1
|
Pfeuty K, Rojas D, Iquille J, Lenot B. Postoperative day 1 discharge following subxiphoid thoracoscopic anatomical lung resection: a single-centre, postoperative enhanced recovery experience. Eur J Cardiothorac Surg 2024; 65:ezae230. [PMID: 38857446 DOI: 10.1093/ejcts/ezae230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 11/29/2023] [Accepted: 05/31/2024] [Indexed: 06/12/2024] Open
Abstract
OBJECTIVES The goal of this study was to assess the safety and quality of recovery (QOR) after discharge on postoperative day (POD) 1 following subxiphoid thoracoscopic anatomical lung resection within an advanced Enhanced Recovery After Surgery (ERAS) program. METHODS A retrospective analysis of prospectively collected data was conducted. Characteristics, perioperative and outcome data, compliance with ERAS pathways and a home-transition QOR survey were analysed using a multivariable logistic regression model. RESULTS From January 2020 to January 2022, a total of 201 consecutive patients underwent subxiphoid multiportal thoracoscopic anatomical lung resection, comprising 108 lobectomies and 93 sublobar resections (SLRs) (59 complex SLRs and 34 simple SLRs). Among them, 113 patients (56%) were discharged on POD 1, 49% after a lobectomy, 59% after a simple sublobar resection and 68% after a complex sublobar resection. In the multivariable analysis, age > 74 years and duration of the operation were associated with discharge after POD 1, whereas forced expiratory volume in 1 s and complex SLRs were associated with discharge on POD 1. Chest tube removal was achieved on POD 0 in 58 patients (29%), and 138 patients (69%) were free from a chest tube on POD 1. There were 13% with in-hospital morbidity, 10% with 90-day readmission (7% after POD 1 discharge and 14% in patients discharged after POD 1), and 0.5% with 90-day mortality. Patients discharged on POD 1 showed better compliance with the ERAS pathway with early chest tube removal and opioid-free analgesia. The home-transition QOR survey reported a better experience of returning home after discharge on POD 1 and similar pain scores. CONCLUSIONS Postoperative day 1 discharge can be safely achieved in appropriately selected patients after subxiphoid thoracoscopic anatomical lung resection, with excellent outcomes and high quality of recovery, supported by early chest tube removal as a determinant ERAS pathway.
Collapse
Affiliation(s)
- Karel Pfeuty
- Department of Thoracic and Vascular Surgery, Yves Le Foll Hospital, Saint-Brieuc, France
| | - Dorian Rojas
- Department of Cardiovascular and Thoracic Surgery, Pontchaillou University Hospital, Rennes, France
| | - Jules Iquille
- Department of Thoracic and Vascular Surgery, Yves Le Foll Hospital, Saint-Brieuc, France
| | - Bernard Lenot
- Department of Thoracic and Vascular Surgery, Yves Le Foll Hospital, Saint-Brieuc, France
| |
Collapse
|
2
|
Lobdell KW, Perrault LP, Drgastin RH, Brunelli A, Cerfolio RJ, Engelman DT. Drainology: Leveraging research in chest-drain management to enhance recovery after cardiothoracic surgery. JTCVS Tech 2024; 25:226-240. [PMID: 38899104 PMCID: PMC11184673 DOI: 10.1016/j.xjtc.2024.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 03/18/2024] [Accepted: 04/01/2024] [Indexed: 06/21/2024] Open
Affiliation(s)
- Kevin W. Lobdell
- Sanger Heart & Vascular Institute, Wake Forest University School of Medicine, Advocate Health, Charlotte, NC
| | - Louis P. Perrault
- Montréal Heart Institute, Université de Montréal, Montréal, Quebec, Canada
| | | | - Alessandro Brunelli
- Department of Thoracic Surgery, Leeds Teaching Hospitals, Leeds, United Kingdom
| | | | - Daniel T. Engelman
- Heart & Vascular Program, Baystate Health, University of Massachusetts Chan Medical, School-Baystate, Springfield, Mass
| |
Collapse
|
3
|
Geraci TC, McCormack AJ, Cerfolio RJ. Discharging Patients Home With a Chest Tube and Digital System After Robotic Lung Resection. Ann Thorac Surg 2024:S0003-4975(24)00378-3. [PMID: 38789008 DOI: 10.1016/j.athoracsur.2024.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Revised: 04/22/2024] [Accepted: 05/06/2024] [Indexed: 05/26/2024]
Abstract
BACKGROUND Our objective is to assess the feasibility, safety, and outcomes for patients discharged home with a chest tube connected to a digital drainage system after robotic pulmonary resection. METHODS This was a retrospective analysis of a prospectively collected database as a quality improvement initiative. All patients had planned discharge on postoperative day one (POD1) after robotic pulmonary resection. Those with an air leak were discharge home with a chest tube connected to a digital drainage system with daily communication with the surgeon. RESULTS From January 2019 to February 2023 there were 580 consecutive robotic resections, of which 69 (12%) patients had an air leak on POD1; 38 of 276 (14%) after lobectomy, 24 of 226 (11%) after segmentectomy, and 7 of 78 (9%) after wedge resection. Of these 69 patients, 52 patients (75%) were discharged on POD1, 15 patients (22%) on POD2, and 2 patients (3%) on POD3. Chest tubes were removed a median outpatient chest tube duration was 4 days (interquartile range, 3-5 days). Of the 69 patients sent home with a digital drainage system, there was 1 complication requiring readmission for increasing subcutaneous emphysema. Five patients (7%) had system malfunctions that required return to our clinic for problem-solving. There were no 30- or 90-day mortalities. CONCLUSIONS Patients who undergo robotic pulmonary resection and have an air leak can be safely and effectively discharged on the first postoperative day and managed as an outpatient by using daily texts and or videos with pulse oximetry data on a digital drainage system with limited morbidity.
Collapse
Affiliation(s)
- Travis C Geraci
- Department of Cardiothoracic Surgery, New York University Langone Health, New York, New York.
| | - Ashley J McCormack
- Department of Cardiothoracic Surgery, New York University Langone Health, New York, New York
| | - Robert J Cerfolio
- Department of Cardiothoracic Surgery, New York University Langone Health, New York, New York
| |
Collapse
|
4
|
Kent MS, Mitzman B, Diaz-Gutierrez I, Khullar OV, Fernando HC, Backhus L, Brunelli A, Cassivi SD, Cerfolio RJ, Crabtree TD, Kakuturu J, Martin LW, Raymond DP, Schumacher L, Hayanga JWA. The Society of Thoracic Surgeons Expert Consensus Document on the Management of Pleural Drains After Pulmonary Lobectomy: Expert Consensus Document. Ann Thorac Surg 2024:S0003-4975(24)00342-4. [PMID: 38723882 DOI: 10.1016/j.athoracsur.2024.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 03/16/2024] [Accepted: 04/16/2024] [Indexed: 07/04/2024]
Abstract
The Society of Thoracic Surgeons Workforce on Evidence-Based Surgery provides this document on management of pleural drains after pulmonary lobectomy. The goal of this consensus document is to provide guidance regarding pleural drains in 5 specific areas: (1) choice of drain, including size, type, and number; (2) management, including use of suction vs water seal and criteria for removal; (3) imaging recommendations, including the use of daily and postpull chest roentgenograms; (4) use of digital drainage systems; and (5) management of prolonged air leak. To formulate the consensus statements, a task force of 15 general thoracic surgeons was invited to review the existing literature on this topic. Consensus was obtained using a modified Delphi method consisting of 2 rounds of voting until 75% agreement on the statements was reached. A total of 13 consensus statements are provided to encourage standardization and stimulate additional research in this important area.
Collapse
Affiliation(s)
- Michael S Kent
- Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
| | - Brian Mitzman
- Division of Cardiothoracic Surgery, University of Utah, Salt Lake City, Utah
| | | | - Onkar V Khullar
- Division of Cardiothoracic Surgery, Emory University, Atlanta, Georgia
| | - Hiran C Fernando
- Division of Thoracic Surgery, Allegheny General Hospital, Pittsburgh, Pennsylvania
| | - Leah Backhus
- Department of Cardiothoracic Surgery, Stanford University, Stanford, California
| | - Alessandro Brunelli
- Department of Thoracic Surgery, St James's University Hospital, Leeds, United Kingdom
| | - Stephen D Cassivi
- Division of General Thoracic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Robert J Cerfolio
- Department of Cardiothoracic Surgery, NYU Langone Health, New York, New York
| | - Traves D Crabtree
- Division of Thoracic Surgery, Southern Illinois University, Springfield, Illinois
| | - Jahnavi Kakuturu
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, West Virginia
| | - Linda W Martin
- Division of Thoracic Surgery, University of Virginia, Charlottesville, Virginia
| | - Daniel P Raymond
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Lana Schumacher
- Division of Thoracic Surgery, Tufts Medical Center, Boston, Massachusetts
| | - J W Awori Hayanga
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, West Virginia
| |
Collapse
|
5
|
Le UT, Hümmler N, Greiser F, Tullius-Modlmeier R, Benitz M, Passlick B. Hybrid (Digital/Water Seal) Chest Drainage System - An Innovative Device for Patients with Anticipated Air Leaks. Surg Innov 2024; 31:185-194. [PMID: 38403897 DOI: 10.1177/15533506241232618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
BACKGROUND To date, several chest drainage systems are available, such as digital drainage systems (DDS) and traditional systems with continuous suction or water seal. However, none of these systems were yet shown to be favorable in the treatment of complex situations such as persistent air leaks or residual spaces. We present in-vitro as well as clinical data of a novel hybrid drainage system consisting of an optimized digital drainage system (ODDS) and an underwater seal drainage system (UWSD). METHODS For in-vitro analysis, a DDS and an ODDS were connected to a pleural cavity simulator. Different air leaks were produced and data on intrapleural pressure and air flow were analyzed. Furthermore, we tested the hybrid drainage system in 10 patients with potential air leaks after pulmonary surgery. RESULTS In in-vitro analysis, we could show, that with advanced pump technology, pressure fluctuations caused by the drainage system when trying to maintain a set pressure level in patients with airleaks were much smaller when using an ODDS and could even be eliminated when using a fluid collection canister with sufficient buffer capacity. This minimized air leak boosts caused by the drainage system. Optimizing the auto-pressure regulation algorithms also led to a reduced airflow through the fistula and promoted rest. Switching to a passive UWSD also reduced the amount of airflow. Clinical application of the hybrid drainage system yielded promising results. CONCLUSION The novel hybrid drainage system shows promising results in the treatment of patients with complex clinical situations such as persistent air leaks.
Collapse
Affiliation(s)
- Uyen-Thao Le
- Department of Thoracic Surgery, Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Nicolas Hümmler
- Department of Thoracic Surgery, Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Frank Greiser
- ATMOS Medizintechnik GmbH & Co. KG, Lenzkirch, Germany
| | | | - Marion Benitz
- ATMOS Medizintechnik GmbH & Co. KG, Lenzkirch, Germany
| | - Bernward Passlick
- Department of Thoracic Surgery, Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Freiburg, Germany
| |
Collapse
|
6
|
Sueyoshi K, Merlini M, Otsubo K, Kojima F, Bando T. Zero-leak prediction during major lung resection aiming for minimal chest drainage duration: a retrospective analysis. J Cardiothorac Surg 2024; 19:120. [PMID: 38481228 PMCID: PMC10935967 DOI: 10.1186/s13019-024-02620-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 03/06/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND Early chest tube removal should be considered to enhance recovery after surgery. The current study aimed to provide a predictive algorithm for air leak episodes (ALE) and to create a knowledge base for early chest tube removal. METHODS This retrospective study enrolled patients who underwent thoracoscopic anatomical pulmonary resections in our unit. We defined ALE as any airflow ≥ 10 mL/min recorded in the follow-up charts based on the digital thoracic drainage device. Multivariate regression analysis was used to control for preoperative and intraoperative confounding factors. The ALE prediction algorithm was constructed by combining an additive ALE risk-scoring system using the coefficients of the significant predictive factors with the intraoperative water-sealing test. RESULTS In 485 consecutive thoracoscopic major pulmonary resections, ALE developed in 209 (43%) patients. Statistically significant ALE-associated preoperative factors included male sex, lower body mass index, radiologically evident emphysema, lobectomy, and upper lobe surgery. Significant ALE-associated intraoperative factors were incomplete fissure and pleural adhesion. The ALE risk scoring demonstrated an average area under the receiver operating characteristic curve of 0.72 in the fivefold cross-validation test. The ALE prediction algorithm correctly predicted ALE-absent patients at a negative predictive value of 80%. CONCLUSIONS The algorithm may promote the optimization of the chest tube-dwelling duration by identifying potential ALE-absent patients for accelerated tube removal.
Collapse
Affiliation(s)
- Kuniyo Sueyoshi
- Department of Thoracic Surgery, St Luke's International Hospital, Akashi-Cho 9-1, Chuo-ku, Tokyo, 104-8560, Japan
| | - McAndrew Merlini
- Department of Thoracic Surgery, St Luke's International Hospital, Akashi-Cho 9-1, Chuo-ku, Tokyo, 104-8560, Japan
| | - Kosuke Otsubo
- Department of Thoracic Surgery, St Luke's International Hospital, Akashi-Cho 9-1, Chuo-ku, Tokyo, 104-8560, Japan
| | - Fumitsugu Kojima
- Department of Thoracic Surgery, St Luke's International Hospital, Akashi-Cho 9-1, Chuo-ku, Tokyo, 104-8560, Japan.
| | - Toru Bando
- Department of Thoracic Surgery, St Luke's International Hospital, Akashi-Cho 9-1, Chuo-ku, Tokyo, 104-8560, Japan
| |
Collapse
|
7
|
Li X, Yang H, Cai Y, Ye X, Chen Q, Ji Y, Wang J, Fu Y, Hu B, Miao J. Chest tube removal at different gas flows in prolonged air leak: a randomized non-inferiority trial. Eur J Cardiothorac Surg 2024; 65:ezae097. [PMID: 38479816 PMCID: PMC10963076 DOI: 10.1093/ejcts/ezae097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 02/20/2024] [Accepted: 03/12/2024] [Indexed: 03/27/2024] Open
Abstract
OBJECTIVES To evaluate the safety and feasibility of removing drainage tubes at larger size of air leak in patients with prolonged air leak after pulmonary surgery. METHODS Ninety-five patients who underwent pulmonary surgery with prolonged air leak in our centre were enrolled in this randomized controlled, single-centre, non-inferiority study. The drainage tube was clamped with a stable size of air leak observed over the last 6 h, which was quantified by gas flow rate using the digital drainage system. The control group (n = 48) and the study group (n = 46) had their drainage tube clamped at 0-20 ml/min and 60-80 ml/min, respectively. We continuously monitored clinical symptoms, conducted imaging and laboratory examinations, and decided whether to reopen the drainage tube. RESULTS The reopening rate in the study group was not lower than that in the control group (2.08% vs 6.52%, P > 0.05). The absolute difference in reopening rate was 4.44% (95% confidence interval -0.038 to 0.126), with an upper limit of 12.6% below the non-inferiority margin (15%). There were significant differences in the length of stay [16.5 (13-24.75) vs 13.5 (12-19.25), P = 0.017] and the duration of drainage [12 (9.25-18.50) vs 10 (8-12.25), P = 0.007] between the control and study groups. No notable differences were observed in chest X-ray results 14 days after discharge or in the readmission rate. CONCLUSIONS For patients with prolonged air leak, removing drainage tubes at larger size of air leak demonstrated similar safety compared to smaller size of air leak, and can shorten both length of stay and drainage duration. CLINICAL TRIAL REGISTRATION NUMBER Name of registry: Gas flow threshold for safe removal of chest drainage in patients with alveolar-pleural fistula prolonged air leak after pulmonary surgery. Registration number: ChiCTR2200067120. URL: https://www.chictr.org.cn/.
