Chest tube removal at different gas flows in prolonged air leak: a randomized non-inferiority trial

Abstract

OBJECTIVES To evaluate the safety and feasibility of removing drainage tubes at larger size of air leak in patients with prolonged air leak (PAL) after pulmonary surgery. METHODS Ninety-five patients who underwent pulmonary surgery with PAL in our center were enrolled in this randomized controlled, single-center, non-inferiority study. The drainage tube was clamped with a stable size of air leak observed over the last 6 hours, which was quantified by gas flow rate using the digital drainage system. The control group(n = 48) and the study group(n = 46) had their drainage tube clamped at 0-20ml/min and 60-80ml/min, respectively. We continuously monitored clinical symptoms, conducted imaging and laboratory examinations, and decided whether to reopen the drainage tube. RESULTS The reopening rate in the study group was not lower than that in the control group (2.08% vs 6.52%, p > 0.05). The absolute difference in reopening rate was 4.44% [95% confidence interval (95% CI) -0.038, 0.126], with an upper limit of 12.6% below the non-inferiority margin (15%). There were significant differences in the length of stay [16.5 (13, 24.75) vs 13.5 (12, 19.25), p = 0.017] and the duration of drainage [12 (9.25, 18.50) vs 10 (8, 12.25), p = 0.007] between the control and study groups. No notable differences were observed in chest X-ray results 14 days after discharge or in the readmission rate. CONCLUSIONS For patients with PAL, removing drainage tubes at larger size of air leak demonstrated similar safety compared to smaller size of air leak, and can shorten both length of stay and drainage duration.