital, University of Melbourne, Melbourne, Australia
- Division of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Deyao Xie
- Department of Cardiovascular and Thoracic Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Qi Xue
- Department of Thoracic Surgical Oncology, Cancer Institute & Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College; National Cancer Center, Beijing 100021, China
| | - Tao Xue
- Department of Thoracic Surgery, Zhongda Hospital Affiliated to Southeast University, Nanjing 210009, China
| | - Lin Xu
- Department of Thoracic Surgery, Jiangsu Cancer Hospital, Nanjing 210008, China
| | - Shidong Xu
- Department of Thoracic Surgery, Heilongjiang Cancer Hospital, Harbin 150049, China
| | - Songtao Xu
- Department of Thoracic Surgery, Shanghai Zhongshan Hospital of Fudan University, Shanghai 200032, China
| | - Tiansheng Yan
- Department of Thoracic Surgery, Peking University Third Hospital, Beijing 100083, China
| | - Fenglei Yu
- Department of Cardiovascular Surgery, Second Xiangya Hospital of Central South University, Changsha 410011, China
| | - Zhentao Yu
- Department of Esophageal Oncology, Tianjin Medical University Cancer Institute and Hospital, Tianjin 300060, China
| | - Chunfang Zhang
- Department of Thoracic Surgery, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Lanjun Zhang
- Cancer Center, San Yat-sen University, Guangzhou 510060, China
| | - Tao Zhang
- Department of Thoracic Surgery, The First Affiliated Hospital of Xinjiang Medical Hospital, Urumqi 830011, China
| | - Xun Zhang
- Department of Thoracic Surgery, Tanjin Chest Hospital, Tianjin 300300, China
| | - Xiaojing Zhao
- Department of Thoracic Surgery, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200003, China
| | - Xuewei Zhao
- Department of Thoracic Surgery, Shanghai Changzheng Hospital, Shanghai 200000, China
| | - Xiuyi Zhi
- Department of Thoracic Surgery, Xuanwu Hospital of Capital University of Medical Sciences, Beijing 100053, China
| | - Qinghua Zhou
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
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97
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Holbek BL, Petersen RH, Kehlet H, Hansen HJ. Early pleural fluid dynamics following video-assisted thoracoscopic lobectomy has limited clinical value. J Thorac Dis 2017; 9:2204-2208. [PMID: 28840021 DOI: 10.21037/jtd.2017.06.107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The objective of this study was to evaluate the potential of predicting the pleural fluid output in patients after video-assisted thoracoscopic lobectomy of the lung. Detailed measurements of continuous fluid output were obtained prospectively using an electronic thoracic drainage device (Thopaz+™, Medela AG, Switzerland). Patients were divided into high (≥500 mL) and low (<500 mL) 24-hour fluid output, and detailed flow curves were plotted graphically to identify arithmetic patterns predicting fluid output in the early (≤24 hours) and later (24-48 hours) post-operative phase. Furthermore, multiple logistic regression analysis was used to predict high 24-hour fluid output using baseline data. Data were obtained from 50 patients, where 52% had a fluid output of <500 mL/24 hours. From visual assessment of flow curves, patients were grouped according to fluid output 6 hours postoperatively. An output ≥200 mL/6 hours was predictive of 'high 24-hour fluid output' (P<0.0001). However, 33% of patients with <200 mL/6 hours ended with a 'high 24-hour fluid output'. Baseline data showed no predictive value of fluid production, and 24-hour fluid output had no predictive value of fluid output between 24 and 48 hours. Assessment of initial fluid production may predict high 24-hour fluid output (≥500 mL) but seems to lack clinical value in drain removal criteria.
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Affiliation(s)
- Bo Laksáfoss Holbek
- Department of Cardiothoracic Surgery, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark.,Section for Surgical Pathophysiology, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - René Horsleben Petersen
- Department of Cardiothoracic Surgery, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Henrik Kehlet
- Section for Surgical Pathophysiology, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Henrik Jessen Hansen
- Department of Cardiothoracic Surgery, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
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98
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Arai H, Tajiri M, Kameda Y, Shiino K, Ando K, Okudela K, Masuda M. Evaluation of a digital drainage system (Thopaz) in over 250 cases at a single site: A retrospective case-control study. CLINICAL RESPIRATORY JOURNAL 2017; 12:1454-1459. [PMID: 28776940 DOI: 10.1111/crj.12683] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 05/29/2017] [Accepted: 07/10/2017] [Indexed: 11/27/2022]
Abstract
PURPOSE The aim of this study was to evaluate the efficacy of the Thopaz system, a new drainage system in management of general thoracic surgery, based on a review of our clinical practice and a comparison of the utility of the Thopaz device compared with a standard drainage system. METHODS A review of 540 thoracic surgeries at our hospital was performed. These cases were divided into 275 treated with the Thopaz system from April 2014 to March 2015 and 265 treated with a standard system from April 2013 to March 2014. The characteristics of patients and outcomes after surgery were compared in these 2 groups. RESULTS The characteristics of the patients were similar in the 2 groups. Outcomes after surgery, including types of operation, period of chest tube placement, chest tube reinsertion rate and clamping test rate also did not differ significantly between the groups. CONCLUSIONS The non-inferiority of the Thopaz system compared to a standard system was verified statistically. With advantages of providing objective data as a small portable system, in addition to the quietness of the unit and the ease of setup and operation, Thopaz system is likely to become mainstream in postoperative management in general thoracic surgery.