Collapse
Affiliation(s)
- Xinyang Li
- Department of Thoracic Surgery, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Hang Yang
- Department of Thoracic Surgery, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Yongsheng Cai
- Department of Thoracic Surgery, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Xin Ye
- Department of Thoracic Surgery, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Qirui Chen
- Department of Thoracic Surgery, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Ying Ji
- Department of Thoracic Surgery, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Jing Wang
- Department of Thoracic Surgery, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Yili Fu
- Department of Thoracic Surgery, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Bin Hu
- Department of Thoracic Surgery, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Jinbai Miao
- Department of Thoracic Surgery, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| |
Collapse
|
8
|
Yamauchi Y, Adachi H, Takahashi N, Morohoshi T, Yamamoto T, Endo M, Ueno T, Woo T, Saito Y, Sawabata N. Suitable Patient Selection and Optimal Timing of Treatment for Persistent Air Leak after Lung Resection. J Clin Med 2024; 13:1166. [PMID: 38398477 PMCID: PMC10890009 DOI: 10.3390/jcm13041166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 02/12/2024] [Accepted: 02/14/2024] [Indexed: 02/25/2024] Open
Abstract
OBJECTIVES The choice of therapeutic intervention for postoperative air leak varies between institutions. We aimed to identify the optimal timing and patient criteria for therapeutic intervention in cases of postoperative air leaks after lung resection. METHODS This study utilized data from a prospective multicenter observational study conducted in 2019. Among the 2187 cases in the database, 420 cases with air leaks on postoperative day 1 were identified. The intervention group underwent therapeutic interventions, such as pleurodesis or surgery, while the observation group was monitored without intervention. A comparison between the intervention group and the observation group were analyzed using the cumulative distribution and hazard functions. RESULTS Forty-six patients (11.0%) were included in the intervention group. The multivariate analysis revealed that low body mass index (p = 0.019), partial resection (p = 0.010), intraoperative use of fibrin glue (p = 0.008), severe air leak on postoperative day 1 (p < 0.001), and high forced expiratory volume in 1 s (p = 0.021) were significant predictors of the requirement for intervention. The proportion of patients with persistent air leak in the observation group was 20% on postoperative day 5 and 94% on postoperative day 7. The hazard of air leak cessation peaked from postoperative day 3 to postoperative day 7. CONCLUSIONS This research contributes valuable insights into predicting therapeutic interventions for postoperative air leaks and identifies scenarios where spontaneous cessation is probable. A validation through prospective studies is warranted to affirm these findings.
Collapse
Affiliation(s)
- Yoshikane Yamauchi
- Department of Surgery, Teikyo University School of Medicine, Tokyo 173-8502, Japan;
| | - Hiroyuki Adachi
- Department of Thoracic Surgery, Kanagawa Cardiovascular and Respiratory Center, Yokohama 236-0051, Japan;
| | - Nobumasa Takahashi
- Department of Thoracic Surgery, Saitama Cardiovascular and Respiratory Center, Kumagaya 360-0197, Japan
| | - Takao Morohoshi
- Department of General Thoracic Surgery, Yokosuka Kyosai Hospital, Yokosuka 238-8558, Japan
| | - Taketsugu Yamamoto
- Department of Thoracic Surgery, Yokohama Rosai Hospital, Yokohama 222-0036, Japan;
| | - Makoto Endo
- Department of Thoracic Surgery, Yamagata Prefectural Central Hospital, Yamagata 990-2292, Japan;
| | - Tsuyoshi Ueno
- Department of Thoracic Surgery, National Hospital Organization Shikoku Cancer Center, Matsuyama 791-0245, Japan;
| | - Tekkan Woo
- Department of Surgery, Yokohama City University, Yokohama 236-0004, Japan
| | - Yuichi Saito
- Department of Surgery, Teikyo University School of Medicine, Tokyo 173-8502, Japan;
| | - Noriyoshi Sawabata
- Department of Thoracic and Cardiovascular Surgery, Nara Medical University, Kashihara 634-8521, Japan
| |
Collapse
|
9
|
Ueda T, Takamochi K, Hattori A, Fukui M, Matsunaga T, Suzuki K. Postoperative management using a digital drainage system for massive air leakage after pulmonary resection. Surg Today 2024; 54:130-137. [PMID: 37204499 DOI: 10.1007/s00595-023-02703-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 05/07/2023] [Indexed: 05/20/2023]
Abstract
PURPOSE To elucidate clinical outcomes using a digital drainage system (DDS) for massive air leakage (MAL) after pulmonary resection. METHODS A total of 135 consecutive patients with pulmonary resection air leakage of > 100 ml/min on the DDS were evaluated retrospectively. In this study, MAL was defined as ≥ 1000 ml/min on the DDS. We analyzed the clinical characteristics and surgical outcomes of patients with MAL compared with non-MAL (101-999 ml/min). Using the DDS data, the duration of the air leak was plotted with the Kaplan‒Meier method and compared using the log-rank test. RESULTS MAL was detected in 19 (14%) patients. The proportions of heavy smokers (P = 0.04) and patients with emphysematous lung (P = 0.03) and interstitial lung disease (P < 0.01) were higher in the MAL group than in the non-MAL group. The MAL group had a higher persistence rate of air leakage at 120 h after surgery than the non-MAL group (P < 0.01) and required significantly more frequent pleurodesis (P < 0.01). Drainage failure occurred in 2 (11%) and 5 (4%) patients from the MAL and non-MAL groups, respectively. Neither reoperation nor 30-day surgical mortality was observed in patients with MAL. CONCLUSIONS MAL was able to be treated conservatively without surgery using the DDS.
Collapse
Affiliation(s)
- Takuya Ueda
- Department of General Thoracic Surgery, Juntendo University School of Medicine, 3-1-3, Hongo, Bunkyo-ku, Tokyo, 113-8431, Japan.
| | - Kazuya Takamochi
- Department of General Thoracic Surgery, Juntendo University School of Medicine, 3-1-3, Hongo, Bunkyo-ku, Tokyo, 113-8431, Japan
| | - Aritoshi Hattori
- Department of General Thoracic Surgery, Juntendo University School of Medicine, 3-1-3, Hongo, Bunkyo-ku, Tokyo, 113-8431, Japan
| | - Mariko Fukui
- Department of General Thoracic Surgery, Juntendo University School of Medicine, 3-1-3, Hongo, Bunkyo-ku, Tokyo, 113-8431, Japan
| | - Takeshi Matsunaga
- Department of General Thoracic Surgery, Juntendo University School of Medicine, 3-1-3, Hongo, Bunkyo-ku, Tokyo, 113-8431, Japan
| | - Kenji Suzuki
- Department of General Thoracic Surgery, Juntendo University School of Medicine, 3-1-3, Hongo, Bunkyo-ku, Tokyo, 113-8431, Japan
| |
Collapse
|
10
|
Patel C, Ruppert SD, Cao H, Fraser C, Laury T, Vaporciyan A. Use of a Digital Air Leak Detection Device to Decrease Chest Tube Duration. Crit Care Nurse 2023; 43:11-21. [PMID: 38035619 DOI: 10.4037/ccn2023951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Abstract
BACKGROUND The aim of this evidence-based practice project was to determine if a digital air leak detection device could speed the identification of chest tube air leak cessation in patients after pulmonary lobectomy. Staff members assessing air leaks have varying levels of expertise, and the digital device is a limited resource in the study institution. A chest tube management algorithm is necessary to standardize care and determine which patients are most likely to benefit. IMPLEMENTATION Twenty-five consecutive patients who underwent pulmonary lobectomy during the study period and continued to have a chest tube air leak on postoperative day 3 were monitored with digital air leak detection devices. The Mann-Whitney U test was used to compare chest tube duration and hospital length of stay between patients with digital devices and 259 patients who had traditional analog air leak detection devices (historical data from the departmental database over the previous 2 years). EVALUATION Median chest tube duration and hospital stay were 1 day less in patients with digital devices than in those with traditional analog devices (P = .01 and P = .004, respectively), with a cost savings of $2659 per hospital day. Reductions in chest tube duration and length of stay aided in the development of a chest tube management algorithm. CONCLUSIONS Critical care nurses are valued team members who treat patients after lung resections. Digital air leak detection devices can help them assess air leaks more accurately, benefiting the patients in their care.
Collapse
Affiliation(s)
- Carla Patel
- Carla Patel is an advanced practice nurse, Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston
| | - Susan D Ruppert
- Susan D. Ruppert is a professor and the associate dean of graduate studies, Cizik School of Nursing, University of Texas Health Science Center, Houston
| | - Hue Cao
- Hue Cao is a physician assistant, Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center
| | - Cheryl Fraser
- Cheryl Fraser is an advanced practice nurse, Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center
| | - TaCharra Laury
- TaCharra Laury is an advanced practice nurse, Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center
| | - Ara Vaporciyan
- Ara Vaporciyan is the Chair of the Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center
| |
Collapse
|
11
|
Abdul Khader A, Pons A, Palmares A, Booth S, Proli C, De Sousa P, Lim E. Are chest drains routinely required after thoracic surgery? A drainology study of on-table chest-drain removals. JTCVS OPEN 2023; 16:960-964. [PMID: 38204634 PMCID: PMC10774897 DOI: 10.1016/j.xjon.2023.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 04/28/2023] [Accepted: 05/09/2023] [Indexed: 01/12/2024]
Abstract
Objectives Advances in perioperative management for thoracic surgery have accelerated the postoperative recovery of patients by decreasing postoperative pain and the incidence of complications. We aimed to study whether it's safe to remove chest drains on table in selected cases. Methods This was a 5-year retrospective analysis of protocolized chest-drain removal on the operating table. The chest drain was removed in patients undergoing sublobar/wedge lung resection and other minor thoracic procedure (pleural biopsy, mediastinal mass biopsy/resection) via a thoracoscopic approach (video-assisted thoracoscopic surgery). Chest drains were removed at the end of the operation if air leak as documented by the digital drain was less than 20 mL/min. Outcome data on postdrain removal pneumothorax, effusion, and need for further intervention were obtained by reviewing the postoperative chest films, all reported by a radiologist. Results Between 2016 and 2021, 107 patients underwent drain removal in theater. Mean age (standard deviation) was 58 (17) years and 54 (50.5%) were male. Postdrain removal pneumothorax occurred in 22 patients (21%), pleural effusion in 6 (5.6%), and 21 of 22 postoperative pneumothoraces were managed conservatively without reinsertion of chest drain. As it is our standard policy to leave no pneumothorax in patients undergoing surgical management of primary spontaneous pneumothorax, only 1 such patient (0.9%) had a drain reinserted as a result. The median (interquartile) length of hospital stay was 1 day (1-2), and 14 patients (13%) were discharged on surgery day. Conclusions Our results demonstrate that on table chest-drain removal in selected cases is safe and repeatable using a digital drain, challenging the practice of routine drain insertion after thoracic surgery.
Collapse
Affiliation(s)
- Ashiq Abdul Khader
- Department of Thoracic Surgery, Royal Brompton and Harefield Hospitals, Part of Guy's and St Thomas NHS Foundation Trust, London, United Kingdom
| | - Aina Pons
- Department of Thoracic Surgery, Royal Brompton and Harefield Hospitals, Part of Guy's and St Thomas NHS Foundation Trust, London, United Kingdom
| | - Abigail Palmares
- Department of Thoracic Surgery, Royal Brompton and Harefield Hospitals, Part of Guy's and St Thomas NHS Foundation Trust, London, United Kingdom
| | - Sarah Booth
- Department of Thoracic Surgery, Royal Brompton and Harefield Hospitals, Part of Guy's and St Thomas NHS Foundation Trust, London, United Kingdom
| | - Chiara Proli
- Department of Thoracic Surgery, Royal Brompton and Harefield Hospitals, Part of Guy's and St Thomas NHS Foundation Trust, London, United Kingdom
| | - Paulo De Sousa
- Department of Thoracic Surgery, Royal Brompton and Harefield Hospitals, Part of Guy's and St Thomas NHS Foundation Trust, London, United Kingdom
| | - Eric Lim
- Department of Thoracic Surgery, Royal Brompton and Harefield Hospitals, Part of Guy's and St Thomas NHS Foundation Trust, London, United Kingdom
- Academic Division of Thoracic Surgery, Imperial College and The Royal Brompton Hospital, London, United Kingdom
| |
Collapse
|
12
|
Frediani S, Romano G, Pardi V, Aloi IP, Bertocchini A, Accinni A, Zarfati A, Inserra A. Benefits of using digital thoracic drainage systems for post-operative treatment in pediatric populations: personal experience and review of literature. Front Pediatr 2023; 11:1280834. [PMID: 37900681 PMCID: PMC10603228 DOI: 10.3389/fped.2023.1280834] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 09/26/2023] [Indexed: 10/31/2023] Open
Abstract
Introduction The digital chest drainage monitoring system (Medela Thopaz+), unlike analogical systems, reliably regulates the pressure applied to the patient's chest and digitally and silently monitors critical therapeutic indicators (volume of fluid and/or drained air). Its use in adulthood has been widely described, but there is still little experience in the pediatric field. The aim of this study is to test this new device in the pediatric population. Materials and methods We conducted a retrospective study of 160 patients undergoing chest surgery at our Hospital. These patients were divided into 82 treated with the Thopaz system in the period from January 2021 to April 2023 and 78 in whom Pleurevac, had been used in the time period from January 2020 to April 2023. Results The average age of patients was 10.45 years (range: 3.1-17.2) for the Thopaz Group and 10.71 years for Pleurevac Group. The groups were homogeneus also by weight and type of intervention. The device was held in place for 10.64 days (mean) for Thopaz Group, compared to 16.87 days (mean) for Pleurevac Group (p < 0.05). The median number of postoperative x-rays before the closure of the chest tube was 4.29 in the digital drainage group compared to 8.41 in the traditional draining group (p < 0.05). Conclusions The digital chest monitoring device provides objective measurement, allows for rapid patient mobilization (with good pain control and increased compliance). In addition, the use of Thopaz in the paediatric population seems to be safe (there is no statistically significant difference in terms of complications such as prolonged air leaks and pneumothorax after the chest tube closure) and potentially beneficial.
