1
|
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; 118:764-777. [PMID: 38723882 DOI: 10.1016/j.athoracsur.2024.04.016] [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: 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
|
2
|
Takamochi K, Haruki T, Oh S, Endo M, Funai K, Kitamura Y, Tsuboi M, Tsukioka T, Suzuki H, Ito H, Okumura N, Ueno T, Ikeda N, Iwata H, Okada M, Ichikawa T, Okamoto T, Nojiri S, Suzuki K. Early chest tube removal regardless of drainage volume after anatomic pulmonary resection: A multicenter, randomized, controlled trial. J Thorac Cardiovasc Surg 2024; 168:401-410.e1. [PMID: 38348845 DOI: 10.1016/j.jtcvs.2023.10.050] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 10/19/2023] [Accepted: 10/24/2023] [Indexed: 07/15/2024]
Abstract
OBJECTIVES This study aimed to evaluate the safety and feasibility of early chest tube removal after anatomic pulmonary resection, regardless of the drainage volume. METHODS We conducted a multicenter, randomized, controlled, noninferiority trial. Patients with greater than 300 mL drainage volume during postoperative day 1 were randomly assigned to group A (tube removed on postoperative day 2) and group B (tube retained until drainage volume ≤300 mL/24 hours). The primary end point was the frequency of respiratory-related adverse events (grade 2 or higher based on the Clavien-Dindo classification) within 30 days postoperatively. RESULTS Between April 2019 and October 2021, 175 patients were assigned to group A (N = 88) or group B (N = 87). One patient in group B who experienced chylothorax was excluded from the study. Respiratory-related adverse events were observed in 10 patients (11.4%) in group A and 12 patients (14.0%) in group B (P = .008). The frequencies of thoracentesis or chest tube reinsertion were not significantly different (8.0% and 9.3% in groups A and B, respectively, P = .752). Additionally, the duration of chest tube placement was significantly shorter in group A than in group B (median, 2 vs 3 days; P < .001). No significant difference between groups A and B was found in postoperative hospital stay (median, 6 vs 7 days, P = .231). CONCLUSIONS Early chest tube removal, regardless of drainage volume, was safe and feasible in patients who underwent anatomic pulmonary resection.
Collapse
Affiliation(s)
- Kazuya Takamochi
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan.
| | - Tomohiro Haruki
- Division of General Thoracic Surgery, Department of Surgery, Faculty of Medicine, Tottori University, Tottori, Japan
| | - Shiaki Oh
- General Thoracic Surgery, Juntendo University Urayasu Hospital, Urayasu, Japan
| | - Makoto Endo
- Department of Thoracic Surgery, Yamagata Prefectural Central Hospital, Yamagata, Japan
| | - Kazuhito Funai
- First Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | | | - Masahiro Tsuboi
- Department of Thoracic Surgery and Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Takuma Tsukioka
- Department of Thoracic Surgery, Osaka Metropolitan University Hospital, Osaka, Japan
| | - Hiroyuki Suzuki
- Department of Chest Surgery, Fukushima Medical University, Fukushima, Japan
| | - Hiroyuki Ito
- Department of Thoracic Surgery, Kanagawa Cancer Center, Yokohama, Japan
| | - Norihito Okumura
- Department of Thoracic Surgery, Kurashiki Central Hospital, Kurashiki, Japan
| | - Tsuyoshi Ueno
- Department of Thoracic Surgery, National Hospital Organization Shikoku Cancer Center, Matsuyama, Japan
| | - Norihito Ikeda
- Department of Surgery, Tokyo Medical University, Tokyo, Japan
| | - Hisashi Iwata
- Department of General Thoracic Surgery, Gifu University Hospital, Gifu, Japan
| | - Morihito Okada
- Department of Surgical Oncology, Hiroshima University, Hiroshima, Japan
| | | | - Tatsuro Okamoto
- Department of Thoracic Oncology, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan
| | - Shuko Nojiri
- Juntendo Clinical Research and Trial Center, Juntendo University School of Medicine, Tokyo, Japan
| | - Kenji Suzuki
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| |
Collapse
|
3
|
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
|
4
|
Leivaditis V, Skevis K, Mulita F, Tsalikidis C, Mitsala A, Dahm M, Grapatsas K, Papatriantafyllou A, Markakis K, Kefaloyannis E, Christou G, Pitiakoudis M, Koletsis E. Advancements in the Management of Postoperative Air Leak following Thoracic Surgery: From Traditional Practices to Innovative Therapies. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:802. [PMID: 38792985 PMCID: PMC11123218 DOI: 10.3390/medicina60050802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Revised: 05/09/2024] [Accepted: 05/11/2024] [Indexed: 05/26/2024]
Abstract
Background: Postoperative air leak (PAL) is a frequent and potentially serious complication following thoracic surgery, characterized by the persistent escape of air from the lung into the pleural space. It is associated with extended hospitalizations, increased morbidity, and elevated healthcare costs. Understanding the mechanisms, risk factors, and effective management strategies for PAL is crucial in improving surgical outcomes. Aim: This review seeks to synthesize all known data concerning PAL, including its etiology, risk factors, diagnostic approaches, and the range of available treatments from conservative measures to surgical interventions, with a special focus on the use of autologous plasma. Materials and Methods: A comprehensive literature search of databases such as PubMed, Cochrane Library, and Google Scholar was conducted for studies and reviews published on PAL following thoracic surgery. The selection criteria aimed to include articles that provided insights into the incidence, mechanisms, risk assessment, diagnostic methods, and treatment options for PAL. Special attention was given to studies detailing the use of autologous plasma in managing this complication. Results: PAL is influenced by a variety of patient-related, surgical, and perioperative factors. Diagnosis primarily relies on clinical observation and imaging, with severity assessments guiding management decisions. Conservative treatments, including chest tube management and physiotherapy, serve as the initial approach, while persistent leaks may necessitate surgical intervention. Autologous plasma has emerged as a promising treatment, offering a novel mechanism for enhancing pleural healing and reducing air leak duration, although evidence is still evolving. Conclusions: Effective management of PAL requires a multifaceted approach tailored to the individual patient's needs and the specifics of their condition. Beyond the traditional treatment approaches, innovative treatment modalities offer the potential to improve outcomes for patients experiencing PAL after thoracic surgery. Further research is needed to optimize treatment protocols and integrate new therapies into clinical practice.