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Affiliation(s)
- Hiromasa Arai
- Department of General Thoracic Surgery, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan
| | - Michihiko Tajiri
- Department of General Thoracic Surgery, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan
| | - Yohei Kameda
- Department of General Thoracic Surgery, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan
| | - Kimihisa Shiino
- Department of General Thoracic Surgery, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan
| | - Kohei Ando
- Department of General Thoracic Surgery, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan
| | - Koji Okudela
- Department of Pathology, Yokohoma City University Graduate School of Medicine, Yokohama, Japan
| | - Munetaka Masuda
- Department of Surgery, Yokohoma City University Graduate School of Medicine, Yokohama, Japan
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99
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Guerrera F, Renaud S, Tabbò F, Filosso PL. How to design a randomized clinical trial: tips and tricks for conduct a successful study in thoracic disease domain. J Thorac Dis 2017; 9:2692-2696. [PMID: 28932577 DOI: 10.21037/jtd.2017.06.147] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Randomized controlled trials (RCTs) are considered one of the highest level of evidence in clinical practice, due to their strong confidence and robustness in producing data. The "randomization" (e.g., allocating patients randomly in each group of the study) allows eliminating many pre-analytical differences that might bias the entire study. Nevertheless, RCTs aren't free of internal pitfalls that might make them not easy to be developed or utilized. Our objective is to explain RCT management difficulties and suggest certain tips useful for the design of a RCT in thoracic disease domain. In particular have a realistic timeline, define a clear objective and precise endpoints, balance the study with a correct randomization and focus on the right equilibrium between strict selection criteria and more heterogeneous parameters are key elements that help researchers assuring a strong scientific validity.
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Affiliation(s)
| | - Stéphane Renaud
- Department of Thoracic Surgery, Nancy University Hospital, Nancy, France
| | - Fabrizio Tabbò
- Department of Oncology, University of Torino, Torino, Italy
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100
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De Waele M, Agzarian J, Hanna WC, Schieman C, Finley CJ, Macri J, Schneider L, Schnurr T, Farrokhyar F, Radford K, Nair P, Shargall Y. Does the usage of digital chest drainage systems reduce pleural inflammation and volume of pleural effusion following oncologic pulmonary resection?-A prospective randomized trial. J Thorac Dis 2017; 9:1598-1606. [PMID: 28740674 DOI: 10.21037/jtd.2017.05.78] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
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 sub-lobar 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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Affiliation(s)
- Michèle De Waele
- Department of Surgery, McMaster University, St. Joseph's Healthcare Hamilton, Hamilton, ON L8N 4A6, Canada
| | - John Agzarian
- Department of Surgery, McMaster University, St. Joseph's Healthcare Hamilton, Hamilton, ON L8N 4A6, Canada
| | - Waël C Hanna
- Department of Surgery, McMaster University, St. Joseph's Healthcare Hamilton, Hamilton, ON L8N 4A6, Canada
| | | | - Christian J Finley
- Department of Surgery, McMaster University, St. Joseph's Healthcare Hamilton, Hamilton, ON L8N 4A6, Canada
| | - Joseph Macri
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton General Hospital, Hamilton, ON L8L 2X2, Canada
| | - Laura Schneider
- Department of Surgery, McMaster University, St. Joseph's Healthcare Hamilton, Hamilton, ON L8N 4A6, Canada
| | - Terri Schnurr
- Department of Surgery, McMaster University, St. Joseph's Healthcare Hamilton, Hamilton, ON L8N 4A6, Canada
| | - Forough Farrokhyar
- Department of Surgery, McMaster University, St. Joseph's Healthcare Hamilton, Hamilton, ON L8N 4A6, Canada.,Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON L8S 4L8, Canada
| | - Katherine Radford
- Department of Medicine, McMaster University, St. Joseph's Healthcare Hamilton, Hamilton, ON L8N 4A6, Canada
| | - Parameswaran Nair
- Department of Medicine, McMaster University, St. Joseph's Healthcare Hamilton, Hamilton, ON L8N 4A6, Canada
| | - Yaron Shargall
- Department of Surgery, McMaster University, St. Joseph's Healthcare Hamilton, Hamilton, ON L8N 4A6, Canada
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