Collapse
Affiliation(s)
- Simone Frediani
- General and Thoracic Pediatric Surgery Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | | | | | | | | | | | | | | |
Collapse
|
13
|
Gabryel P, Skrzypczak P, Campisi A, Kasprzyk M, Roszak M, Piwkowski C. Predictors of Long-Term Survival of Thoracoscopic Lobectomy for Stage IA Non-Small Cell Lung Cancer: A Large Retrospective Cohort Study. Cancers (Basel) 2023; 15:3877. [PMID: 37568693 PMCID: PMC10416904 DOI: 10.3390/cancers15153877] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 07/24/2023] [Accepted: 07/27/2023] [Indexed: 08/13/2023] Open
Abstract
The standard of care for patients with early-stage non-small cell lung cancer (NSCLC) is anatomical lung resection with lymphadenectomy. This multicenter, retrospective, cohort study aimed to identify predictors of 5-year survival in patients after thoracoscopic lobectomy for stage IA NSCLC. The study included 1249 patients who underwent thoracoscopic lobectomy for stage IA NSCLC between 17 April 2007, and December 28, 2016. The 5-year survival rate equaled 77.7%. In the multivariate analysis, higher age (OR, 1.025, 95% CI: 1.002 to 1.048; p = 0.032), male sex (OR, 1.410, 95% CI: 1.109 to 1.793; p = 0.005), chronic obstructive pulmonary disease (OR, 1.346, 95% CI: 1.005 to 1.803; p = 0.046), prolonged postoperative air leak (OR, 2.060, 95% CI: 1.424 to 2.980; p < 0.001) and higher pathological stage (OR, 1.271, 95% CI: 1.048 to 1.541; p = 0.015) were related to the increased risk of death within 5 years after surgery. Lobe-specific mediastinal lymph node dissection (OR, 0.725, 95% CI: 0.548 to 0.959; p = 0.024) was related to the decreased risk of death within 5 years after surgery. These findings provide valuable insights for clinical practice and may contribute to improving the quality of treatment of early-stage NSCLC.
Collapse
Affiliation(s)
- Piotr Gabryel
- Department of Thoracic Surgery, Poznan University of Medical Sciences, Szamarzewskiego 62 Street, 60-569 Poznan, Poland; (P.S.); (M.K.); (C.P.)
| | - Piotr Skrzypczak
- Department of Thoracic Surgery, Poznan University of Medical Sciences, Szamarzewskiego 62 Street, 60-569 Poznan, Poland; (P.S.); (M.K.); (C.P.)
| | - Alessio Campisi
- Department of Thoracic Surgery, University and Hospital Trust—Ospedale Borgo Trento, Piazzale Aristide Stefani 1, 37126 Verona, Italy;
| | - Mariusz Kasprzyk
- Department of Thoracic Surgery, Poznan University of Medical Sciences, Szamarzewskiego 62 Street, 60-569 Poznan, Poland; (P.S.); (M.K.); (C.P.)
| | - Magdalena Roszak
- Department of Computer Science and Statistics, Poznan University of Medical Sciences, Rokietnicka 7 Street, 60-806 Poznan, Poland;
| | - Cezary Piwkowski
- Department of Thoracic Surgery, Poznan University of Medical Sciences, Szamarzewskiego 62 Street, 60-569 Poznan, Poland; (P.S.); (M.K.); (C.P.)
| |
Collapse
|
14
|
Comacchio GM, Marulli G, Mendogni P, Andriolo LG, Guerrera F, Brascia D, Russo MD, Parini S, Lopez C, Tosi D, Lorenzoni G, Gregori D, Filosso PL, Rena O, Rosso L, Surrente C, Rea F. Comparison Between Electronic and Traditional Chest Drainage Systems: A Multicenter Randomized Study. Ann Thorac Surg 2023; 116:104-109. [PMID: 36935028 DOI: 10.1016/j.athoracsur.2023.02.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 01/12/2023] [Accepted: 02/14/2023] [Indexed: 03/21/2023]
Abstract
BACKGROUND Air leak is the major factor that influences the permanence of the chest tube and the in-hospital length of stay (LOS) among patients undergoing lung resections. The aim of this study was to determine whether the use of digital chest drain systems, compared with traditional ones, reduced the duration of chest drainage and postoperative in-hospital LOS in patients undergoing video-assisted thoracoscopic (VATS) lobectomy. METHODS The study was a prospective, randomized, multicenter trial. Patients undergoing VATS lobectomy were randomized in 2 groups, receiving a digital drain system or a traditional one and managed accordingly to the protocol. RESULTS Among 503 patients who fulfilled inclusion criteria and were randomized, 38 dropped out after randomization. Finally, 465 patients were analyzed, of whom 204 used the digital device and 261 the traditional one. In the digital group, there was a significantly shorter median chest tube duration of 3 postoperative days (interquartile range [IQR], 2-4 days) vs 4 postoperative days (IQR, 3-4 days; P = .001) and postoperative in-hospital LOS of 4 days (IQR, 3-6 days) vs 5 days (IQR, 4-6 days; P = .035). Analysis of predictors for increased duration of air leaks showed a relationship with male sex (P = .039), forced expiratory volume in 1 second percentage (P = .004), forced vital capacity percentage (P = .03), and presence of air leaks at the end of surgery (P = .001). CONCLUSIONS In patients undergoing VATS lobectomy, the use of a digital drainage system allows an earlier removal of the chest drain compared with the traditional system, leading to a shorter in-hospital LOS.
Collapse
Affiliation(s)
| | | | - Paolo Mendogni
- Thoracic Surgery and Lung Transplant Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | | | - Francesco Guerrera
- Department of Surgical Science, University of Torino, Torino, Italy; Department of Thoracic Surgery, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Debora Brascia
- Thoracic Surgery Unit, University Hospital of Bari, Bari, Italy
| | - Michele Dario Russo
- Thoracic Surgery and Lung Transplant Unit, University Hospital of Padua, Padua, Italy
| | - Sara Parini
- Division of Thoracic Surgery, Ospedale Maggiore della Carità, Novara, Italy
| | - Camillo Lopez
- Thoracic Surgery Unit, "Vito Fazzi" Hospital, Lecce, Italy
| | - Davide Tosi
- Thoracic Surgery and Lung Transplant Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Giulia Lorenzoni
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Dario Gregori
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Pier Luigi Filosso
- Department of Surgical Science, University of Torino, Torino, Italy; Department of Thoracic Surgery, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Ottavio Rena
- Division of Thoracic Surgery, Ospedale Maggiore della Carità, Novara, Italy
| | - Lorenzo Rosso
- Thoracic Surgery and Lung Transplant Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | | | - Federico Rea
- Thoracic Surgery and Lung Transplant Unit, University Hospital of Padua, Padua, Italy
| |
Collapse
|
15
|
Thakur S, Kashyap NK, Saurabh G, Mehsare P. Evaluation of the Efficacy of a Digital Chest Drainage System in Traumatic Pneumothorax. Cureus 2023; 15:e41188. [PMID: 37397687 PMCID: PMC10312119 DOI: 10.7759/cureus.41188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2023] [Indexed: 07/04/2023] Open
Abstract
INTRODUCTION Pneumothorax is the major complication in patients with chest trauma. Thoracic injury is a major cause of trauma-related deaths, with up to half of these patients developing pneumothorax. The initial primary management of pneumothorax is intercostal chest drainage (ICD). Chest drainage systems are used to resolve pleural air leakage (PAL), lymphatic or exudative effusion, blood accumulation after chest surgery or trauma, and other disease conditions such as pneumothorax. This study evaluates the efficacy of a digital chest drainage system (Thopaz+, Medela AG, Baar, Switzerland) in patients with pneumothorax following chest trauma and analyzes the satisfaction score by patients. METHOD A hospital-based cross-sectional study was conducted in a tertiary care centre at the Department of Cardiovascular and Thoracic Surgery (CTVS). All patients with a diagnosis of traumatic pneumothorax/hemopneumothorax from January 2021 to June 2022, aged more than 15 years, were enrolled for the study. A total of 102 patients required chest drainage systems and were selected for the study. We analysed demographic data, clinical profiles, and routine investigations with chest X-rays and computed tomography (CT) scans. All patients were connected with digital drainage devices and monitored for air leaks and other complications. Patient satisfaction was evaluated by a purposefully developed survey questionnaire. RESULTS Most of our study subjects were male (84.3%) and the mean age was 42.38±15.75 years. The total duration of chest tube, post-operative air leak and duration of hospital stay were noted. The mean chest tube duration was 4.39±1.18 days. Twelve patients were found to have air leaks with digital drainage devices. The mean duration of hospital stay was 5.75±1.49 days. All subjects were provided with a survey questionnaire to assess their response to digital drainage devices. We found that patients were comfortable and had positive responses for the Thopaz+ device. CONCLUSION We found that Thopaz+ digital drainage system is useful in reducing chest tube duration and hospital stay. It also helps in the early resolution of air leaks and minimises complications. Most of our patients showed a positive attitude. With regard to Thopaz+ digital device, our study concludes that Thopaz+ should be considered for patients who need chest tube drain for pneumothorax.
Collapse
Affiliation(s)
- Shiva Thakur
- Cardiothoracic Surgery, All India Institute of Medical Sciences, Raipur, Raipur, IND
| | - Nitin Kumar Kashyap
- Cardiothoracic Surgery, All India Institute of Medical Sciences, Raipur, Raipur, IND
| | - Gaind Saurabh
- Cardiothoracic Surgery, All India Institute of Medical Sciences, Raipur, Raipur, IND
| | - Pranay Mehsare
- Cardiothoracic Surgery, All India Institute of Medical Sciences, Raipur, Raipur, IND
| |
Collapse
|
16
|
Adachi H, Wakimoto S, Ando K, Yamamoto T, Saito Y, Shiono S, Woo T, Ito H, Sakao Y, Sawabata N. Optimal Chest Drainage Method After Anatomic Lung Resection: A Prospective Observational Study. Ann Thorac Surg 2023; 115:845-852. [PMID: 35868556 DOI: 10.1016/j.athoracsur.2022.06.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 06/20/2022] [Accepted: 06/27/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Several methods for chest drainage after pulmonary resection of malignant lung tumors exist, but consensus on the ideal method has not been reached. METHODS We conducted a multicenter prospective observational study. We enrolled 2200 patients who underwent lung resection for lung tumors. Of the 1470 patients who underwent anatomic resection, 347 showed air leak on the morning of postoperative day 1. They were assigned to 3 groups according to the chest drainage method on postoperative day 1. RESULTS Of 347 patients with postoperative air leaks, 107 (30.8%), 179 (51.6%), and 61 (17.6%) were assigned to water seal, continuous suction, and digital drainage, respectively. The median postoperative air leak duration was significantly longer with digital drainage (4.0 days) than with either water seal (2.5 days) or continuous suction (3.0 days; P = .009). Chest tubes were required for significantly more days on average with digital drainage (6.0 days) than with water seal (4.0 days) or continuous suction (4.0 days; P = .003). Prolongation of air leak duration was significantly more likely to occur in patients with body mass index <18.5 kg/m2 (hazard ratio [HR], 1.6; 95% CI, 1.1-2.3), moderate or severe air leak on postoperative day 1 (HR, 2.0; 95% CI, 1.5-2.6), or digital drainage (HR, 1.4; 95% CI, 1.01-1.9). CONCLUSIONS Water seal was associated with significantly shorter duration of postoperative air leak and chest drainage compared with continuous suction and digital drainage.
