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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.
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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)
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Ojo OO, Thomas MO, Ogunleye E, Olusoji O, Onakpoya UU. Comparison between flutter valve drainage bag and underwater seal device for the management of non-massive malignant and paramalignant pleural effusions. Pan Afr Med J 2020; 35:3. [PMID: 32117519 PMCID: PMC7026516 DOI: 10.11604/pamj.2020.35.3.19197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 12/05/2019] [Indexed: 11/11/2022] Open
Abstract
Introduction The aim of this study is to compare the use of flutter valve drainage bag system as an alternative to conventional underwater seal drainage bottle in the management of non-massive malignant/paramalignant pleural effusion. Methods Forty-one patients with non-massive malignant and paramalignant pleural effusions were randomized into two groups. Group A (21patients) had their chest tubes connected to an underwater seal drainage bottle, while group B (20 patients) had their chest tubes connected to a flutter bag drainage device. Data obtained was analyzed with SPSS statistical package (version 16.0). Results Breast cancer was the malignancy present at diagnosis in 24(58%) patients. Complication rates were similar, 9.5% in the underwater seal group and 10 % in the flutter bag drainage group. The mean duration to full mobilization was 35.0±20.0 hours in the flutter bag group and 52.7±18.5 hours in the underwater seal group, p-value 0.007. The mean length of hospital was 7.9±2.2 days in the flutter bag group and 9.8±2.7 days in the underwater seal group. This was statistically significant, p-value of 0.019. There was no difference in the effectiveness of drainage between both groups, complete lung re-expansion was observed in 16(80%) of the flutter bag group and 18(85.7%) of the underwater seal drainage group, p-value 0.70. Conclusion The flutter valve drainage bag is an effective and safe alternative to the standard underwater seal drainage bottle in the management of non-massive malignant and paramalignant pleural effusion.
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Affiliation(s)
- Olugbenga Olalekan Ojo
- Department of Surgery, College of Health Sciences, Obafemi Awolowo University, Ile-ife, Nigeria
| | | | - Ezekiel Ogunleye
- Department of surgery, College of Medicine, University of Lagos, Idi-araba, Lagos, Nigeria
| | - Olugbenga Olusoji
- Department of surgery, College of Medicine, University of Lagos, Idi-araba, Lagos, Nigeria
| | - Uvie Ufuoma Onakpoya
- Department of Surgery, College of Health Sciences, Obafemi Awolowo University, Ile-ife, Nigeria
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3
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Wu MH, Wu HY. Pleural drainage using drainage bag for thoracoscopic lobectomy. Asian Cardiovasc Thorac Ann 2018; 26:212-217. [PMID: 29448831 DOI: 10.1177/0218492318760876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective This study was designed to compare the effectiveness and convenience of a drainage bag and a chest bottle following thoracoscopic lobectomy. Methods We conducted a test to ensure that the drainage bag was characterized by easy drainage and an antireflux effect. Thereafter, the drainage bag was used in all thoracic operations in our service. To understand the usefulness of the drainage bag, a retrospective cohort study enrolled 30 patients who had a drainage bag after thoracoscopic lobectomy and compared them with 30 similar patients operated on previously who had chest bottles. Variables studied included total drainage volume, duration of drainage, complications, and satisfaction of the care providers. Results There was no significant difference between the chest bottle and drainage bag groups respectively in terms of total drainage (697.5 ± 89.7 vs. 614.1 ± 76.6 mL, p = 0.483) or duration of drainage (4.23 ± 0.38 vs. 4.43 ± 0.38 days, p = 0.713). No device-related complication was observed. After our experience with the drainage bag, we abandoned use of the chest bottle. The drainage bag was more convenient for patients and promoted early ambulation as well improving cost effectiveness. Most care providers preferred to use the drainage bag (p = 0.000). Conclusion The drainage bag is superior to the chest bottle for postoperative drainage.