Collapse
Affiliation(s)
- Vasileios Leivaditis
- Department of Cardiothoracic and Vascular Surgery, Westpfalz Klinikum, 67655 Kaiserslautern, Germany; (V.L.); (M.D.); (A.P.)
| | - Konstantinos Skevis
- Department of Thoracic Surgery, General Hospital of Rhodos, 85133 Rhodos, Greece;
| | - Francesk Mulita
- Department of General Surgery, Patras University Hospital, 26504 Patras, Greece;
| | - Christos Tsalikidis
- Second Department of Surgery, Democritus University of Thrace Medical School, 68100 Alexandroupolis, Greece; (C.T.); (A.M.)
| | - Athanasia Mitsala
- Second Department of Surgery, Democritus University of Thrace Medical School, 68100 Alexandroupolis, Greece; (C.T.); (A.M.)
| | - Manfred Dahm
- Department of Cardiothoracic and Vascular Surgery, Westpfalz Klinikum, 67655 Kaiserslautern, Germany; (V.L.); (M.D.); (A.P.)
| | - Konstantinos Grapatsas
- Department of Thoracic Surgery and Thoracic Endoscopy, Ruhrlandklinik, West German Lung Center, University Hospital Essen, University Duisburg-Essen, 45239 Essen, Germany;
| | - Athanasios Papatriantafyllou
- Department of Cardiothoracic and Vascular Surgery, Westpfalz Klinikum, 67655 Kaiserslautern, Germany; (V.L.); (M.D.); (A.P.)
| | - Konstantinos Markakis
- Department of Cardiothoracic Surgery, General Hospital of Nicosia, 2031 Nicosia, Cyprus;
| | - Emmanuel Kefaloyannis
- Department of Thoracic Surgery, University Hospital of Heraklion, 71500 Heraklion, Greece;
| | - Glykeria Christou
- Department of Thoracic Surgery, KAT Attica General Hospital, 14561 Athens, Greece;
| | - Michail Pitiakoudis
- Second Department of Surgery, Democritus University of Thrace Medical School, 68100 Alexandroupolis, Greece; (C.T.); (A.M.)
| | - Efstratios Koletsis
- Department of Cardiothoracic Surgery, Patras University Hospital, 26504 Patras, Greece;
| |
Collapse
|
5
|
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
|
6
|
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
|
7
|
Ali NY, Uchikov P, Uchikov A, Paunov L, Ilieva A, Koev N, Atliev K. Conventional and digital pleural drainage systems - advantages and disadvantages. Folia Med (Plovdiv) 2023; 65:753-759. [PMID: 38351757 DOI: 10.3897/folmed.65.e97825] [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: 11/21/2022] [Accepted: 02/14/2023] [Indexed: 02/16/2024] Open
Abstract
INTRODUCTION Pleural cavity drainage is a crucial component of the surgical management of patients with various chest diseases. Digital drainage systems are increasingly used in contemporary thoracic surgical procedure, which is likely a result of their effectiveness in achieving early postoperative ambulation, cutting down on hospital stays and lowering costs. The vast majority of thoracic surgeons worldwide prefer digital drainage systems to traditional ones. The advantages of the former, however, are disputed by some researchers.