Collapse
Affiliation(s)
- Hiroyuki Adachi
- Department of Thoracic Surgery, Kanagawa Cancer Center, Yokohama, Japan; Department of General Thoracic Surgery, Kanto-Rosai Hospital, Kawasaki, Japan.
| | - Shin Wakimoto
- Department of Thoracic Surgery, Saitama Cardiovascular and Respiratory Center, Kumagaya, Japan
| | - Kohei Ando
- Department of General Thoracic Surgery, Yokosuka Kyosai Hospital, Yokosuka, Japan
| | - Taketsugu Yamamoto
- Department of Thoracic Surgery, Yokohama Rosai Hospital, Yokohama, Japan
| | - Yuichi Saito
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Satoshi Shiono
- Department of Thoracic Surgery, Yamagata Prefectural Central Hospital, Yamagata, Japan
| | - Tekkan Woo
- Department of Surgery, Yokohama City University, Yokohama, Japan
| | - Hiroyuki Ito
- Department of Thoracic Surgery, Kanagawa Cancer Center, Yokohama, Japan
| | - Yukinori Sakao
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Noriyoshi Sawabata
- Department of Thoracic and Cardiovascular Surgery, Nara Medical University School of Medicine, Kashihara, Japan
| |
Collapse
|
17
|
Cheng AM, Berfield KS. Air Leak Management in the Digital Age-We Still Need to Decipher the Data. Ann Thorac Surg 2023; 115:853. [PMID: 35970227 DOI: 10.1016/j.athoracsur.2022.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 08/05/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Aaron M Cheng
- Division of Cardiothoracic Surgery, Department of Surgery, University of Washington, 1959 NE Pacific St, Box 356310, Seattle, WA 98195.
| | - Kathleen S Berfield
- Division of Cardiothoracic Surgery, Department of Surgery, University of Washington, 1959 NE Pacific St, Box 356310, Seattle, WA 98195
| |
Collapse
|
18
|
Zhu J, Xia X, Li R, Song W, Zhang Z, Lu H, Li Z, Guo Q. Efficacy and safety of early chest tube removal after selective pulmonary resection with high-output drainage: A systematic review and meta-analysis. Medicine (Baltimore) 2023; 102:e33344. [PMID: 36961179 PMCID: PMC10036022 DOI: 10.1097/md.0000000000033344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 03/01/2023] [Indexed: 03/25/2023] Open
Abstract
BACKGROUND There is controversy over the drainage threshold for removal of chest tubes in the absence of significant air leakage after selective pulmonary resection. METHODS A comprehensive search of online databases (PubMed, Web of Science, Embase, Cochrane Library, Scopus, Ovid, Elsevier, Ebsco, and Wiley) and clinical trial registries (WHO-ICTRP and ClinicalTrials.gov) was performed to investigate the efficacy and safety of early chest tube removal with high-output drainage. Primary outcome (postoperative hospital day) and secondary outcomes (30-day complications, rate of thoracentesis, and chest tube placement) were extracted and synthesized. Subgroup analysis, meta-regression, and sensitivity analysis were used to explore the potential heterogeneity. Study quality was assessed with the Newcastle-Ottawa Scale, and evidence was graded using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) assessment by the online GRADEpro Guideline Development Tool. RESULTS Six cohort studies with a total of 1262 patients were included in the final analysis. The postoperative hospital stay in the high-output group was significantly shorter than in the conventional treatment group (weighted mean difference: -1.34 [-2.34 to -0.34] day, P = .009). While there was no significant difference between 2 groups in 30-day complications (relative ratio [RR]: 0.92 [0.77-1.11], P = .38), the rate of thoracentesis (RR: 1.93 [0.63-5.88], P = .25) and the rate of chest tube placement (RR: 1.00 [0.37-2.70], P = .99). According to the sensitivity analysis, the relative impacts of the 2 groups had already stabilized. Subgroup analysis revealed that postoperative hospital stay was modified by Newcastle-Ottawa Scale score. The online GRADEpro Guideline Development Tool presented very low quality of evidence for the available data. CONCLUSIONS This meta-analysis revealed that it is feasible and safe to remove a chest tube with high-output drainage after pulmonary resection for selected patients.
Collapse
Affiliation(s)
- Junwei Zhu
- Department of Thoracic Surgery, Zhoukou Central Hospital, Zhoukou, China
| | - Xueyang Xia
- Department of Thoracic Surgery, Zhoukou Central Hospital, Zhoukou, China
| | - Rongyao Li
- Department of Thoracic Surgery, Zhoukou Central Hospital, Zhoukou, China
| | - Weikang Song
- Department of Thoracic Surgery, Zhoukou Central Hospital, Zhoukou, China
| | - Zhiqiang Zhang
- Department of Thoracic Surgery, Zhoukou Central Hospital, Zhoukou, China
| | - Huawei Lu
- Department of Thoracic Surgery, Zhoukou Central Hospital, Zhoukou, China
| | - Zhiwei Li
- Department of Thoracic Surgery, Zhoukou Central Hospital, Zhoukou, China
| | - Qingwei Guo
- Department of Thoracic Surgery, Zhoukou Central Hospital, Zhoukou, China
| |
Collapse
|
19
|
Kruk A, Dziedzic R, Terech-Skóra S, Piotrkowska R, Mędrzycka-Dąbrowska W. Patients' Perceptions of Experiences of Postoperative Chest Drain Tube Insertion: A Pilot Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3773. [PMID: 36900784 PMCID: PMC10001358 DOI: 10.3390/ijerph20053773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 02/03/2023] [Accepted: 02/11/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Pleural drainage is a routine procedure conducted after thoracotomy and thoracoscopy. It is used to remove air or excess fluid from a pleural cavity and enables proper lung expansion. Essential elements of care provided during hospitalization and treatment include meeting patients' growing expectations and continually improving quality while optimizing safety. AIM This study aimed to explore patients' experiences with pleural drainage after thoracic surgery and their correlation with socio-demographic data. METHODS A pilot survey with an exploratory design was conducted at a large teaching hospital in Poland, in the Department of Thoracic Surgery at the University Clinical Centre in Gdansk. The study involved the analysis of 100 randomly selected subjects with a chest tube drain. A self-designed questionnaire was used to collect social, demographic, and clinical data. Twenty-three questions related to experiences with pleural drainage, ailments, limitations in daily functioning, and security with a chest tube were evaluated using a 5-point Likert scale. Patients completed the questionnaire on the third postoperative day. RESULTS Individuals fitted with a traditional water-seal drainage system felt safer than those from the digital drainage group (p = 0.017). Statistically significant differences were found in the assessment of nursing assistance (p = 0.025); the number of satisfied patients was greater in a group of unemployed people. No correlation was found between demographic and social factors and the patients' sense of security (gender: p = 0.348, age: p = 0.172, education level: p = 0.154, professional activity: p = 0.665). CONCLUSIONS Demographic and social characteristics did not significantly affect patients' sense of safety with chest drainage types. Patients with traditional drainage felt significantly safer than patients with digital drainage. Patient knowledge of pleural drainage management was not satisfactory, with a number of patients indicating a lack of knowledge in this area. This is important information that should be considered when planning measures to improve the quality of care.
Collapse
Affiliation(s)
- Agnieszka Kruk
- Department of Surgical Nursing, Medical University of Gdansk, Dębinki 7, 80-211 Gdansk, Poland
- Thoracic Surgery Department, Medical University of Gdansk, Smoluchowskiego 17, 80-211 Gdansk, Poland
| | - Robert Dziedzic
- Thoracic Surgery Department, Medical University of Gdansk, Smoluchowskiego 17, 80-211 Gdansk, Poland
| | - Sylwia Terech-Skóra
- Department of Surgical Nursing, Medical University of Gdansk, Dębinki 7, 80-211 Gdansk, Poland
| | - Renata Piotrkowska
- Department of Surgical Nursing, Medical University of Gdansk, Dębinki 7, 80-211 Gdansk, Poland
| | - Wioletta Mędrzycka-Dąbrowska
- Department of Anaesthesiology Nursing and Intensive Care, Medical University of Gdansk, Dębinki 7, 80-211 Gdansk, Poland
| |
Collapse
|
20
|
Advantages of applying digital chest drainage system for postoperative management of patients following pulmonary resection: a systematic review and meta-analysis of 12 randomized controlled trials. Gan To Kagaku Ryoho 2023; 71:1-11. [PMID: 36175611 DOI: 10.1007/s11748-022-01875-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 09/20/2022] [Indexed: 01/07/2023]
Abstract
OBJECTIVES This meta-analysis aimed to evaluate the value of the chest digital drainage system for the postoperative management of patients who have undergone pulmonary resection. METHODS We searched the PubMed, EMBASE, the Cochrane Library, and Web of Science databases for included randomized controlled trials (RCTs) on the application of digital drainage systems versus the analog drainage system for patients with lung disease after pulmonary resection. Dichotomous variables were evaluated using risk ratios (RRs) and 95% confidence intervals (CIs), and mean and standardized mean differences (MDs and SMDs, respectively) with 95% CIs were used to calculate continuous variables. Statistical analyses were performed using Stata and RevMan software. RESULTS In total, 12 RCTs involving 2000 patients were analyzed. Significant differences in duration of chest tube placement (SMD = -0.49; 95% CI = -0.78 to -0.20), length of hospital stay (MD =-0.79 days; 95% CI = -1.24 to -0.34), and number of chest tube clamping tests (RR = 0.74; 95% CI = 0.36-1.49) were observed between the two groups, which did not significant differ in the occurrence of prolonged air leak or cardiopulmonary complication rate. CONCLUSIONS The digital chest drainage system is mainly advantageous in the duration of chest tube placement, length of hospital stay, and number of chest tube clamping tests. Future research should evaluate the requirements and economic impact of using digital system in routine clinical practice.
Collapse
|
21
|
Wu EB, Huang SC, Lu HI, Illias AM, Wang PM, Huang CJ, Shih TH, Chin JC, Wu SC. Use of rocuronium and sugammadex for video-assisted thoracoscopic surgery is associated with reduced duration of chest tube drainage: a propensity score-matched analysis. Br J Anaesth 2023; 130:e119-e127. [PMID: 36038393 DOI: 10.1016/j.bja.2022.07.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 07/20/2022] [Accepted: 07/21/2022] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND We investigated the influence of different neuromuscular blocking agents and reversal agents during anaesthesia on early removal of chest tube drainage after video-assisted thoracoscopic surgery (VATS). METHODS This retrospective single-centre study included patients who underwent VATS after tracheal intubation under general anaesthesia. Patients received either cisatracurium and neostigmine (n=547) or rocuronium and sugammadex (n=151). Quantitative neuromuscular monitoring was used and one chest tube (size 24 Fr) was inserted. To reduce potential bias, 140 patients from each group were matched by propensity score for sex, age, body mass index and indication for VATS. Primary outcome was duration of chest tube drainage after surgery. RESULTS Use of rocuronium and sugammadex was associated with a shorter duration of chest tube drainage (2 [1-2] vs 2 [1-3] days; P=0.049) and a 63% reduction in delayed chest tube removal (odds ratio 0.37; 95% confidence interval [CI]: 0.20-0.67; P=0.005). This group also had a lower incidence of postoperative atelectasis (P=0.047) and consolidation (P=0.008). Each 1 h increase in the duration of anaesthesia was associated with a 1.57-fold increase in the delayed removal of the chest tube (95% CI: 1.25-1.96; P=0.005). CONCLUSIONS During general anaesthesia for VATS, compared with cisatracurium and neostigmine, use of rocuronium and sugammadex was associated with a significant decrease in the incidence of postoperative delayed removal of the chest tube, atelectasis, and pulmonary consolidation.
Collapse
Affiliation(s)
- En-Bo Wu
- Department of Anaesthesiology, Kaohsiung, Taiwan
| | | | - Hung-I Lu
- Department of Thoracic Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Amina M Illias
- Department of Anaesthesiology, Linko Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan.
| | - Pei-Ming Wang
- Department of Family Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | | | | | - Jo-Chi Chin
- Department of Anaesthesiology, Park One International Hospital, Kaohsiung, Taiwan
| | - Shao-Chun Wu
- Department of Anaesthesiology, Kaohsiung, Taiwan.
| |
Collapse
|
22
|
Lobdell KW, Engelman DT. Chest Tube Management: Past, Present, and Future Directions for Developing Evidence-Based Best Practices. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2023; 18:41-48. [PMID: 36803288 DOI: 10.1177/15569845231153623] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
In the field of modern cardiothoracic surgery, chest drainage has become ubiquitous and yet characterized by a wide variation in practice. Meanwhile, the evolution of chest drain technology has created gaps in knowledge that represent opportunities for new research to support the development of best practices in chest drain management. The chest drain is an indispensable tool in the recovery of the cardiac surgery patient. However, decisions about chest drain management-including those about type, material, number, maintenance of patency, and the timing of removal-are largely driven by tradition due to a scarcity of quality evidence. This narrative review surveys the available evidence regarding chest-drain management practices with the objective of highlighting scientific gaps, unmet needs, and opportunities for further research.
Collapse
Affiliation(s)
- Kevin W Lobdell
- Sanger Heart & Vascular Institute, Atrium Health, Charlotte, NC, USA
| | - Daniel T Engelman
- Heart & Vascular Program, Baystate Health, University of Massachusetts Medical School - Baystate, Springfield, MA, USA
| |
Collapse
|
23
|
Yagi S, Miwa H, Kono M, Ikeda S, Tsunoda T, Hirama R, Watanuki M, Oshima Y, Tsutsumi A, Miki Y, Hashimoto D, Nakamura H. Comparison of clinical utility between digital and analog drainage systems in patients with spontaneous pneumothorax. Respir Investig 2022; 60:840-846. [PMID: 35965216 DOI: 10.1016/j.resinv.2022.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 06/24/2022] [Accepted: 06/29/2022] [Indexed: 10/31/2022]
Abstract
BACKGROUND Digital drainage systems can continuously and numerically monitor air leakage, which may lead to a shorter duration of drainage and hospitalization; however, the usefulness of digital drainage systems compared to that of analog drainage systems for patients with primary or secondary spontaneous pneumothorax remains unclear. METHODS This retrospective study included 108 patients with spontaneous pneumothorax who were successfully treated with chest drainage alone at our institution. We compared the clinical efficacy of digital and analog chest drainage systems. RESULTS From the study population, 68 patients were diagnosed with primary and the other 40 with secondary spontaneous pneumothorax. The analog drainage system was used in 44 patients, and the digital drainage system in 64 patients. Among patients with primary spontaneous pneumothorax, the digital group had a significantly shorter duration of chest drainage than the analog group (median 2 vs. 4 days; p = 0.001), but there was no significant difference in those with secondary spontaneous pneumothorax. Additionally, the length and cost of hospitalization in the digital group were significantly lower than those in the analog group for both patients with primary and secondary spontaneous pneumothorax. There was no significant difference in recurrence within 1 week after chest tube removal between the two groups, neither among patients with primary nor among those with secondary pneumothorax. CONCLUSIONS Digital drainage system may be better than analog drainage system for patients with primary spontaneous pneumothorax who need chest drainage, but further research is needed on drainage system selection for those with secondary disease.