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Affiliation(s)
- Ming-Ho Wu
- Department of Surgery, Tainan Municipal Hospital, Show Chwan Medical Care Corporation, Tainan, Taiwan
| | - Han-Yun Wu
- Department of Surgery, Tainan Municipal Hospital, Show Chwan Medical Care Corporation, Tainan, Taiwan
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4
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Abstract
Background Intercostal chest drainage is required for varied lung diseases with the pleural involvement. While the conventional method of intercostal drainage (ICD) insertion with the bulky underwater drain (UWD) was the gold standard for management, it had numerous disadvantages. It was time and again challenged with better ambulatory methods, although the documentation and continued use of the same are rare in practice. We studied the efficacy of ambulatory chest drainage (ACD) with pigtail and urosac against the conventional drainage methods (ICD-UWD) at a tertiary care center. Materials and Methods This prospective, observational study included the patients requiring chest drainage grouping them as per the intervention they underwent, i.e., (1) Pigtail-Urosac (ACD group) and (2) ICD-UWD (Non-ACD group). The clinical data were recorded and analyzed for the difference in the hospital stay, the total duration of drainage, successful outcome, residual disease, and pain in both groups using unpaired t-test and Chi-square test. Results Of the 85 patients included in the study; 45 had pigtail-urosac and 40 had ICD-UWD, consisting of 34 pleural effusions and 51 pneumothoraces. The ACD and non-ACD groups were similar in etiology. Of the 85 patients, 50 had complete lung expansion, 18 pleural thickening, 15 loculated residual disease, and two pleurocutaneous fistulae. In the ACD group, the hospital stay was less as compared to the non-ACD group, i.e., 4.06 (4.42) versus 19.68 (31.39) days (P = 0.0008). The duration of chest drainage showed a similar trend, i.e., 19.29 (66.91) versus 52.18 (46.38) days (P = 0.006). Pain (P < 0.0001) recorded was significantly less with better expansion (P < 0.0001), less pleural thickening (P = 0.0067), and residual disease (P = 0.0087) in the ACD group. Conclusion The use of pigtail-urosac is a safe, effective, and preferred method for ACD.
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Affiliation(s)
- Unnati Desai
- Department of Pulmonary Medicine, T. N. Medical College, B. Y. L. Nair Hospital, Mumbai, Maharashtra, India
| | - Jyotsna M Joshi
- Department of Pulmonary Medicine, T. N. Medical College, B. Y. L. Nair Hospital, Mumbai, Maharashtra, India
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Abstract
The authors present a review of the pathophysiology of pneumothoraces, the indications and the procedures required for the insertion of chest drains, and review paediatric practice using the recently developed Seldinger-style percutaneous chest drains.
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Affiliation(s)
- PM Parslow
- Poole Hospital NHS Trust, Poole, Dorset, UK
| | - JM Sandell
- Poole Hospital NHS Trust, Poole, Dorset, UK,
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Paul AO, Kirchhoff C, Kay MV, Hiebl A, Koerner M, Braunstein VA, Mutschler W, Kanz KG. Malfunction of a Heimlich flutter valve causing tension pneumothorax: case report of a rare complication. Patient Saf Surg 2010; 4:8. [PMID: 20565768 PMCID: PMC2901307 DOI: 10.1186/1754-9493-4-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2010] [Accepted: 06/17/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Thoracic injuries play an important role in major trauma patients due to their high incidence and critical relevance. A serious consequence of thoracic trauma is pneumothorax, a condition that quickly can become life-threatening and requires immediate treatment.Decompression is the state of the art for treating tension pneumothorax. There are many different methods of decompression using different techniques, devices, valves and drainage systems. Referring to our case report we would like to discuss the utilization of these devices. CASE PRESENTATION We report of a patient suffering from tension pneumothorax despite insertion of a chest drain at the accident scene. The decompression was by tube thoracostomy which was connected to a Heimlich flutter valve. During air transportation the patient suffered from cardiorespiratory arrest with asystole and was admitted to the trauma room undergoing manual chest compressions. The initial chest film showed a persisting tension pneumothorax, despite the chest tube that had been correctly placed and connected properly to the Heimlich valve. We assume that the Heimlich valve leaves did not open up and thus tension pneumothorax was not released. CONCLUSION We would like to raise awareness to the fact that if a Heimlich flutter valve is applied in the pre-hospital setting it should be used with caution. Failure in this type of valve may lead to recurrent tension pneumothorax.