Collapse
Affiliation(s)
| | | | | | | | | | - Nikolay Koev
- Medical University of Plovdiv, Plovdiv, Bulgaria
| | - Kiril Atliev
- Medical University of Plovdiv, Plovdiv, Bulgaria
| |
Collapse
|
8
|
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
|
9
|
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
|
10
|
Granell-Gil M, Murcia-Anaya M, Sevilla S, Martínez-Plumed R, Biosca-Pérez E, Cózar-Bernal F, Garutti I, Gallart L, Ubierna-Ferreras B, Sukia-Zilbeti I, Gálvez-Muñoz C, Delgado-Roel M, Mínguez L, Bermejo S, Valencia O, Real M, Unzueta C, Ferrando C, Sánchez F, González S, Ruiz-Villén C, Lluch A, Hernández A, Hernández-Beslmeisl J, Vives M, Vicente R. Clinical guide to perioperative management for videothoracoscopy lung resection (Section of Cardiac, Vascular and Thoracic Anesthesia, SEDAR; Spanish Society of Thoracic Surgery, SECT; Spanish Society of Physiotherapy). REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2022; 69:266-301. [PMID: 35610172 DOI: 10.1016/j.redare.2021.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 03/19/2021] [Indexed: 06/15/2023]
Abstract
The introduction of video-assisted thoracoscopic (VATS) techniques has led to a new approach in thoracic surgery. VATS is performed by inserting a thoracoscope through a small incisions in the chest wall, thus maximizing the preservation of muscle and tissue. Because of its low rate of morbidity and mortality, VATS is currently the technique of choice in most thoracic procedures. Lung resection by VATS reduces prolonged air leaks, arrhythmia, pneumonia, postoperative pain and inflammatory markers. This reduction in postoperative complications shortens hospital length of stay, and is particularly beneficial in high-risk patients with low tolerance to thoracotomy. Compared with conventional thoracotomy, the oncological results of VATS surgery are similar or even superior to those of open surgery. This aim of this multidisciplinary position statement produced by the thoracic surgery working group of the Spanish Society of Anesthesiology and Reanimation (SEDAR), the Spanish Society of Thoracic Surgery (SECT), and the Spanish Association of Physiotherapy (AEF) is to standardize and disseminate a series of perioperative anaesthesia management guidelines for patients undergoing VATS lung resection surgery. Each recommendation is based on an in-depth review of the available literature by the authors. In this document, the care of patients undergoing VATS surgery is organized in sections, starting with the surgical approach, and followed by the three pillars of anaesthesia management: preoperative, intraoperative, and postoperative anaesthesia.
Collapse
Affiliation(s)
- M Granell-Gil
- Sección en Anestesiología, Reanimación y T. Dolor, Consorcio Hospital General Universitario de Valencia, Profesor Contratado Doctor en Anestesiología, Universitat de València, Valencia, Spain
| | - M Murcia-Anaya
- Anestesiología, Reanimación y T. Dolor, Unidad de Cuidados Intensivos, Hospital IMED Valencia, Valencia, Spain.
| | - S Sevilla
- Sociedad de Cirugía Torácica, Complejo Hospitalario Universitario de Jaén, Jaén, Spain
| | - R Martínez-Plumed
- Anestesiología, Reanimación y T. Dolor, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - E Biosca-Pérez
- Anestesiología, Reanimación y T. Dolor, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - F Cózar-Bernal
- Cirugía Torácica, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - I Garutti
- Anestesiología, Reanimación y T. Dolor, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - L Gallart
- Anestesiología, Reanimación y T. Dolor, Hospital del Mar de Barcelona, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - I Sukia-Zilbeti
- Fisioterapia, Hospital Universitario Donostia de San Sebastián, Spain
| | - C Gálvez-Muñoz
- Cirugía Torácica, Hospital General Universitario de Alicante, Alicante, Spain
| | - M Delgado-Roel
- Cirugía Torácica, Complejo Hospitalario Universitario La Coruña, La Coruña, Spain
| | - L Mínguez
- Anestesiología, Reanimación y T. Dolor, Hospital Universitario La Fe de Valencia, Valencia, Spain
| | - S Bermejo
- Anestesiología, Reanimación y T. Dolor, Hospital del Mar de Barcelona, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - O Valencia
- Anestesiología, Reanimación y T. Dolor, Hospital Universitario Doce de Octubre de Madrid, Madrid, Spain
| | - M Real
- Anestesiología, Reanimación y T. Dolor, Hospital Universitario Doce de Octubre de Madrid, Madrid, Spain
| | - C Unzueta
- Anestesiología, Reanimación y T. Dolor, Hospital Sant Pau de Barcelona, Barcelona, Spain
| | - C Ferrando
- Anestesiología, Reanimación y T. Dolor, Hospital Clínic Universitari de Barcelona, Barcelona, Spain
| | - F Sánchez
- Anestesiología, Reanimación y T. Dolor, Hospital Universitario de la Ribera de Alzira, Valencia, Spain
| | - S González
- Anestesiología, Reanimación y T. Dolor, Hospital Universitario Donostia de San Sebastián, Spain
| | - C Ruiz-Villén
- Anestesiología, Reanimación y T. Dolor, Hospital Universitario Reina Sofía de Córdoba, Córdoba, Spain
| | - A Lluch
- Anestesiología, Reanimación y T. Dolor, Hospital Universitario La Fe de Valencia, Valencia, Spain
| | - A Hernández
- Anestesiología, Reanimación y T. Dolor, Grupo Policlínica de Ibiza, Ibiza, Spain
| | - J Hernández-Beslmeisl
- Anestesiología, Reanimación y T. Dolor, Complejo Hospitalario Universitario de Canarias, Canarias, Spain
| | - M Vives
- Anestesiología, Reanimación y T. Dolor, Hospital Universitari Dr. Josep Trueta de Girona, Girona, Spain
| | - R Vicente
- Sección de Anestesia Cardiaca, Vascular y Torácica, SEDAR, Anestesiología, Reanimación y T. Dolor, Hospital Universitario La Fe de Valencia, Universitat de València, Valencia, Spain