Collapse
Affiliation(s)
- Shota Yagi
- Department of Pulmonary Medicine, Seirei Hamamatsu General Hospital, 2-12-12 Sumiyoshi, Hamamatsu, Shizuoka, 430-8558, Japan
| | - Hideki Miwa
- Department of Pulmonary Medicine, Seirei Hamamatsu General Hospital, 2-12-12 Sumiyoshi, Hamamatsu, Shizuoka, 430-8558, Japan.
| | - Masato Kono
- Department of Pulmonary Medicine, Seirei Hamamatsu General Hospital, 2-12-12 Sumiyoshi, Hamamatsu, Shizuoka, 430-8558, Japan
| | - Shin Ikeda
- Department of Pulmonary Medicine, Seirei Hamamatsu General Hospital, 2-12-12 Sumiyoshi, Hamamatsu, Shizuoka, 430-8558, Japan
| | - Tomo Tsunoda
- Department of Pulmonary Medicine, Seirei Hamamatsu General Hospital, 2-12-12 Sumiyoshi, Hamamatsu, Shizuoka, 430-8558, Japan
| | - Ryutaro Hirama
- Department of Pulmonary Medicine, Seirei Hamamatsu General Hospital, 2-12-12 Sumiyoshi, Hamamatsu, Shizuoka, 430-8558, Japan
| | - Masayuki Watanuki
- Department of Pulmonary Medicine, Seirei Hamamatsu General Hospital, 2-12-12 Sumiyoshi, Hamamatsu, Shizuoka, 430-8558, Japan
| | - Yuiko Oshima
- Department of Pulmonary Medicine, Seirei Hamamatsu General Hospital, 2-12-12 Sumiyoshi, Hamamatsu, Shizuoka, 430-8558, Japan
| | - Akari Tsutsumi
- Department of Pulmonary Medicine, Seirei Hamamatsu General Hospital, 2-12-12 Sumiyoshi, Hamamatsu, Shizuoka, 430-8558, Japan
| | - Yoshihiro Miki
- Department of Pulmonary Medicine, Seirei Hamamatsu General Hospital, 2-12-12 Sumiyoshi, Hamamatsu, Shizuoka, 430-8558, Japan
| | - Dai Hashimoto
- Department of Pulmonary Medicine, Seirei Hamamatsu General Hospital, 2-12-12 Sumiyoshi, Hamamatsu, Shizuoka, 430-8558, Japan
| | - Hidenori Nakamura
- Department of Pulmonary Medicine, Seirei Hamamatsu General Hospital, 2-12-12 Sumiyoshi, Hamamatsu, Shizuoka, 430-8558, Japan
| |
Collapse
|
24
|
Izaaryene J, Dassa M, Orsini B, Gach P, Ferre M, Stoffaes L, Schönenberger W, Piana G. Initial Experience of Digital Air Leak Quantification in Interventional Radiology. Cardiovasc Intervent Radiol 2022; 45:1750-1754. [PMID: 35701583 DOI: 10.1007/s00270-022-03190-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 05/24/2022] [Indexed: 11/02/2022]
Affiliation(s)
- Jean Izaaryene
- Interventional Radiology Department, Institut Paoli Calmettes, Aix Marseille University, 232 boulevard Sainte Marguerite, 13009, Marseille, France.
| | - Michael Dassa
- Interventional Radiology Department, Institut Paoli Calmettes, Aix Marseille University, 232 boulevard Sainte Marguerite, 13009, Marseille, France
| | - Bastien Orsini
- Department of Thoracic Surgery, Clairval Private Hospital, Ramsay Générale de Santé, Marseille, France
| | - Pierre Gach
- Interventional Radiology Department, Institut Paoli Calmettes, Aix Marseille University, 232 boulevard Sainte Marguerite, 13009, Marseille, France
| | - Marjorie Ferre
- Interventional Radiology Department, Institut Paoli Calmettes, Aix Marseille University, 232 boulevard Sainte Marguerite, 13009, Marseille, France
| | - Louis Stoffaes
- Oncology Department, Institut Paoli Calmettes, 232 boulevard Sainte Marguerite, 13009, Marseille, France
| | | | - Gilles Piana
- Interventional Radiology Department, Institut Paoli Calmettes, Aix Marseille University, 232 boulevard Sainte Marguerite, 13009, Marseille, France
| |
Collapse
|
25
|
Obafemi OO, Wang H, Bajaj SS, O'Donnell CT, Elde S, Boyd JH. An automated line-clearing chest tube system after cardiac surgery. JTCVS OPEN 2022; 10:246-253. [PMID: 36004272 PMCID: PMC9390781 DOI: 10.1016/j.xjon.2022.02.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 02/17/2022] [Indexed: 11/22/2022]
Abstract
Objective To complete the first in-human study of the automated line clearance Thoraguard chest tube system. The study focuses on the viability and efficacy of the device in comparison with conventional models as well as secondary matters such as patient experience and ease of use. Methods This was a single-center, prospective, open-label study involving adult patients (n = 27) who underwent nonemergent, first-time, cardiac surgery. Patients received automated clearance chest tubes for surgical drainage in both the mediastinal and pleural spaces. The control group was retrospective (n = 80); individuals received conventional chest tubes placed and secured in locations determined at the surgeon's discretion. Results The automated-clearance tubes exhibited a similar drainage profile at 1, 3, 6, 12, and 24 hours compared with the conventional chest tubes. The final output at the time of tube removal was also similar (1150 [750-1590] vs 1289 [766.3-1890] mL, respectively, P = .76). The number of patients readmitted for drainage of an effusion was similar in both groups (1/27 [3.7%] vs 3/80 [3.75%], P > .99). Conclusions This study has shown that the Centese Thoraguard chest tube system is a viable option for surgical chest drainage and effective when used in routine cardiac surgery operations.
Collapse
Affiliation(s)
| | - Hanjay Wang
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford University, Stanford, Calif
| | - Simar S. Bajaj
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford University, Stanford, Calif
| | - Christian T. O'Donnell
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford University, Stanford, Calif
| | - Stefan Elde
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford University, Stanford, Calif
| | - Jack H. Boyd
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford University, Stanford, Calif
| |
Collapse
|
26
|
Yaftian N, Dunne B, Ferrari I, Antippa P. -8 cm H 2 O, the new paradigm in chest drain management following thoracoscopic lung resection? ANZ J Surg 2022; 92:1056-1059. [PMID: 35352444 PMCID: PMC9310860 DOI: 10.1111/ans.17645] [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: 12/18/2021] [Revised: 02/24/2022] [Accepted: 03/04/2022] [Indexed: 11/28/2022]
Abstract
Background Chest drain suction of −20 cm H2O has been used universally after lung resection. After introducing new guidelines,−8 cm H2O was used routinely for all non‐pneumonectomy, thoracoscopic lung resections. We conducted a review to determine outcomes and safety. Methods After introduction of the guidelines data were collected in the study institutions' thoracic surgical database and subsequently analysed. Results A total of 155 patients underwent thoracoscopic lung resection. Mean patient age was 61.5 ± 13.6 years. Video‐assisted thoracoscopic surgery was performed in 92.2% (144/155) of patients and robotically‐assisted thoracoscopic surgery was performed in 7.8% (12/155) of patients. Lobectomy was performed in 56.8% (88/155) of patients, segmentectomy was performed in 11.6% (18/155) of patients and wedge resection was performed in 31.6% (49/155) of patients. Median ICC duration time was 1 day (IQR 1–3). Median length of stay was 3 days (IQR 2–6). For patients undergoing lobectomy median ICC time was 2 days (IQR 1–4.5) and median length of stay was 3.5 days (IQR 2–7), for segmentectomy median ICC time was 1 day (IQR 1–5) and median length of stay was 2 days (IQR 1–5) and for wedge resection median ICC time was 1 day (IQR 1–1) and median admission time was 2 days (IQR 1–4). Conclusion A suction level −8 cm H2O is safe to use for thoracoscopic lung resections from day 0 post‐operatively. A dedicated, prospective study comparing levels of suction should be performed.
Collapse
Affiliation(s)
- Nima Yaftian
- Department of Cardiothoracic Surgery, Royal Melbourne Hospital, Melbourne, Australia
| | - Benjamin Dunne
- Department of Cardiothoracic Surgery, Royal Melbourne Hospital, Melbourne, Australia
| | - Isabelle Ferrari
- Department of Cardiothoracic Surgery, Royal Melbourne Hospital, Melbourne, Australia
| | - Phillip Antippa
- Department of Cardiothoracic Surgery, Royal Melbourne Hospital, Melbourne, Australia.,Department of Surgery, University of Melbourne, Melbourne, Australia
| |
Collapse
|
27
|
Chang PC, Chen KH, Jhou HJ, Lee CH, Chou SH, Chen PH, Chang TW. Promising Effects of Digital Chest Tube Drainage System for Pulmonary Resection: A Systematic Review and Network Meta-Analysis. J Pers Med 2022; 12:jpm12040512. [PMID: 35455628 PMCID: PMC9029690 DOI: 10.3390/jpm12040512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 03/16/2022] [Accepted: 03/17/2022] [Indexed: 11/16/2022] Open
Abstract
Objective: The chest tube drainage system (CTDS) of choice for the pleural cavity after pulmonary resection remains controversial. This systematic review and network meta-analysis (NMA) aimed to assess the length of hospital stay, chest tube placement duration, and prolonged air leak among different types of CTDS. Methods: This systemic review and NMA included 21 randomized controlled trials (3399 patients) in PubMed and Embase until 1 June 2021. We performed a frequentist random effect in our NMA, and a P-score was adopted to determine the best treatment. We assessed the clinical efficacy of different CTDSs (digital/suction/non-suction) using the length of hospital stay, chest tube placement duration, and presence of prolonged air leak. Results: Based on the NMA, digital CTDS was the most beneficial intervention for the length of hospital stay, being 1.4 days less than that of suction CTDS (mean difference (MD): −1.40; 95% confidence interval (CI): −2.20 to −0.60). Digital CTDS also had significantly reduced chest tube placement duration, being 0.68 days less than that of suction CTDSs (MD: −0.68; 95% CI: −1.32 to −0.04). Neither digital nor non-suction CTDS significantly reduced the risk of prolonged air leak. Conclusions: Digital CTDS is associated with better outcomes than suction and non-suction CTDS for patients undergoing pulmonary resections, specifically 0.68 days shorter chest tube duration and 1.4 days shorter hospital stay than suction CTDS.
Collapse
Affiliation(s)
- Po-Chih Chang
- Division of Thoracic Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung City 80708, Taiwan; (P.-C.C.); (S.-H.C.)
- Weight Management Center, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung City 80708, Taiwan
- Ph.D. Program in Biomedical Engineering, College of Medicine, Kaohsiung Medical University, Kaohsiung City 80708, Taiwan
- Department of Sports Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung City 80708, Taiwan
| | - Kai-Hua Chen
- Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung City 80708, Taiwan;
| | - Hong-Jie Jhou
- Department of Neurology, Changhua Christian Hospital, Changhua 50006, Taiwan;
| | - Cho-Hao Lee
- Division of Hematology and Oncology Medicine, Department of Internal Medicine, National Defense Medical Center, Tri-Service General Hospital, Taipei City 11490, Taiwan;
| | - Shah-Hwa Chou
- Division of Thoracic Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung City 80708, Taiwan; (P.-C.C.); (S.-H.C.)
- Department of Surgery, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung City 80708, Taiwan
| | - Po-Huang Chen
- Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei City 11490, Taiwan
- Correspondence: (P.-H.C.); (T.-W.C.); Tel.: +886-7-3121101 (ext. 6206)
| | - Ting-Wei Chang
- Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung City 80708, Taiwan;
- Correspondence: (P.-H.C.); (T.-W.C.); Tel.: +886-7-3121101 (ext. 6206)
| |
Collapse
|
28
|
Abstract
Abstract
Purpose of Review
This review summarizes the key issues for preoperative, peri- and intraoperative, and postoperative patient management for robotic-assisted thoracic surgery (RATS). It provides practical guidance for anesthesiologists and thoracic surgeons starting a RATS program.
Recent Findings
RATS is a new technological approach to execute minimal invasive chest operations. In management of RATS patients, the established ERAS principles for video-assisted thoracoscopic surgery (VATS) apply. In addition, RATS imposes additional conditions on anesthesiologists, nurses, and surgeons alike: The spatial constriction in operation theaters caused by the large robotic equipment longs for a reallocation of the anesthetist’s and surgeon’s working environment that may vary additionally depending on the type of surgery performed in the individual patient. Additionally, the implementation of a positive pressure carbon dioxide gas cavity in the pleura has a direct effect on patient cardio-circulatory and respiratory mechanics that have to be balanced by the anesthesiologist.
Summary
RATS advances by replacing open surgery approaches and will complement—but most likely not replace—video-assisted thoracoscopic surgery (VATS). RATS brings new specific intraoperative requirements to the anesthesiological and surgical team members that have to be implemented into clinical routine.
Collapse
|
29
|
Tamura K, Sakurai S. Clinical efficacy of digital chest drainage system in cardiac valve surgery. Gen Thorac Cardiovasc Surg 2021; 70:619-623. [PMID: 34843072 DOI: 10.1007/s11748-021-01752-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 11/23/2021] [Indexed: 11/28/2022]
Abstract
OBJECTS The portable digitalized suction was used widely in thoracic surgery. The aim of the study was to access the early outcomes of using the portable digitalized suction system after cardiac surgery. METHODS We invested 80 patients including 30 women (mean age 72.7 ± 9.2 years) who underwent cardiac surgery at our hospital, excluded coronary artery bypass grafting only, with or only aortic surgery, emergency operation, and patients with hemodialysis. Patients were categorized as those treated with digital chest drainage system (DCS group, n = 38) or analog chest drainage system (ACS group, n = 42), and the following data were analyzed in two groups. The primary endpoint was the duration of chest drainage, and the secondary endpoints were the rate of drainage-related complications and the length of hospitalization. RESULTS The duration of drainage was significantly shorter in the DCS group (ACS vs. DCS = 94.8 ± 31.5 vs. 81.1 ± 20.6 h, p = 0.036). The duration needed for rehabilitation completion was significantly shorter in the DCS group (ACS vs. DCS = 10.7 ± 1.2 vs. 9.6 ± 1.5 days, p = 0.047), and the length of hospitalization was significantly shorter in the DCS group (ACS vs. DCS = 21.9 ± 5.3 vs. 18.8 ± 7.2 days, p = 0.031). CONCLUSIONS This study provided evidence that DCS might be effective for patients who underwent cardiac valve surgery.