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Affiliation(s)
- April O Paul
- Munich University Hospital LMU, Department of Trauma Surgery - Campus Innenstadt, Nussbaumstrasse 20, D-80336 Munich, Germany.
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7
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Varela G, Jiménez MF, Novoa N. Portable chest drainage systems and outpatient chest tube management. Thorac Surg Clin 2010; 20:421-6. [PMID: 20619234 DOI: 10.1016/j.thorsurg.2010.03.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Ambulatory treatment of pleural problems such as pneumothorax and malignant pleural effusions has been extensively described and is commonly used. On the contrary, outpatient management of chest tubes after lung resection is less frequently performed. Because prolonged air leak after lobectomy is a common problem, early discharge of these patients under pleural drainage can avoid many hospital days without compromising the quality of care. In this article, general rules for outpatient chest tube management are described and available portable devices are reviewed.
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Affiliation(s)
- Gonzalo Varela
- Service of Thoracic Surgery, Salamanca University Hospital, Paseo San Vicente, 58-182 Salamanca, Spain.
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8
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Bar I, Papiashvilli M, Kurtzer B, Bahar M. Effect of Heimlich valve and underwater seal on lung expansion after pulmonary resection. Indian J Thorac Cardiovasc Surg 2010. [DOI: 10.1007/s12055-009-0053-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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9
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Vega NDA, Ortega HAV, Tincani AJ, Toro IFC. Use of a one-way flutter valve drainage system in the postoperative period following lung resection. J Bras Pneumol 2009; 34:559-66. [PMID: 18797739 DOI: 10.1590/s1806-37132008000800004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2007] [Accepted: 12/05/2007] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To evaluate pleural drainage using a one-way flutter valve following elective lung resection. METHODS This was a prospective study, with descriptive analysis, of 39 lung resections performed using a one-way flutter valve to achieve pleural drainage during the postoperative period. Patients less than 12 years of age were excluded, as were those submitted to pneumonectomy or emergency surgery, those who were considered lost to follow-up and those in whom water-seal drainage was used as the initial method of pleural drainage. Lung expansion, duration of the drainage, hospital stay and postoperative complications were noted. RESULTS A total of 36 patients were included and analyzed in this study. The mean duration of pleural drainage was 3.0 +/- 1.6 days. At 30 days after the surgical procedure, chest X-ray results were considered normal for 34 patients (95.2%). Postoperative complications occurred in 8 patients (22.4%) and were related to the drainage system in 3 (8.4%) of those. CONCLUSIONS The use of a one-way flutter valve following elective lung resection was effective, was well tolerated and presented a low rate of complications.
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Lima AGD, Rocha ERF, Seabra JCT, Mussi RK, Santos JGD, Contrera Toro IF. A influência do uso do "clamp" ou braçadeira no acúmulo de coágulos em drenos pleurais tubulares. Rev Col Bras Cir 2008. [DOI: 10.1590/s0100-69912008000200003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJETIVO: Conduziu-se este estudo prospectivo a fim de avaliar-se a influência do uso da braçadeira sobre o acúmulo de coágulos dentro dos drenos pleurais. MÉTODO: Os drenos pleurais foram pesados logo após sua retirada, lavados e secados e pesados novamente. A diferença entre a primeira e a segunda pesagem foi admitida como a quantidade de coágulos acumulada. RESULTADOS: Houve maior acúmulo de coágulo nos drenos temporariamente obstruídos por braçadeira em relação àqueles não obstruídos. CONCLUSÃO: Notou-se, neste estudo, maior acúmulo de coágulo dentro de drenos pleurais obstruídos, mesmo que intermitentemente, o que pode levar ao mau funcionamento de todo o sistema de drenagem. A discussão sobre o correto uso dos drenos pleurais deve ser constante e fazer parte de programas de educação continuada para médicos e enfermagem, a fim de que este sistema, amplamente utilizado e altamente eficiente, seja otimizado.