| |
Collapse
|
11
|
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
|
12
|
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
|
13
|
Granell-Gil M, Murcia-Anaya M, Sevilla S, Martínez-Plumed R, Biosca-Pérez E, Cózar-Bernal F, Garutti I, Gallart L, Ubierna-Ferreras B, Sukia-Zilbeti I, Gálvez-Muñoz C, Delgado-Roel M, Mínguez L, Bermejo S, Valencia O, Real M, Unzueta C, Ferrando C, Sánchez F, González S, Ruiz-Villén C, Lluch A, Hernández A, Hernández-Beslmeisl J, Vives M, Vicente R. Clinical guide to perioperative management for videothoracoscopy lung resection (Section of Cardiac, Vascular and Thoracic Anesthesia, SEDAR; Spanish Society of Thoracic Surgery, SECT; Spanish Society of Physiotherapy). REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2021; 69:S0034-9356(21)00129-8. [PMID: 34330548 DOI: 10.1016/j.redar.2021.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 03/09/2021] [Accepted: 03/19/2021] [Indexed: 10/20/2022]
Abstract
The introduction of video-assisted thoracoscopic (VATS) techniques has led to a new approach in thoracic surgery. VATS is performed by inserting a thoracoscope through a small incisions in the chest wall, thus maximizing the preservation of muscle and tissue. Because of its low rate of morbidity and mortality, VATS is currently the technique of choice in most thoracic procedures. Lung resection by VATS reduces prolonged air leaks, arrhythmia, pneumonia, postoperative pain and inflammatory markers. This reduction in postoperative complications shortens hospital length of stay, and is particularly beneficial in high-risk patients with low tolerance to thoracotomy. Compared with conventional thoracotomy, the oncological results of VATS surgery are similar or even superior to those of open surgery. This aim of this multidisciplinary position statement produced by the thoracic surgery working group of the Spanish Society of Anesthesiology and Reanimation (SEDAR), the Spanish Society of Thoracic Surgery (SECT), and the Spanish Association of Physiotherapy (AEF) is to standardize and disseminate a series of perioperative anaesthesia management guidelines for patients undergoing VATS lung resection surgery. Each recommendation is based on an in-depth review of the available literature by the authors. In this document, the care of patients undergoing VATS surgery is organized in sections, starting with the surgical approach, and followed by the three pillars of anaesthesia management: preoperative, intraoperative, and postoperative anaesthesia.
Collapse
Affiliation(s)
- M Granell-Gil
- Sección en Anestesiología, Reanimación y T. Dolor, Consorcio Hospital General Universitario de Valencia, Profesor Contratado Doctor en Anestesiología, Universitat de València, Valencia, España
| | - M Murcia-Anaya
- Anestesiología, Reanimación y T. Dolor, Unidad de Cuidados Intensivos, Hospital IMED Valencia, Valencia, España.
| | - S Sevilla
- Sociedad de Cirugía Torácica, Complejo Hospitalario Universitario de Jaén, Jaén, España
| | - R Martínez-Plumed
- Anestesiología, Reanimación y T. Dolor, Consorcio Hospital General Universitario de Valencia, Valencia, España
| | - E Biosca-Pérez
- Anestesiología, Reanimación y T. Dolor, Consorcio Hospital General Universitario de Valencia, Valencia, España
| | - F Cózar-Bernal
- Cirugía Torácica, Hospital Universitario Virgen Macarena, Sevilla, España
| | - I Garutti
- Anestesiología, Reanimación y T. Dolor, Hospital Universitario Gregorio Marañón, Madrid, España
| | - L Gallart
- Anestesiología, Reanimación y T. Dolor, Hospital del Mar de Barcelona, Universitat Autònoma de Barcelona, Barcelona, España
| | | | - I Sukia-Zilbeti
- Fisioterapia, Hospital Universitario Donostia, San Sebastián, España
| | - C Gálvez-Muñoz
- Cirugía Torácica, Hospital General Universitario de Alicante, Alicante, España
| | - M Delgado-Roel
- Cirugía Torácica, Complejo Hospitalario Universitario La Coruña, La Coruña, España
| | - L Mínguez
- Anestesiología, Reanimación y T. Dolor, Hospital Universitario La Fe de Valencia, Valencia, España
| | - S Bermejo
- Anestesiología, Reanimación y T. Dolor, Hospital del Mar de Barcelona, Universitat Autònoma de Barcelona, Barcelona, España
| | - O Valencia
- Anestesiología, Reanimación y T. Dolor. Hospital Universitario Doce de Octubre de Madrid, Madrid, España
| | - M Real
- Anestesiología, Reanimación y T. Dolor. Hospital Universitario Doce de Octubre de Madrid, Madrid, España
| | - C Unzueta
- Anestesiología, Reanimación y T. Dolor. Hospital Sant Pau de Barcelona, Barcelona, España
| | - C Ferrando
- Anestesiología, Reanimación y T. Dolor. Hospital Clínic Universitari de Barcelona, Barcelona, España
| | - F Sánchez
- Anestesiología, Reanimación y T. Dolor, Hospital Universitario de la Ribera de Alzira, Valencia, España
| | - S González
- Anestesiología, Reanimación y T. Dolor, Hospital Universitario Donostia de San Sebastián, España
| | - C Ruiz-Villén
- Anestesiología, Reanimación y T. Dolor, Hospital Universitario Reina Sofía de Córdoba, Córdoba, España
| | - A Lluch
- Anestesiología, Reanimación y T. Dolor, Hospital Universitario La Fe de Valencia, Valencia, España
| | - A Hernández
- Anestesiología, Reanimación y T. Dolor, Grupo Policlínica de Ibiza, Ibiza, España
| | - J Hernández-Beslmeisl
- Anestesiología, Reanimación y T. Dolor, Complejo Hospitalario Universitario de Canarias, Canarias, España
| | - M Vives
- Anestesiología, Reanimación y T. Dolor, Hospital Universitari Dr. Josep Trueta de Girona, Girona, España
| | - R Vicente
- Sección de Anestesia Cardiaca, Vascular y Torácica, SEDAR, Anestesiología, Reanimación y T. Dolor. Hospital Universitario La Fe de Valencia, Universitat de València, Valencia, España