Collapse
Affiliation(s)
- Kiyoshi Tamura
- Department of Cardiovascular Surgery, Soka Municipal Hospital, 2-21-1 Soka, Soka-shi, Saitama, 340-8560, Japan.
| | - Shogo Sakurai
- Department of Cardiovascular Surgery, Soka Municipal Hospital, 2-21-1 Soka, Soka-shi, Saitama, 340-8560, Japan
| |
Collapse
|
30
|
Eriguchi D, Ito H, Nagashima T, Adachi H, Samejima J, Nemoto D, Nakayama H, Ikeda N. Usefulness of monitoring intrapleural pressure with digital chest drainage system for the management of air leakage after lung resection. Interact Cardiovasc Thorac Surg 2021; 33:580-587. [PMID: 34000044 PMCID: PMC8759466 DOI: 10.1093/icvts/ivab122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 03/27/2021] [Accepted: 04/01/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES The objective of this study was to determine the variation in intrapleural pressure (IPP) with and without air leakage using a digital chest drainage system (DCS) for each pressure setting. METHODS In this retrospective single-centre study, we analysed 49,553 h of air leakage after anatomical lung resection in 714 patients between 2018 and 2020. The transition of mean IPP and mean air leak flow was monitored using DCS, and the association between mean IPP and mean air leak flow was examined. The relationship between the transition of mean IPP and air leakage according to the varying suction pressures on DCS was also investigated. RESULTS Overall, 272 patients (38.1%) showed air leakage after surgery. The mean IPP in patients without air leakage was -12.0 ± 2.9 cmH2O and maintained at about -12 cmH2O constantly, while the mean IPP in patients with air leakage was -8.3 ± 1.9 cmH2O, which changed to -12 cmH2O instantly if air leakage disappeared (P < 0.001). Among patients with air leakage, the mean IPP changed more distinctly in patients with mild suction management than in those with conventional suction management (-5.0 ± 2.6 to -11.5 ± 4.2 and -8.8 ± 1.3 to -12.1 ± 2.5 cmH2O, respectively; P < 0.001). CONCLUSIONS The change in IPP on a DCS is useful for detecting air leakage. Furthermore, management with a mild suction setting on DCS makes it easy to recognize the disappearance of postoperative air leakage.
Collapse
Affiliation(s)
- Daisuke Eriguchi
- Department of Thoracic Surgery, Kanagawa Cancer Center, Yokohama, Japan
- Department of Thoracic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Hiroyuki Ito
- Department of Thoracic Surgery, Kanagawa Cancer Center, Yokohama, Japan
| | - Takuya Nagashima
- Department of Thoracic Surgery, Kanagawa Cancer Center, Yokohama, Japan
| | - Hiroyuki Adachi
- Department of Thoracic Surgery, Kanagawa Cancer Center, Yokohama, Japan
| | - Joji Samejima
- Department of Thoracic Surgery, Kanagawa Cancer Center, Yokohama, Japan
| | - Daiji Nemoto
- Department of Thoracic Surgery, Kanagawa Cancer Center, Yokohama, Japan
| | - Haruhiko Nakayama
- Department of Thoracic Surgery, Kanagawa Cancer Center, Yokohama, Japan
| | - Norihiko Ikeda
- Department of Thoracic Surgery, Tokyo Medical University, Tokyo, Japan
| |
Collapse
|
31
|
Brunelli A. Prolonged air leak following lung resection: a common but often underestimated problem. Eur J Cardiothorac Surg 2021; 61:118-119. [PMID: 34542597 DOI: 10.1093/ejcts/ezab406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
32
|
Kurman JS. Persistent air leak management in critically ill patients. J Thorac Dis 2021; 13:5223-5231. [PMID: 34527361 PMCID: PMC8411173 DOI: 10.21037/jtd-2021-32] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 06/11/2021] [Indexed: 12/13/2022]
Abstract
Persistent air leak (PAL) is a challenging clinical entity, particularly in the setting of critical illness. It is a significant cause of morbidity, health care expenditure, and resource utilization. Data on its prevalence in the critically ill patient population are limited. Unique patient factors often necessitate an individualized approach. Guidelines on this subject are antiquated and do not specially address patients on mechanical ventilation. Critically ill patients may not be able to tolerate surgical intervention. Treatment in this population relies upon lung protective ventilation, various anecdotal modalities, chemical pleurodesis, autologous blood patching, and bronchoscopic insertion of endobronchial valves. Ventilation strategies center on rapid weaning and reduction of airway pressures. Anecdotal methods include implantable devices and chemical agents. Data on these modalities are limited to case reports. None have United States Food and Drug Administration (FDA) approval. The Spiration Valve System is FDA approved as a Humanitarian Device Exemption. Data on endobronchial valves are based on large case series, and only one small case series has focused exclusively on critically ill patients. The majority of valves in critically ill mechanically ventilated patients are used for non-FDA approved indications. Updated guidelines are desperately needed to ensure a standardized approach to this common clinical situation.
Collapse
Affiliation(s)
- Jonathan S Kurman
- Division of Pulmonary & Critical Care, Medical College of Wisconsin, Milwaukee, WI, USA
| |
Collapse
|
33
|
Yong LS, Lin MW, Chen KC, Huang PM, Lee JM. Drainless Thoracoscopic Lobectomy for Lung Cancer. J Clin Med 2021; 10:jcm10163679. [PMID: 34441975 PMCID: PMC8396950 DOI: 10.3390/jcm10163679] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 08/06/2021] [Accepted: 08/09/2021] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES: Drainless video-assisted thoracoscopic (VATS) wedge resection has been demonstrated as feasible in treating various lung diseases. However, it remains unknown whether this surgical technique can be effectively applied to lobectomy. In the current study, we evaluated the perioperative outcome of drainless, minimally invasive lobectomy in patients with lung cancer. METHODS: A total of 26 lung cancer patients who received surgery-performed pulmonary lobectomy were enrolled. The perioperative outcomes were analyzed based on a propensity score matching a comparison with those who had chest drainage. RESULTS: No major surgical morbidity and mortality was noted during the perioperative period. The mean of postoperative hospital stay was 5.08 ± 2.48 days. There was no significant difference in postoperative hospital stay between the two groups of patients. However, the presence of significant postoperative pain (VAS score > 30) on the first day after surgery was less in the drainless group (34.6% vs. 3.8%; p = 0.005). CONCLUSIONS: Our results demonstrated that drainless, minimally invasive lobectomy for selected lung cancer patients is feasible. Further evaluation of its impact on short- and long-term surgical outcomes is required in the future.
Collapse
|
34
|
Geraci TC, Chang SH, Shah SK, Kent A, Cerfolio RJ. Postoperative Air Leaks After Lung Surgery: Predictors, Intraoperative Techniques, and Postoperative Management. Thorac Surg Clin 2021; 31:161-169. [PMID: 33926669 DOI: 10.1016/j.thorsurg.2021.02.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Postoperative air leak is one of the most common complications after pulmonary resection and contributes to postoperative pain, complications, and increased hospital length of stay. Several risk factors, including both patient and surgical characteristics, increase the frequency of air leaks. Appropriate intraoperative tissue handling is the most important surgical technique to reduce air leaks. Digital drainage systems have improved the management of postoperative air leak via objective data, portability, and ease of use in the outpatient setting. Several treatment strategies have been used to address prolonged air leak, including pleurodesis, blood patch, placement of endobronchial valves, and reoperative surgery.
Collapse
Affiliation(s)
- Travis C Geraci
- Department of Cardiothoracic Surgery, New York University Langone Health, 550 1st Avenue, 15th Floor, New York, NY 10016, USA.
| | - Stephanie H Chang
- Department of Cardiothoracic Surgery, New York University Langone Health, 550 1st Avenue, 15th Floor, New York, NY 10016, USA
| | - Savan K Shah
- Department of Cardiothoracic Surgery, New York University Langone Health, 550 1st Avenue, 15th Floor, New York, NY 10016, USA
| | - Amie Kent
- Department of Cardiothoracic Surgery, New York University Langone Health, 550 1st Avenue, 15th Floor, New York, NY 10016, USA
| | - Robert J Cerfolio
- Department of Cardiothoracic Surgery, New York University Langone Health, 550 1st Avenue, 15th Floor, New York, NY 10016, USA
| |
Collapse
|
35
|
Shintani Y, Yamamoto H, Sato Y, Shimizu K, Endo S, Okada M, Suzuki K, Fukuchi E, Miyata H, Chida M. A risk model for prolonged air leak after lobectomy using the National Clinical Database in Japan. Surg Today 2021; 52:69-74. [PMID: 33999269 DOI: 10.1007/s00595-021-02300-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 04/11/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE The objective of our study was to develop a clinical prediction model for prolonged air leak (PAL) after lobectomy for lung cancer using preoperative variables in a large patient dataset from the National Clinical Database (NCD) in Japan. METHODS The preoperative characteristics of 57,532 and 30,967 patients who had undergone standard lobectomy for lung cancer were derived from the 2014 to 2015 and 2016 NCD datasets, respectively. PAL was defined as air leak persisting ≥ 7 days postoperatively or requiring postoperative interventional treatment, such as pleurodesis or reoperation. Risk models were developed from the 2014 to 2015 dataset and validated using the 2016 dataset. When performing model derivation, the least absolute shrinkage and selection operator (LASSO) method were applied for parameter selection. RESULTS The rate of PAL was 4.5% in 2014-2015 and 5.3% in 2016. The age, sex, body mass index, comorbid interstitial pneumonia, smoking habits, forced expiratory volume in 1 s, tumor histology, multiple lung cancer, and tumor location were selected as important variables for PAL. Our risk model for predicting PAL was fair with a concordance index of 0.6895. CONCLUSION The LASSO-based risk model for PAL after lobectomy provided important preoperative variables for PAL and risk weighting for each variable.
Collapse
Affiliation(s)
- Yasushi Shintani
- Japanese Association for Chest Surgery, Kyoto, Japan. .,Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan.
| | - Hiroyuki Yamamoto
- Department of Healthcare Quality Assessment, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yukio Sato
- Japanese Association for Chest Surgery, Kyoto, Japan.,Faculty of Medicine, Department of Thoracic Surgery, University of Tsukuba, Ibaraki, Japan
| | - Kimihiro Shimizu
- Japanese Association for Chest Surgery, Kyoto, Japan.,Division of Thoracic Surgery, Department of Surgery, Shinshu University School of Medicine, Nagano, Japan
| | - Shunsuke Endo
- Japanese Association for Chest Surgery, Kyoto, Japan.,Department of Thoracic Surgery, Jichi Medical University, Tochigi, Japan
| | - Morihito Okada
- Japanese Association for Chest Surgery, Kyoto, Japan.,Department of Surgical Oncology, Hiroshima University, Hiroshima, Japan
| | - Kenji Suzuki
- Japanese Association for Chest Surgery, Kyoto, Japan.,Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Eriko Fukuchi
- Department of Healthcare Quality Assessment, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroaki Miyata
- Department of Healthcare Quality Assessment, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Masayuki Chida
- Japanese Association for Chest Surgery, Kyoto, Japan.,Department of General Thoracic Surgery, Dokkyo Medical University, Tochigi, Japan
| |
Collapse
|
36
|
Zurich H, Preda A, Dhanasopon AP. A Comprehensive Overview of Chest Tubes. PHYSICIAN ASSISTANT CLINICS 2021. [DOI: 10.1016/j.cpha.2020.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
37
|
Berna P, Quesnel C, Assouad J, Bagan P, Etienne H, Fourdrain A, Le Guen M, Leone M, Lorne E, Nguyen YNL, Pages PB, Roz H, Garnier M. Guidelines on enhanced recovery after pulmonary lobectomy. Anaesth Crit Care Pain Med 2021; 40:100791. [PMID: 33451912 DOI: 10.1016/j.accpm.2020.100791] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To establish recommendations for optimisation of the management of patients undergoing pulmonary lobectomy, particularly Enhanced Recovery After Surgery (ERAS). DESIGN A consensus committee of 13 experts from the French Society of Anaesthesia and Intensive Care Medicine (Soci,t, franOaise d'anesth,sie et de r,animation, SFAR) and the French Society of Thoracic and Cardiovascular Surgery (Soci,t, franOaise de chirurgie thoracique et cardiovasculaire, SFCTCV) was convened. A formal conflict-of-interest policy was developed at the onset of the process and enforced throughout. The entire guidelines process was conducted independently of any industry funding. The authors were advised to follow the principles of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system to guide assessment of quality of evidence. METHODS Five domains were defined: 1) patient pathway and patient information; 2) preoperative management and rehabilitation; 3) anaesthesia and analgesia for lobectomy; 4) surgical strategy for lobectomy; and 5) enhanced recovery after surgery. For each domain, the objective of the recommendations was to address a number of questions formulated according to the PICO model (Population, Intervention, Comparison, Outcome). An extensive literature search on these questions was carried out and analysed using the GRADE® methodology. Recommendations were formulated according to the GRADE® methodology, and were then voted by all experts according to the GRADE grid method. RESULTS The SFAR/SFCTCV guideline panel provided 32 recommendations on the management of patients undergoing pulmonary lobectomy. After two voting rounds and several amendments, a strong consensus was reached for 31 of the 32 recommendations and a moderate consensus was reached for the last recommendation. Seven of these recommendations present a high level of evidence (GRADE 1+), 23 have a moderate level of evidence (18 GRADE 2+ and 5 GRADE 2-), and 2 correspond to expert opinions. Finally, no recommendation was provided for 2 of the questions. CONCLUSIONS A strong consensus was expressed by the experts to provide recommendations to optimise the whole perioperative management of patients undergoing pulmonary lobectomy.