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11
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Affiliation(s)
- Ben Sullivan
- Guy’s Main Theatres. Guy’s and St Thomas’ NHS Foundation Trust, London
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12
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Waydhas C, Sauerland S. Pre-hospital pleural decompression and chest tube placement after blunt trauma: A systematic review. Resuscitation 2006; 72:11-25. [PMID: 17118508 DOI: 10.1016/j.resuscitation.2006.06.025] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2006] [Revised: 06/13/2006] [Accepted: 06/20/2006] [Indexed: 02/01/2023]
Abstract
Pre-hospital insertion of chest tubes or decompression of air within the pleural space is one of the controversial topics in emergency medical care of trauma patients. While a wide variety of opinions exist medical personnel on the scene require guidance in situations when tension pneumothorax or progressive pneumothorax is suspected. To ensure evidence based decisions we performed a systematic review of the current literature with respect to the diagnostic accuracy in the pre-hospital setting to identify patients with (tension) pneumothorax, the efficacy and safety of performing pleural decompression in the field and the choice of method and technique for the procedure. The evidence found is presented and discussed and recommendations are drawn from the authors' perspective.
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Affiliation(s)
- Christian Waydhas
- Department of Trauma Surgery, University Hospital Essen, Hufelandstr. 55, 45147 Essen, Germany.
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13
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Lima AGD, Toro IFC, Tincani AJ, Barreto G. A drenagem pleural pré-hospitalar: apresentação de mecanismo de válvula unidirecional. Rev Col Bras Cir 2006. [DOI: 10.1590/s0100-69912006000200009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJETIVO: O objetivo do presente estudo é apresentar um mecanismo de válvula unidirecional para substituição do selo de água na drenagem pleural tubular fechada, em ambiente pré-hospitalar, bem como registrar os resultados de seu uso inicial no SAMU-Campinas/SP/Brasil. MÉTODO: Foram realizadas 22 (vinte e duas) drenagens pleurais com válvula em doentes vítimas de traumatismo ou pneumotórax espontâneo, todos em ambiente pré-hospitalar, de forma prospectiva, não randomizada. RESULTADOS: O débito total de líquidos através da válvula variou de zero a 1500 ml, com média de 700 ± 87,4 ml, para um tempo de percurso em média de 18 ± 1,1 minutos, variando de 8 a 26 minutos. A frequência cardíaca inicial foi 120 ± 2,7 bpm e final de 100 ± 2 bpm (p 0,00) e a frequência respiratória inicial foi 24 ± 0,8 ipm e o valor final foi de 15 ± 0,3 ipm (p 0,03). Houve apenas duas falhas mecânicas do sistema e uma foi corrigida pela substituição da mesma, trazudindo num índice de sucesso de 95,4% neste trabalho. CONCLUSÃO: Levando em conta exame físico inicial com o exame físico final, bem como pela quantificação de débitos, concluímos que a válvula mostrou-se eficiente e funcionante, e que é segura para o uso em urgências pré-hospitalares.
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Vuorisalo S, Aarnio P, Hannukainen J. Comparison between flutter valve drainage bag and underwater seal device for pleural drainage after lung surgery. Scand J Surg 2005; 94:56-8. [PMID: 15865119 DOI: 10.1177/145749690509400114] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIM OF THE STUDY The purpose of the present study was to compare the use of a conventional underwater seal device with suction and a flutter valve drainage bag for pleural drainage after lung surgery. PATIENTS AND METHODS Altogether 59 patients undergoing elective lung surgery except pneumonectomy between February 2001 and April 2002 were prospectively randomized to receive postoperative pleural drainage by 28F chest tube(s) attached to underwater seal device placed on negative pressure of 15 cm of water or flutter valve drainage bag. Following withdrawal of four patients from the study, 55 patients were evaluated (31 patients in the underwater seal device group and 24 patients in the flutter valve drainage bag group). RESULTS In the conventional underwater seal device group the mean drainage time was 2.6 (SD +/- 2.0) days and in the flutter valve drainage bag group the mean drainage time was 3.3 days (SD +/- 4.0); difference -0.8, 95% confidence interval (CI) -2.4 to 0.9. The mean length of hospitalization in the surgical ward was 3.6 (SD +/- 2.7) and 4.1 (SD +/- 4.4) days respectively (difference -0.5, 95% CI -2.5 to 1.4). CONCLUSIONS The results of this study suggest that flutter valve drainage system is a safe and feasible alternative in managing postoperative air leaks and haemorrhage after lung surgery other than pneumonectomy if air leaks are not extremely massive.