| |
Collapse
|
14
|
Yu W, Pan L, Zhang J, Ye P, Tu Z, Lv W, Hu J. [Study on the Application of A New Type of Anhydrous Thoracic Negative Pressure Drainage Device in Patients after Thoracic Surgery]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2021; 23:509-513. [PMID: 32517457 PMCID: PMC7309536 DOI: 10.3779/j.issn.1009-3419.2020.104.06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND After general thoracic surgery, a chest tube is usually placed for closed drainage to expel gas accumulation in the thoracic cavity and fluid accumulation to promote lung re-expansion. It can also be observed whether there is active bleeding after the operation and whether there is a pulmonary leak. The conventional drainage of the chest cavity is connected with a water-sealed drainage bottle, and the patient condition is judged by observing the drainage situation and the fluctuation of the water column, which is a very classic method. However, the water-sealed bottle has the disadvantages of being easy to overturn and inconvenient to carry, which is not conducive to the early activities of patients. Under the concept of accelerated rehabilitation, our center applied a new type of anhydrous thorax negative pressure drainage device and achieved good results. The purpose of this study was to observe the effect of a new type of anhydrous thoracic negative pressure drainage device in patients after thoracic surgery. METHODS Retrospective analysis of patients who underwent lung surgery in the First Affiliated Hospital of Zhejiang University Medical College from January 2018 to December 2019, patients were divided into two groups. One group of patients used a traditional closed-chest drainage water-sealed bottle as a control group, and the other group used a new type of anhydrous negative-pressure drainage bottle as an experimental group. Patients' gender, age, hypertension, diabetes, smoking history, surgical incisions and surgical methods, and the length of hospital stay and postoperative hospital stay were calculated. RESULTS There were no statistical differences in age, gender, comorbidities (hypertension, diabetes, smoking history), scope of surgery, and duration of surgery between the two groups of patients, but there were statistical differences in surgical incisions between the two groups of patients (P=0.01). We found that patients using the new waterless negative pressure drainage device were shorter than patients with water negative pressure drainage device in terms of postoperative hospital stay and total hospitalization time, and the difference was statistically significant (P=0.02, P=0.04). CONCLUSIONS The new type of anhydrous thoracic negative pressure drainage device has a good effect on the rapid recovery and advancement after thoracic surgery.
Collapse
Affiliation(s)
- Wenfeng Yu
- Department of Thoracic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Liang Pan
- Department of Thoracic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Jieping Zhang
- Department of Thoracic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Peng Ye
- Department of Thoracic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Zhengliang Tu
- Department of Thoracic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Wang Lv
- Department of Thoracic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Jian Hu
- Department of Thoracic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| |
Collapse
|
15
|
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
|
16
|
Nakamura A, Kondo N, Nakamichi T, Hashimoto M, Takuwa T, Matsumoto S, Kuribayashi K, Kijima T, Hasegawa S. Complications and Predictive Factors for Air Leak > 10 Days with Neoadjuvant Chemotherapy Followed by Pleurectomy/Decortication for Malignant Pleural Mesothelioma. Ann Surg Oncol 2020; 28:3057-3065. [PMID: 33123856 DOI: 10.1245/s10434-020-09275-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 09/22/2020] [Indexed: 01/18/2023]
Abstract
BACKGROUND A few studies have reported the incidence and clinical implications of complications after pleurectomy/decortication (P/D). OBJECTIVE The aim of this study was to assess the details of complications and predictive factors of particularly durable air leak with P/D. METHODS Data on 163 consecutive patients who underwent neoadjuvant chemotherapy (NAC) followed by P/D for malignant pleural mesothelioma between September 2012 and May 2020 at our institution were retrospectively analyzed. Postoperative complications and the significance of various preoperative risk factors for air leak > 10 days (AL10) to identify the group having a higher risk for particularly durable air leak were investigated. Risk factors for AL10 were sought using univariate and multivariate analyses. RESULTS Of 163 patients, 30- and 90-day mortality was 0.6% and 2.5%, respectively. Eighty-four (51.4%) patients experienced grade III or worse postoperative complications according to the Clavien-Dindo classification. The median duration of air leak was 7 postoperative days. AL10 occurred in 53 (32.5%) patients. Fifty-eight patients (35.6%) underwent pleurodesis and five patients (3.1%) underwent reoperation to control the air leak. On univariate analysis, performance status (PS; p = 0.003), prognostic nutritional index (p = 0.01), and pleural effusion (p = 0.04) were statistically significant risk factors for AL10, while on multivariate analysis, PS (odds ratio 4.0, 95% confidence interval 1.3-12.7; p = 0.02) remained the only variable predicted for AL10. CONCLUSIONS Recent postoperative mortality rates in NAC followed by P/D are quite acceptable. Approximately one in every three patients experienced AL10, and PS may be a risk factor associated with AL10.