Collapse
Affiliation(s)
- Pascal Berna
- Department of Thoracic Surgery, Amiens University Hospital, 80000 Amiens, France
| | - Christophe Quesnel
- Sorbonne Universit,, APHP, DMU DREAM, Service d'Anesth,sie-R,animation et M,decine P,riop,ratoire, H"pital Tenon, 75020 Paris, France
| | - Jalal Assouad
- Department of Thoracic Surgery, Tenon University Hospital, Sorbonne Universit,, 75020 Paris, France
| | - Patrick Bagan
- Department of Thoracic and Vascular Surgery, Victor Dupouy Hospital, 95100 Argenteuil, France
| | - Harry Etienne
- Department of Thoracic Surgery, Tenon University Hospital, Sorbonne Universit,, 75020 Paris, France
| | - Alex Fourdrain
- Department of Thoracic Surgery, Amiens University Hospital, 80000 Amiens, France
| | - Morgan Le Guen
- D,partement d'Anesth,sie, H"pital Foch, Universit, Versailles Saint Quentin, 92150 Suresnes, France; INRA UMR 892 VIM, 78350 Jouy-en-Josas, France
| | - Marc Leone
- Aix Marseille Universit, - Assistance Publique H"pitaux de Marseille - Service d'Anesth,sie et de R,animation - H"pital Nord - 13005 Marseille, France
| | - Emmanuel Lorne
- Departement d'Anesth,sie-R,animation, Clinique du Mill,naire, 34000 Montpellier, France
| | - Y N-Lan Nguyen
- Anaesthesiology and Critical Care Department, APHP Centre, Paris University, 75000 Paris, France
| | - Pierre-Benoit Pages
- Department of Thoracic Surgery, Dijon Burgundy University Hospital, 21000 Dijon, France; INSERM UMR 1231, Dijon Burgundy University Hospital, University of Burgundy, 21000 Dijon, France
| | - Hadrien Roz
- Unit, d'Anesth,sie R,animation Thoracique, H"pital Haut Leveque, CHU de Bordeaux, 33000 Bordeaux, France
| | - Marc Garnier
- Sorbonne Universit,, APHP, DMU DREAM, Service d'Anesth,sie-R,animation et M,decine P,riop,ratoire, H"pital Tenon, 75020 Paris, France.
| |
Collapse
|
38
|
Lee SA, Kim JS, Chee HK, Hwang JJ, Ji M, Kim YH, Moon HJ, Lee WS. Clinical application of a digital thoracic drainage system for objectifying and quantifying air leak versus the traditional vacuum system: a retrospective observational study. J Thorac Dis 2021; 13:1020-1035. [PMID: 33717575 PMCID: PMC7947544 DOI: 10.21037/jtd-20-2993] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Background Digital thoracic drainage systems have recently been introduced and widely used in clinical practices in developed countries. These systems can monitor intrathoracic pressure changes and air leaks in real time, and also allow for objective and quantitative analyses, which aid in managing patients with a prolonged persistent air leak into the pleural space. We investigated the feasibility and effectiveness of such a new device versus the traditional vacuum system for treating patients with pneumothorax. Methods Closed thoracostomy drainage was carried out on 100 adult patients with primary or secondary pneumothorax between January 2017 and December 2018. All the patients were aged ≥18 years and treated with a chest tube at a single medical center by the same cardiothoracic surgeons and intensivists. Patients who underwent closed thoracostomy drainage using an indwelling 24-French chest tube were divided into 2 groups immediately before closed thoracostomy: the digital thoracic drainage group (digital group, n=50) and the traditional analogue thoracic drainage group (analogue group, n=50). The detailed information about demographic data, treatment outcome, duration of indwelling catheterization., hospital days, cost-effectiveness and patient satisfaction was evaluated. We also evaluated whether digitally recorded intrapleural pressure changes and air leaks would predict chest tube removal timing and outcome. Results The baseline parameters of the 2 groups were comparable with no significant differences in sex, age, weight or body mass index. The mean hospital day was shorter in the digital group than in the analogue group (17.96±12.23 vs. 18.32±16.64, P=0.902), and there was no statistically significant difference in the hospital length of stay between the 2 groups. Air leaks through the chest tube and duration of chest tube indwelling hours showed no significant statistical differences between the digital and analogue groups (213.47±219.80 vs. 261.94±184.47, P=0.235 and 223.44±218.75 vs 275.29±186.06, P=0.205, respectively). Total drainage amount and ambulation time per day were significantly higher in the digital group than in the analogue group [209.62±139.63 vs. 162.48±80.42 (P=0.042) and 6.42±3.62 vs.3.94±1.74 (P<0.001), respectively]. Hours of full expansion were significantly shorter and sleep disturbance caused by the noise of chest tube drainage was less in the digital group than in the analogue group [25.64±14.55 vs. 46.52±25.53 (P<0.001) and 2.38±1.03 vs. 5.70±2.87 (P<0.001), respectively]. Conclusions To date, there is no definite consensus and guidelines on the standardized digital suction system in pneumothorax. This study proposed the guidelines for the application of digital thoracic drainage systems in pneumothorax and also suggested that digital thoracic drainage systems might be a valuable tool to determine chest tube removal timing and reducing the length of hospital stay in patients with pneumothorax.
Collapse
Affiliation(s)
- Song Am Lee
- Department of Thoracic and Cardiovascular Surgery, School of Medicine, Konkuk University, Konkuk University Seoul Hospital, Seoul, Republic of Korea
| | - Jun Seok Kim
- Department of Thoracic and Cardiovascular Surgery, School of Medicine, Konkuk University, Konkuk University Seoul Hospital, Seoul, Republic of Korea
| | - Hyun Keun Chee
- Department of Thoracic and Cardiovascular Surgery, School of Medicine, Konkuk University, Konkuk University Seoul Hospital, Seoul, Republic of Korea
| | - Jae Joon Hwang
- Department of Thoracic and Cardiovascular Surgery, School of Medicine, Konkuk University, Konkuk University Seoul Hospital, Seoul, Republic of Korea
| | - Michael Ji
- Department of Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Yo Han Kim
- Department of Thoracic and Cardiovascular Surgery, School of Medicine, Konkuk University, Konkuk University Chungju Hospital, Chungju-si, Chungbuk, Republic of Korea
| | - Hyeong Ju Moon
- Department of Thoracic and Cardiovascular Surgery, School of Medicine, Konkuk University, Konkuk University Chungju Hospital, Chungju-si, Chungbuk, Republic of Korea
| | - Woo Surng Lee
- Department of Thoracic and Cardiovascular Surgery, School of Medicine, Konkuk University, Konkuk University Chungju Hospital, Chungju-si, Chungbuk, Republic of Korea
| |
Collapse
|
39
|
Kato Y, Okuda M, Fukuda K, Tanaka N, Nobuyama S. Refractory secondary pneumothorax complicated with lung cancer treated by bronchial occlusion: a case report. J Med Case Rep 2020; 14:236. [PMID: 33276808 PMCID: PMC7718702 DOI: 10.1186/s13256-020-02554-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 10/11/2020] [Indexed: 12/04/2022] Open
Abstract
Background Pneumothorax is defined as the presence of air or gas in the pleural cavity. Secondary pneumothorax usually occurs in patients with overt underlying lung disease, most commonly chronic obstructive pulmonary disease (COPD). Patients with poor lung function often suffer from pneumothorax with a persistent air leak. Various strategies have been employed in the treatment of such refractory pneumothorax. Bronchial occlusion with an Endobronchial Watanabe Spigot (EWS) (Novatech, Grasse, France) has been shown to be useful in treating prolonged bronchopleural fistulas. Although the effects of bronchial occlusion with EWS are known, refractory pneumothorax often involves multiple affected bronchi, and in some cases the affected bronchi cannot be easily identified. In addition, secondary pneumothorax associated with advanced lung cancer often prolongs the treatment of pneumothorax, which can significantly reduce patients’ quality of life and prognosis. Case presentation We report a case of refractory pneumothorax where collateral ventilation was successfully treated by bronchial occlusion of the affected bronchi using multiple methods. In August 2019, an 80-year-old Japanese man with asthma and COPD overlap was admitted for exacerbation triggered by respiratory tract infection. During hospitalization, he presented with chest pain due to pneumothorax. Subsequently, a chest drain tube was inserted and pleurodesis was performed; however, the lung could not be sufficiently expanded and an air leak remained. Further investigation revealed a tumor suspicious for lung cancer at the entrance of the left upper lobe bronchus. Due to poor lung function, surgical treatments were deemed high risk. Therefore, we performed bronchial occlusion using the Endobronchial Watanabe Spigot (EWS). Because we could not determine the affected bronchi by computed tomography (CT), we located the affected bronchi by balloon occlusion test and bronchography with iopamidol. After occlusion, the air leak decreased but still persisted. Thus, we performed pleurodesis twice, and the air leak ceased completely. Conclusions Refractory secondary pneumothorax, which affected multiple bronchi and developed into collateral ventilation due to lung cancer, was treated successfully with bronchial occlusion and EWS. In cases where the affected bronchi cannot be determined by the balloon occlusion test, bronchography with iopamidol might be an effective treatment.
Collapse
Affiliation(s)
- Yuto Kato
- Hirakata Kohsai Hospital, 1-2-1, Fujisakahigashimachi, Hirakata, Osaka, 573-0153, Japan.
| | - Miyuki Okuda
- Hirakata Kohsai Hospital, 1-2-1, Fujisakahigashimachi, Hirakata, Osaka, 573-0153, Japan
| | - Koji Fukuda
- Hirakata Kohsai Hospital, 1-2-1, Fujisakahigashimachi, Hirakata, Osaka, 573-0153, Japan
| | - Nobuya Tanaka
- Hirakata Kohsai Hospital, 1-2-1, Fujisakahigashimachi, Hirakata, Osaka, 573-0153, Japan
| | - Seiichi Nobuyama
- Kansai Medical University Kori Hospital, 8-45, Korihondoricho, Neyagawa, Osaka, 572-8551, Japan
| |
Collapse
|
40
|
Ferrari-Light D, Geraci TC, Chang SH, Cerfolio RJ. Novel Pre- and Postoperative Care Using Telemedicine. Front Surg 2020; 7:596970. [PMID: 33335911 PMCID: PMC7735987 DOI: 10.3389/fsurg.2020.596970] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 11/05/2020] [Indexed: 12/15/2022] Open
Abstract
The use of telemedicine and telehealth services has grown exponentially over the past decade and has become increasingly relevant and necessary during the coronavirus 2019 (COVID-19) pandemic. There remains ample opportunity to electronically connect cardiothoracic surgeons with their patients during both preoperative and postoperative visits. In this review, we examine the various implementations of telemedicine within thoracic surgery and explore future applications in this quickly developing field.
Collapse
Affiliation(s)
- Dana Ferrari-Light
- Department of Surgery, New York Presbyterian-Queens, Flushing, NY, United States
| | - Travis C Geraci
- Department of Cardiothoracic Surgery, NYU Langone Health, New York, NY, United States
| | - Stephanie H Chang
- Department of Cardiothoracic Surgery, NYU Langone Health, New York, NY, United States
| | - Robert J Cerfolio
- Department of Cardiothoracic Surgery, NYU Langone Health, New York, NY, United States
| |
Collapse
|
41
|
Abstract
Introduction: The management of empyema thoracis has evolved over the years. After all lung surgeries chest drain is required, however they suffer from inter observer variability and impair mobility of the patient. However, the newer digital thoracic drain system are portable and have alarms for various situations, furthermore they eliminate inter-observer variability. One such device is Thopaz™ (Medela inc, Switzerland). We wanted to compare efficacy of Thopaz™ with our conventional intercostal chest tube drain in patients undergoing decortications for empyema thoracis. Materials and Methods: One hundred patients were enrolled in study and were randomized into conventional and thopaz group with 50 patients in each group with help of opaque envelopes. Results: Both the groups were comparable in demographic parameters. Majority of the patients in our study were children and young adults. Majority of empyema thoracis involved right side with nontubercular empyema thoracis being the most common cause of decorticartion. Patients managed with Thopaz had a significantly shorter air leak duration, shorter duration of postdecortication chest tube placement and shorter postoperative hospital stay. All postoperative complications were less in Thopaz group. Conclusions: Patients with empyema thoracis undergoing open decortications when managed with digital chest drainage system (Thopaz) experienced faster reduction in air leak, a shorter duration of chest tube placement and in hospital stay. Thopaz usage is also associated with reduction in rate of postoperative complications. We recommend that this digital chest tube drainage system is a very useful tool in armamentarium of thoracic surgeon after lung surgeries.
Collapse
Affiliation(s)
| | - Mohd Azam Haseen
- Department of Cardiothoracic Surgery, JNMC, AMU, Aligarh, Uttar Pradesh, India
| | - Mohd Aslam
- Department of Surgery, JNMC, AMU, Aligarh, Uttar Pradesh, India
| | - Mohd Hanif Beg
- Department of Cardiothoracic Surgery, JNMC, AMU, Aligarh, Uttar Pradesh, India
| |
Collapse
|
42
|
Mustaev M, Bille A, Hasan M, Garg S, Pontiki AA, Darwish O, Lucchese G. Simulation and Measurement of Aerosolisation in Different Chest Drainage Systems. Semin Thorac Cardiovasc Surg 2020; 33:597-604. [PMID: 33171236 PMCID: PMC7833832 DOI: 10.1053/j.semtcvs.2020.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 10/14/2020] [Indexed: 01/25/2023]
Abstract
The aim of the study was to assess the degree of aerosolisation in different chest drainage systems according to different air leak volumes, in a simulated environment. This novel simulation model was designed to produce an air leak by passing air through and agitating a fluorescent fluid. The air leak volume and amount of fluorescent fluid were tested in various combinations and aerosolisation was assessed at 10-minute intervals using the ultraviolet light. The following chest drainage systems were compared: (1) single-chamber chest drainage system, (2) 3-compartment wet-dry suction chest drainage system, (3) digital drainage and monitoring system. The impact of suction (−2 and −4 kPa) in generating aerosolised particles was tested as well. A total number of 187 of 10-minute interval measurements were performed. The single-chamber chest drainage system generated the largest number of aerosolised particles at different air leak volumes and drainage output. The 3-compartment wet-dry suction system and the digital drainage and monitoring system did not generate any identifiable aerosolised particles at any of the air leak or drain output volumes considered. Suction applied to the chest drainage systems did not have an effect on aerosolisation. Aerosol generation in the simulated air-leak model demonstrated the potential risk of SARS-CoV-2 spread in the clinical setting. Full personal protective equipment must be used in patients with an air leak. Single-chamber chest drainage system generates the highest rate of aerosolised particles and it should not be used as an open system in patients with an air leak.