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Affiliation(s)
- S Vuorisalo
- Department of Surgery, Satakunta Central Hospital, Pori, Finland.
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15
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Wallen M, Morrison A, Gillies D, O'Riordan E, Bridge C, Stoddart F. Mediastinal chest drain clearance for cardiac surgery. Cochrane Database Syst Rev 2004; 2002:CD003042. [PMID: 15495040 PMCID: PMC8094876 DOI: 10.1002/14651858.cd003042.pub2] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Cardiac tamponade may occur following cardiac surgery as a result of blood or fluid collecting in the pericardial space compressing the heart and reducing cardiac output. Mediastinal chest drains (including pericardial drains) are inserted as standard post-operative practice following cardiac surgery to assist the clearance of blood from the pericardial space and to prevent cardiac tamponade. To prevent chest tubes from blocking and so causing tamponade nurses manipulate them to prevent or remove clots. Manipulation methods including milking, stripping, fanfolding and tapping may be applied to the tubes to keep them from blocking. Evidence is required as to the safest and most effective means of preventing chest tube blockage and preventing cardiac tamponade. OBJECTIVES To compare different methods of chest drain clearance (i.e. varying levels of suction or suction in combination with milking, stripping, fanfolding and tapping of chest drains) in preventing cardiac tamponade in patients following cardiac surgery. SEARCH STRATEGY Over both the initial review and the 2004 revision, we searched the Cochrane Heart Group trials register, the Cochrane Controlled Trials Register (CCTR) (Issue 4, 2003) The Cochrane Database of Systematic Reviews (CDSR), the Database of Abstracts of Reviews of Effectiveness (DARE), Issue 4, 2003, MEDLINE (1966 to Nov Week 2, 2003), EMBASE (1980 to 2003 Week 47), CINAHL (1982 to Nov 2003), the Clinical Trials site of the NIH, (USA) (24.11.03) and reference lists of articles. SELECTION CRITERIA Randomised, quasi-randomised or systematically allocated clinical trials of chest tube manipulation methods in adults and children with mediastinal chest drains following cardiac surgery were included. DATA COLLECTION AND ANALYSIS Two reviewers independently assessed trial quality and extracted data. Study authors were contacted for additional information where required. Adverse effects information was collected from the trials. MAIN RESULTS Three studies with a total of 471 participants were included. There was no data, however, which could be included in a meta-analysis. This was due to inadequate data provision by two of the studies. Where adequate data were provided there were no common interventions or outcomes to pool. On the basis of single studies there was no evidence of a difference between groups on incidence of chest tube blockage, heart rate, cardiac tamponade or incidence of surgical re-entry. REVIEWERS' CONCLUSIONS There are insufficient studies which compare differing methods of chest drain clearance to support or refute the relative efficacy of the various methods in preventing cardiac tamponade. Nor can the need to manipulate chest drains be supported or refuted by results from RCT's.
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Affiliation(s)
- D Laws
- Department of Thoracic Medicine, Royal Bournemouth Hospital, Bournemouth BH7 7DW,
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17
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Affiliation(s)
- D Laws
- Department of Thoracic Medicine, Royal Bournemouth Hospital, Bournemouth BH7 7DW,
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18
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Abstract
The aim of this systematic review was to summarise the best available evidence relating to the nursing management of chest drains. Studies included were those involving hospital patients with a chest drain in situ. A comprehensive and systematic search of the literature was undertaken that included all major databases. Methodological quality was assessed using a developed checklist. The randomised controlled trial (RCT) design was rarely used and therefore evidence was summarised using a narrative discussion. Studies using other methods were also assessed for inclusion in this narrative summary. The findings of this review highlight the lack of research on most aspects of the nursing management of patients with chest drains in situ. RCTs suggest that chest drains remain patent with or without stripping and milking of tubes, but that the total drainage was greater from manipulated tubes. There is little evidence relating to other aspects of chest drain management such as dressing of insertion site, actions following accidental disconnection and tube removal. There is therefore a need for rigorous research in many areas of the nursing management of chest drains, particularly with subjects under the age of 18 years.