Collapse
Affiliation(s)
- Akifumi Nakamura
- Division of Thoracic Surgery, Department of Surgery, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan.
| | - Nobuyuki Kondo
- Division of Thoracic Surgery, Department of Surgery, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Toru Nakamichi
- Division of Thoracic Surgery, Department of Surgery, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Masaki Hashimoto
- Division of Thoracic Surgery, Department of Surgery, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Teruhisa Takuwa
- Department of Thoracic Surgery, Saiseikai Noe Hospital, Osaka, Japan
| | - Seiji Matsumoto
- Division of Thoracic Surgery, Department of Surgery, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Kozo Kuribayashi
- Division of Respiratory Medicine, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan
| | - Takashi Kijima
- Division of Respiratory Medicine, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan
| | - Seiki Hasegawa
- Division of Thoracic Surgery, Department of Surgery, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| |
Collapse
|
17
|
You J, Zhang H, Li W, Dai N, Zheng Z. Single versus double chest drains after pulmonary lobectomy: a systematic review and meta-analysis. World J Surg Oncol 2020; 18:175. [PMID: 32690055 PMCID: PMC7372892 DOI: 10.1186/s12957-020-01945-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 07/03/2020] [Indexed: 12/25/2022] Open
Abstract
Background Previous randomized controlled trials have compared the efficacy and safety of single chest drain (SCD) and double chest drains (DCD) in the patients undergone pulmonary lobectomy, yet the results remain inconsistent. Therefore, we aimed to conduct this present systematic review and meta-analysis to evaluate the role of SCD and DCD in the patients undergone pulmonary lobectomy. Methods PubMed, Medline, EMBASE, Cochrane library, Web of Science, China National Knowledge Infrastructure, Wanfang, Weipu, and China Biomedical Literature databases were searched up to February 28, 2020, to identify the potential RCTs on SCD and DCD in the patients undergone pulmonary lobectomy. The main outcomes including verbal pain score, the duration of drainage (days), the length of hospital stay (days), and the incidence of air leak and re-drainage were collected and analyzed. All the data were processed and analyzed with software RevMan 5.3. We calculated and analyzed the odds ratios (OR) for dichotomous outcomes and the mean difference (MD) for continuous outcomes. Results A total of 11 RCTs with 1214 patients were included, in which 589 patients received SCD treatment and 625 patients DCD treatment. The verbal pain score (MD = − 0.54, 95%CI (− 0.87, − 0.21)), the duration of drainage (MD = − 0.65, 95%CI (− 1.04, − 0.26)), and the length of hospital stay (MD = − 0.55, 95%CI (− 0.80, − 0.29)) in SCD group were significantly less than that of DCD group. There were no significant differences on the incidence of air leak (OR = 1.35, 95%CI (0.86, 2.11)) and re-drainage (OR = 0.88, 95%CI (0.41, 1.90)) among the two groups. Conclusions SCD is a safe option, and it has the advantages of less postoperative pain, shortened duration of drain, and reduced length of hospital stay when compared with DCD in the patients undergone pulmonary lobectomy.
Collapse
Affiliation(s)
- Jinzhi You
- Department of Cardiothoracic Surgery, The Affiliated Suqian Hospital of Xuzhou Medical University, No.138 South Huanghe Road, Sucheng District, Suqian, China
| | - Hailing Zhang
- The Suqian Clinical College of Xuzhou Medical University, Suqian, China
| | - Wei Li
- Department of Cardiothoracic Surgery, The Affiliated Suqian Hospital of Xuzhou Medical University, No.138 South Huanghe Road, Sucheng District, Suqian, China
| | - Ninghuang Dai
- Department of Cardiothoracic Surgery, The Affiliated Suqian Hospital of Xuzhou Medical University, No.138 South Huanghe Road, Sucheng District, Suqian, China
| | - Zhongfeng Zheng
- Department of Cardiothoracic Surgery, The Affiliated Suqian Hospital of Xuzhou Medical University, No.138 South Huanghe Road, Sucheng District, Suqian, China.
| |
Collapse
|
18
|
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
|
19
|
Aldaghlawi F, Kurman JS, Lilly JA, Hogarth DK, Donington J, Ferguson MK, Murgu SD. A Systematic Review of Digital vs Analog Drainage for Air Leak After Surgical Resection or Spontaneous Pneumothorax. Chest 2020; 157:1346-1353. [PMID: 31958444 DOI: 10.1016/j.chest.2019.11.046] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Revised: 10/27/2019] [Accepted: 11/21/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The concerns regarding air leak after lung surgery or spontaneous pneumothorax include detection and duration. Prior studies have suggested that digital drainage systems permit shorter chest tube duration and hospital length of stay (LOS) by earlier detection of air leak cessation. We conducted a systematic review to assess the impact of digital drainage on chest tube duration and hospital LOS after pulmonary surgery and spontaneous pneumothorax. METHODS Ovid MEDLINE, PubMed, Embase, the Cochrane Library, Scopus, and Google Scholar were searched from inception through January 2019. We included randomized controlled trials, cohort studies, and case series of adult patients, using digital or traditional drainage devices for air leaks of either postsurgical or spontaneous pneumothorax origin. RESULTS Of 1,272 references reviewed, 23 articles were included. Nineteen articles addressed postoperative air leak, and four articles pertained to air leak after spontaneous pneumothorax. Thirteen studies were randomized controlled trials. Digital drainage resulted in significantly shorter chest tube duration in eight of 18 studies and shorter hospital LOS in six of 14 studies for postoperative air leak. For postpneumothorax air leak, digital drainage resulted in significantly shorter chest tube duration in two of three studies and hospital LOS in one of two studies with an analog control group. CONCLUSIONS Most studies show no significant differences in chest tube duration and hospital LOS with digital vs analog drainage systems for patients with air leak after pulmonary resection. For post-spontaneous pneumothorax air leak, the limited published evidence suggests shorter chest tube duration and hospital LOS with digital drainage systems.