Collapse
Affiliation(s)
- Muslim Mustaev
- Department of Adult Cardiac Surgery, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom.
| | - Andrea Bille
- Department of Thoracic Surgery, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Mehdi Hasan
- Department of Adult Cardiac Surgery, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Sheena Garg
- Department of Adult Cardiac Surgery, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Antonia A Pontiki
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Omar Darwish
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Gianluca Lucchese
- Department of Adult Cardiac Surgery, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| |
Collapse
|
43
|
Pfeuty K, Lenot B. Early postoperative day 0 chest tube removal using a digital drainage device protocol after thoracoscopic major pulmonary resection. Interact Cardiovasc Thorac Surg 2020; 31:657-663. [PMID: 33051652 DOI: 10.1093/icvts/ivaa170] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 07/01/2020] [Accepted: 07/20/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES The aim of this study was to assess the safety of early chest tube removal on postoperative day 0 (POD 0) on the basis of a digital drainage device protocol in patients undergoing thoracoscopic major lung resection and its contribution as a component of an enhanced recovery after surgery programme. METHODS One hundred consecutive patients who underwent thoracoscopic lobectomy or segmentectomy were submitted to the following criteria for chest tube removal: Air flow ≤20 ml/min for at least 4 h without fluid threshold, except if haemorrhagic or chylous. Two groups were defined according to chest tube removal on POD 0 (G0) or POD ≥1 (G1). Primary outcome was pleural complication and secondary outcomes were cardiopulmonary complication, length of drainage, length of stay (LOS), compliance with opioid-free analgesic protocol and readmission. The follow-up was 90 days from discharge. RESULTS The chest tube was removed on POD 0 in 45% of patients (G0). None of them required tube reinsertion for pneumothorax and 1 patient was readmitted for a delayed pleural effusion. Among the 55% remaining patients (G1), the median length of drainage was 2 days, including 3 prolonged air leaks (>5 days). G0 and G1 were not different in terms of cardiopulmonary complication and readmission (6.6% vs 9% and 4.4% vs 7.2%, respectively). The median LOS was 1 day in G0 and 2 days in G1. The compliance with opioid-free analgesic protocol was significantly higher (75% vs 45%, P = 0.004) in G0 compared to G1. CONCLUSIONS Early POD 0 chest tube removal after thoracoscopic major pulmonary resection is safe in selected patients on the basis of a digital drainage device protocol. Also, it may contribute, by reducing early postoperative pain, to enhance postoperative recovery as part of an advanced enhanced recovery after surgery programme.
Collapse
Affiliation(s)
- Karel Pfeuty
- Department of Thoracic and Vascular Surgery, Yves Le Foll Hospital, Saint-Brieuc, France
| | - Bernard Lenot
- Department of Thoracic and Vascular Surgery, Yves Le Foll Hospital, Saint-Brieuc, France
| |
Collapse
|
44
|
Pulle MV, Tiwari N, Asaf BB, Puri HV, Bishnoi S, Gopinath SK, Kumar A. Does an enhanced recovery after surgery protocol affect perioperative surgical outcomes in stage III tubercular empyema? A comparative analysis of 243 patients. Asian Cardiovasc Thorac Ann 2020; 29:218492320966435. [PMID: 33131291 DOI: 10.1177/0218492320966435] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Enhanced recovery after surgery protocols in tuberculous empyema surgery have the potential for improved outcomes, but have not been studied widely. This study aimed to analyze the outcomes after implementation of an enhanced recovery after surgery protocol in patients undergoing surgery for tubercular empyema. METHODS A retrospective analysis of patients who underwent surgery for tuberculous empyema in a dedicated thoracic surgery center from March 2012 to March 2019 was performed. The control group included patients operated on between March 2012 and March 2016. The enhanced recovery after surgery protocol was strictly introduced into our practice from April 2016. The study group included patients operated on between April 2016 and March 2019. All perioperative outcomes were measured, documented, analyzed, and compared between the two groups. There were 166 patients in the control group and 77 in the study group. RESULTS Intraoperative blood loss (p = 0.0001), prolonged air leak (p = 0.04), chest tube duration (p = 0.005), and length of stay (p = 0.003) were significantly reduced in the study group. Overall rates of postoperative complications (p = 0.04) including wound infection (p = 0.01) were also significantly lower in the study group. CONCLUSIONS Implementation of an enhanced recovery after surgery protocol in patients undergoing surgery for tuberculous empyema is feasible and effective. Application of such a protocol leads to less intraoperative blood loss, shorter hospital stay and duration of chest drainage, and fewer complications. Application of enhanced recovery after surgery protocols are strongly recommended in tubercular empyema surgery.
Collapse
Affiliation(s)
| | - Neha Tiwari
- 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
| | | | - Sukhram Bishnoi
- Centre for Chest Surgery, Sir Ganga Ram Hospital, New Delhi, India
| | | | - Arvind Kumar
- Centre for Chest Surgery, Sir Ganga Ram Hospital, New Delhi, India
| |
Collapse
|
45
|
Piccioni F, Droghetti A, Bertani A, Coccia C, Corcione A, Corsico AG, Crisci R, Curcio C, Del Naja C, Feltracco P, Fontana D, Gonfiotti A, Lopez C, Massullo D, Nosotti M, Ragazzi R, Rispoli M, Romagnoli S, Scala R, Scudeller L, Taurchini M, Tognella S, Umari M, Valenza F, Petrini F. Recommendations from the Italian intersociety consensus on Perioperative Anesthesa Care in Thoracic surgery (PACTS) part 2: intraoperative and postoperative care. Perioper Med (Lond) 2020; 9:31. [PMID: 33106758 PMCID: PMC7582032 DOI: 10.1186/s13741-020-00159-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 09/22/2020] [Indexed: 02/08/2023] Open
Abstract
Introduction Anesthetic care in patients undergoing thoracic surgery presents specific challenges that require a multidisciplinary approach to management. There remains a need for standardized, evidence-based, continuously updated guidelines for perioperative care in these patients. Methods A multidisciplinary expert group, the Perioperative Anesthesia in Thoracic Surgery (PACTS) group, was established to develop recommendations for anesthesia practice in patients undergoing elective lung resection for lung cancer. The project addressed three key areas: preoperative patient assessment and preparation, intraoperative management (surgical and anesthesiologic care), and postoperative care and discharge. A series of clinical questions was developed, and literature searches were performed to inform discussions around these areas, leading to the development of 69 recommendations. The quality of evidence and strength of recommendations were graded using the United States Preventive Services Task Force criteria. Results Recommendations for intraoperative care focus on airway management, and monitoring of vital signs, hemodynamics, blood gases, neuromuscular blockade, and depth of anesthesia. Recommendations for postoperative care focus on the provision of multimodal analgesia, intensive care unit (ICU) care, and specific measures such as chest drainage, mobilization, noninvasive ventilation, and atrial fibrillation prophylaxis. Conclusions These recommendations should help clinicians to improve intraoperative and postoperative management, and thereby achieve better postoperative outcomes in thoracic surgery patients. Further refinement of the recommendations can be anticipated as the literature continues to evolve.
Collapse
Affiliation(s)
- Federico Piccioni
- Department of Critical and Supportive Care, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Alessandro Bertani
- Division of Thoracic Surgery and Lung Transplantation, Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS ISMETT - UPMC, Palermo, Italy
| | - Cecilia Coccia
- Department of Anesthesia and Critical Care Medicine, National Cancer Institute "Regina Elena"-IRCCS, Rome, Italy
| | - Antonio Corcione
- Department of Critical Care Area Monaldi Hospital, Ospedali dei Colli, Naples, Italy
| | - Angelo Guido Corsico
- Division of Respiratory Diseases, IRCCS Policlinico San Matteo Foundation and Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
| | - Roberto Crisci
- Department of Thoracic Surgery, University of L'Aquila, L'Aquila, Italy
| | - Carlo Curcio
- Thoracic Surgery, AORN dei Colli Vincenzo Monaldi Hospital, Naples, Italy
| | - Carlo Del Naja
- Department of Thoracic Surgery, IRCCS Casa Sollievo della Sofferenza Hospital, San Giovanni Rotondo, FG Italy
| | - Paolo Feltracco
- Department of Medicine, Anaesthesia and Intensive Care, University Hospital of Padova, Padova, Italy
| | - Diego Fontana
- Thoracic Surgery Unit - San Giovanni Bosco Hospital, Turin, Italy
| | | | - Camillo Lopez
- Thoracic Surgery Unit, 'V Fazzi' Hospital, Lecce, Italy
| | - Domenico Massullo
- Anesthesiology and Intensive Care Unit, Azienda Ospedaliero Universitaria S. Andrea, Rome, Italy
| | - Mario Nosotti
- Thoracic Surgery and Lung Transplant Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Riccardo Ragazzi
- Department of Morphology, Surgery and Experimental Medicine, Azienda Ospedaliero-Universitaria Sant'Anna, Ferrara, Italy
| | - Marco Rispoli
- Anesthesia and Intensive Care, AORN dei Colli Vincenzo Monaldi Hospital, Naples, Italy
| | - Stefano Romagnoli
- Department of Health Science, Section of Anesthesia and Critical Care, University of Florence, Florence, Italy.,Department of Anesthesia and Critical Care, Careggi University Hospital, Florence, Italy
| | - Raffaele Scala
- Pneumology and Respiratory Intensive Care Unit, San Donato Hospital, Arezzo, Italy
| | - Luigia Scudeller
- Clinical Epidemiology Unit, Scientific Direction, Fondazione IRCCS San Matteo, Pavia, Italy
| | - Marco Taurchini
- Department of Thoracic Surgery, IRCCS Casa Sollievo della Sofferenza Hospital, San Giovanni Rotondo, FG Italy
| | - Silvia Tognella
- Respiratory Unit, Orlandi General Hospital, Bussolengo, Verona, Italy
| | - Marzia Umari
- Combined Department of Emergency, Urgency and Admission, Cattinara University Hospital, Trieste, Italy
| | - Franco Valenza
- Department of Critical and Supportive Care, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.,Department of Oncology and Onco-Hematology, University of Milan, Milan, Italy
| | - Flavia Petrini
- Department of Anaesthesia, Perioperative Medicine, Pain Therapy, RRS and Critical Care Area - DEA ASL2 Abruzzo, Chieti University Hospital, Chieti, Italy
| | | |
Collapse
|
46
|
Joshi V, Dimarakis I. Objective analysis of postoperative air leaks can aid in decision-making, but does the use of digital drains really impact patient outcomes? J Thorac Dis 2020; 12:3927-3929. [PMID: 32944301 PMCID: PMC7475533 DOI: 10.21037/jtd.2020.04.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Vijay Joshi
- Department of Cardiothoracic Surgery, Wythenshawe Hospital, Manchester, UK
| | - Ioannis Dimarakis
- Department of Cardiothoracic Surgery, Wythenshawe Hospital, Manchester, UK.,Division of Cardiovascular Sciences, University of Manchester, Manchester, UK
| |
Collapse
|
47
|
Sihoe ADL. Video-assisted thoracoscopic surgery as the gold standard for lung cancer surgery. Respirology 2020; 25 Suppl 2:49-60. [PMID: 32734596 DOI: 10.1111/resp.13920] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 06/20/2020] [Accepted: 07/07/2020] [Indexed: 12/25/2022]
Abstract
Surgical resection remains the only effective means of cure in the vast majority of patients with early-stage lung cancer. It can be performed via a traditional open approach (particularly thoracotomy) or a minimally invasive approach. VATS is 'keyhole' surgery in the chest, and was first used for lung cancer resection in the early 1990s. Since then, a large volume of evolving clinical evidence has confirmed that VATS lung cancer resection offered proven safety and feasibility, better patient-reported post-operative outcomes, less surgical trauma as quantified by objective outcome measures and equivalent or better survival than open surgery. This has firmly established VATS as the surgical approach of choice for early-stage lung cancer today. Although impressive new non-surgical lung cancer therapies have emerged in recent years, VATS is also being constantly rejuvenated by the development of 'next generation' VATS techniques, the refinement of VATS sublobar resection for selected patients, the utilization of bespoke post-operative recovery programmes for VATS and the synthesis of VATS into multi-modality lung cancer therapy. There is little doubt that VATS will remain as the gold standard for lung cancer surgery for the foreseeable future.
Collapse
Affiliation(s)
- Alan D L Sihoe
- Gleneagles Hong Kong Hospital, Hong Kong SAR, China.,International Medical Centre, Hong Kong SAR, China
| |
Collapse
|
48
|
Marulli G, Brascia D, De Iaco G, Comacchio GM, Natale G, Nosotti M, Mendogni P, Pieropan S, Lopez C, Di Rienzo G, Andriolo LG, Rea F. Bubbles-in-the-chamber vs digital screen in chest drainage: A blind analysis of compared postoperative air leaks evaluation. Heart Lung 2020; 50:226-230. [PMID: 32703619 DOI: 10.1016/j.hrtlng.2020.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 06/10/2020] [Accepted: 06/29/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Chest drainage systems are affected by intra and inter-observer variability and poor sensibility in detecting minimal or apparent air leaks. OBJECTIVES Overcome intra and inter-observer variability in detecting air leaks. METHODS After surgery, a single apical chest tube was connected to the Drentech™ PalmEVO device and air leaks were checked twice a day by observation of both bubbles-in-the-chamber and digital data. RESULTS On a total of 624 observations, disagreement between digital and traditional systems was recorded in 60(9.6%) cases. In 25(21.4%) patients, a disagreement was recorded. Overall, the digital evaluation influenced clinical management in 13(52%). In 10(40%) patients with temporary discordant features, the presence of high pleural fluid output led to a progressive final concordance. CONCLUSIONS Disagreement between traditional and digital systems in checking air leaks is not negligible. Digital systems could give advantages in making an objective assessment of air leaks, standardizing the timing of chest tube removal.
Collapse
Affiliation(s)
- Giuseppe Marulli
- Thoracic Surgery Unit, Department of Organ Transplantation and Emergency, University Hospital of Bari, P.zza Giulio Cesare, 11 70124 Bari, Italy.
| | - Debora Brascia
- Thoracic Surgery Unit, Department of Organ Transplantation and Emergency, University Hospital of Bari, P.zza Giulio Cesare, 11 70124 Bari, Italy.
| | - Giulia De Iaco
- Thoracic Surgery Unit, Department of Organ Transplantation and Emergency, University Hospital of Bari, P.zza Giulio Cesare, 11 70124 Bari, Italy.
| | - Giovanni Maria Comacchio
- Thoracic Surgery Unit, Department of Cardiologic, Thoracic and Vascular Sciences, University Hospital of Padova, Padova, Italy.
| | - Giuseppe Natale
- Thoracic Surgery Unit, Department of Cardiologic, Thoracic and Vascular Sciences, University Hospital of Padova, Padova, Italy.
| | - Mario Nosotti
- Thoracic Surgery and Lung Transplant Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milano, Italy.
| | - Paolo Mendogni
- Thoracic Surgery and Lung Transplant Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milano, Italy.
| | - Sara Pieropan
- Thoracic Surgery and Lung Transplant Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milano, Italy.
| | - Camillo Lopez
- Thoracic Surgery Unit, 'V Fazzi' Hospital, Lecce, Italy.
| | | | | | - Federico Rea
- Thoracic Surgery Unit, Department of Cardiologic, Thoracic and Vascular Sciences, University Hospital of Padova, Padova, Italy.
| |
Collapse
|
49
|
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
| |
Collapse
|
50
|
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.
Collapse
|