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Affiliation(s)
- Y Charnock
- The Department of Clinical Nursing, Adelaide University, SA
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19
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Affiliation(s)
- G J Peek
- Department of Cardiothoracic Surgery, Northern General Hospital, Sheffield S5 7AN.
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20
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Waller DA, Edwards JG, Rajesh PB. A physiological comparison of flutter valve drainage bags and underwater seal systems for postoperative air leaks. Thorax 1999; 54:442-3. [PMID: 10212112 PMCID: PMC1763778 DOI: 10.1136/thx.54.5.442] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND A study was undertaken to compare the relative physiological effects of underwater seal (UWS) versus flutter valve (FV) pleural drainage systems in the treatment of postoperative air leaks. METHOD Fourteen patients with air leaks of 1-11 days duration, following lobectomy (n = 5), bullectomy (n = 4), decortication (n = 4), and pleural biopsy (n = 1) were analysed. Intrapleural pressure (IPP) measurements were made using an in-line external strain gauge connected directly to the intercostal tube. Patients were connected simultaneously to both UWS and FV drainage systems and pressures were measured sequentially, isolating each system in turn. Maximum (IPPmax) and minimum (IPPmin) intrapleural pressures were calculated from graphic traces. The degree of lung expansion was recorded by chest radiography. RESULTS At resting tidal volume IPPmax was significantly higher with the UWS system (mean difference 0.8 mm Hg, 95% CI 0 to 1.6, p = 0.046) and IPPmin was significantly lower with the FV system (1.8 mm Hg, 95% CI 0.3 to 3.3, p = 0.023). The lung was fully expanded in 50% of patients at the time of study. The mean difference in IPPmin between systems was significantly increased when the lung was fully expanded (mean 2.8 mm Hg, 95% CI 0.1 to 5.5, p = 0.042). The mean difference in IPPmax was not affected by the degree of lung expansion (0.79, 95% CI -0.83 to 2.4, p = 0.31). CONCLUSION The results of this study suggest that, when postoperative air leak exists without a persistent pleural space, the flutter valve may provide a physiologically more effective alternative to the underwater seal drainage system.
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Affiliation(s)
- D A Waller
- Department of Thoracic Surgery, Birmingham Heartlands Hospital, Birmingham B9 5SS, UK
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Johansson J, Lindberg CG, Johnsson F, von Holstein CS, Zilling T, Walther B. Active or passive chest drainage after oesophagectomy in 101 patients: a prospective randomized study. Br J Surg 1998; 85:1143-6. [PMID: 9718016 DOI: 10.1046/j.1365-2168.1998.00778.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND This study evaluates the efficiency and safety of two methods of chest drainage after uncomplicated oesophagectomy. METHODS A prospective randomized study between active suction drainage and passive chest drainage was carried out in 101 patients who underwent gastric pull-up oesophagectomy. RESULTS No difference in the prevalence of pneumothorax during treatment was noted between the active (nine of 55) and the passive (four of 46) drainage groups (P=0.20). Nor was there any difference in the size (P=0.46) and duration (P=0.53) of the pneumothorax. There was no significant difference in right (P=0.84) and left (P=0.61) basal atelectases and the amounts of right (P=0.10) and left (P=0.24) pleural effusions. There were significantly more basal atelectases (P < 0.001) and pleural effusions (P<0.001) in the non-operated left side compared with the operated right side. Postoperative hospital stay was the same in both groups (median 13 days; P=0.86). The hospital mortality rate was two of 101, and was not affected by the type of drainage. CONCLUSION Passive drainage did not reduce hospital stay, but was as safe and effective as the active system in draining the pleural cavity after uncomplicated oesophagectomy.
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Affiliation(s)
- J Johansson
- Department of Surgery, Lund University Hospital, Sweden
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Waller DA. Video-assisted thoracoscopic surgery (VATS) in the management of spontaneous pneumothorax. Thorax 1997; 52:307-8. [PMID: 9196508 PMCID: PMC1758540 DOI: 10.1136/thx.52.4.307] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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