Collapse
Affiliation(s)
- Fadi Aldaghlawi
- Department of Medicine, Indiana University Goshen Health, Goshen, IN
| | - Jonathan S Kurman
- Division of Pulmonary and Critical Care, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Jason A Lilly
- Ruth Lilly Medical Library, Indiana University School of Medicine, Indianapolis, IN
| | - D Kyle Hogarth
- Section of Pulmonary and Critical Care, Department of Medicine, University of Chicago, Chicago, IL
| | - Jessica Donington
- Section of Thoracic Surgery, Department of Surgery, University of Chicago, Chicago, IL
| | - Mark K Ferguson
- Section of Thoracic Surgery, Department of Surgery, University of Chicago, Chicago, IL
| | - Septimiu D Murgu
- Section of Pulmonary and Critical Care, Department of Medicine, University of Chicago, Chicago, IL.
| |
Collapse
|
20
|
Raymond DP. Are we ready for the Digital Age? J Thorac Cardiovasc Surg 2019; 155:1841-1842. [PMID: 29554792 DOI: 10.1016/j.jtcvs.2017.10.043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 10/13/2017] [Indexed: 10/17/2022]
Affiliation(s)
- Daniel P Raymond
- Thoracic Surgery, Cleveland Clinic Health System, Cleveland, Ohio.
| |
Collapse
|
21
|
|
22
|
Wang H, Hu W, Ma L, Zhang Y. Digital chest drainage system versus traditional chest drainage system after pulmonary resection: a systematic review and meta-analysis. J Cardiothorac Surg 2019; 14:13. [PMID: 30658680 PMCID: PMC6339372 DOI: 10.1186/s13019-019-0842-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 01/14/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Several randomized controlled trials (RCTs) and observational studies have compared the efficacy of digital chest drainage system versus traditional chest drainage system. However, the results were inconsistent. METHODS We searched the Web of Science and Pubmed for observational studies and RCTs that compared the effect of digital chest drainage system with traditional chest drainage system after pulmonary resection. Eight studies (5 randomized control trails and 3 observational studies) comprising 1487 patients met the eligibility criteria. RESULTS Compared with the traditional chest drainage system, digital chest drainage system reduced the risk of prolonged air leak (PAL) (RR = 0.54, 95%CI 0.40-0.73, p < 0.0001), and shortened the duration of chest drainage (SMD = - 0.35, 95%CI -0.60 - -0.09, p = 0.008) and length of hospital stay (SMD = - 0.35, 95%CI -0.61 - -0.09, p = 0.007) in patients after pulmonary resection. CONCLUSIONS Digital chest drainage system is expected to benefit patients to attain faster recovery and higher life quality as well as to reduce the risk of postoperative complications. Further RCTs with larger sample size are still needed to more clearly elucidate the advantages of digital chest drainage system.
Collapse
Affiliation(s)
- Hong Wang
- Department of Surgery, Zhejiang University Hospital, Zhejiang University, Hangzhou, China
| | - Wenbin Hu
- Department of Cardiothoracic Surgery, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China
| | - Liang Ma
- Department of Cardiothoracic Surgery, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China
| | - Yiran Zhang
- Department of Cardiothoracic Surgery, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China.
| |
Collapse
|
23
|
Yeung C, Gilbert S. Digital pleural drainage technology is here to stay-time to realize its potential. J Thorac Dis 2019; 10:S3882-S3883. [PMID: 30631505 DOI: 10.21037/jtd.2018.09.71] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Ching Yeung
- Division of Thoracic Surgery, University of Ottawa, Ottawa, Ontario, Canada
| | - Sebastien Gilbert
- Division of Thoracic Surgery, University of Ottawa, Ottawa, Ontario, Canada.,The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| |
Collapse
|
24
|
Jiménez M, Novoa N, Varela G. Digital pleural drainages-what is the real value for patients? J Thorac Dis 2019; 10:S3867-S3869. [PMID: 30631501 DOI: 10.21037/jtd.2018.09.79] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Marcelo Jiménez
- Service of Thoracic Surgery, Salamanca University Hospital, Salamanca, Spain.,Department of Surgery, School of Medicine, Salamanca University, Salamanca, Spain
| | - Nuria Novoa
- Service of Thoracic Surgery, Salamanca University Hospital, Salamanca, Spain.,Department of Surgery, School of Medicine, Salamanca University, Salamanca, Spain
| | - Gonzalo Varela
- Department of Surgery, School of Medicine, Salamanca University, Salamanca, Spain
| |
Collapse
|
25
|
Yeung C, Ghazel M, French D, Japkowicz N, Gottlieb B, Maziak D, Seely AJE, Shamji F, Sundaresan S, Villeneuve PJ, Gilbert S. Forecasting pulmonary air leak duration following lung surgery using transpleural airflow data from a digital pleural drainage device. J Thorac Dis 2018; 10:S3747-S3754. [PMID: 30505561 DOI: 10.21037/jtd.2018.08.11] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background Prolonged air leak (PAL) is often the limiting factor for hospital discharge after lung surgery. Our goal was to develop a statistical model that reliably predicts pulmonary air leak resolution by applying statistical time series modeling and forecasting techniques to digital drainage data. Methods Autoregressive Integrated Moving Average (ARIMA) modeling was used to forecast air leak flow from transplural air flow data. The results from ARIMA were retrospectively internally validated with a group of 100 patients who underwent lung resection between December 2012 and March 2017, for whom digital pleural drainage data was available for analysis and a persistent air leak was the limiting factor for chest tube removal. Results The ARIMA model correctly identified 82% (82/100) of patients as to whether or not the last chest tube removal was appropriate. The performance characteristics of the model in properly identifying patients whose air leak would resolve and who would therefore be candidates for safe chest tube removal were: sensitivity 80% (95% CI, 69-88%), specificity 88% (95% CI, 68-97%), positive predictive value 95% (95% CI, 86-99%), and negative predictive value 59% (95% CI, 42-79%). The false positive and false negative rate was 12% (95% CI, 12-31%) and 20% (95% CI, 12-31%). Conclusions We were able to validate a statistical model that that reliably predicted resolution of pulmonary air leak resolution over a 24-hour period. This information may improve the care of patients with chest tube by optimizing duration of pleural drainage.
Collapse
Affiliation(s)
- Ching Yeung
- Division of Thoracic Surgery, University of Ottawa, Ottawa, Ontario, Canada
| | - Mohsen Ghazel
- School of Electrical Engineering and Computer Science, University of Ottawa, Ottawa, Ontario, Canada
| | - Daniel French
- Division of Thoracic Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Nathalie Japkowicz
- Division of Thoracic Surgery, University of Ottawa, Ottawa, Ontario, Canada.,Department of Computer Science, American University, Washington, DC, USA
| | - Bram Gottlieb
- Division of Thoracic Surgery, University of Ottawa, Ottawa, Ontario, Canada
| | - Donna Maziak
- Division of Thoracic Surgery, University of Ottawa, Ottawa, Ontario, Canada.,The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Andrew J E Seely
- Division of Thoracic Surgery, University of Ottawa, Ottawa, Ontario, Canada.,The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Farid Shamji
- Division of Thoracic Surgery, University of Ottawa, Ottawa, Ontario, Canada.,The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Sudhir Sundaresan
- Division of Thoracic Surgery, University of Ottawa, Ottawa, Ontario, Canada.,The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Patrick James Villeneuve
- Division of Thoracic Surgery, University of Ottawa, Ottawa, Ontario, Canada.,The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Sebastien Gilbert
- Division of Thoracic Surgery, University of Ottawa, Ottawa, Ontario, Canada.,The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| |
Collapse
|
26
|
Shintani Y, Funaki S, Ose N, Kanou T, Kanzaki R, Minami M, Okumura M. Chest tube management in patients undergoing lobectomy. J Thorac Dis 2018; 10:6432-6435. [PMID: 30746183 DOI: 10.21037/jtd.2018.11.47] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Yasushi Shintani
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Soichiro Funaki
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Naoko Ose
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Takashi Kanou
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Ryu Kanzaki
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Masato Minami
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Meinoshin Okumura
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| |
Collapse
|
27
|
Baringer K, Talbert S. Chest drainage systems and management of air leaks after a pulmonary resection. J Thorac Dis 2017; 9:5399-5403. [PMID: 29312751 DOI: 10.21037/jtd.2017.11.15] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Air leaks after a pulmonary resection continue to be the most common postoperative complication. The presence of an air leak occurs in approximately 30-50% of patients immediately after surgery. Prolonged air leaks (PALs) predict an increased hospital length of stay, additional chest tube days and increased pain. The two types of systems used after surgery are digital and traditional chest drainage devices. Eighteen articles from four databases were evaluated for this analysis in chest drainage systems and managing air leaks after thoracic surgery. The digital and traditional drainage devices were evaluated. PALs were examined with interobserver variability of air leak assessment and differences in the two systems were addressed. The research gaps in the digital system are examining what flow thresholds should be used to safely remove a chest tube after surgery and for what length of time. In future research, the next step is standardizing chest tube management to decrease individual surgeon preference. Treatment of air leaks implementing scientific data instead of personal preference and opinion by a surgeon can lead to earlier chest tube removal, decreased morbidity and a shorter hospital stay.
Collapse
Affiliation(s)
- Kristina Baringer
- Division of Cardiothoracic Surgery, Florida Hospital, University of Central Florida, Orlando, FL, USA
| | - Steve Talbert
- UCF College of Nursing, University of Central Florida, Orlando, FL, USA
| |
Collapse
|