Clinical Evaluation and Outcomes of Digital Chest Drainage after Lung Resection

Abstract

Background: Analog chest drainage systems (ACS) are generally used to monitor postoperative alveolar air leakage (PAL) after lung resection. An electronic digital chest drainage system (DCS) has recently been developed that reportedly has several advantages over the traditional ACS. Here, we report a single institution's experience of PAL management with the DCS. We also sought to establish whether DCS had superior clinical benefits and outcomes compared with ACS. Methods: We enrolled 112 consecutive patients who underwent lung resection and were subsequently managed with DCS. We compared PAL rate, duration of chest drainage, and the incidence of complications with a group of 121 consecutive patients previously managed with ACS after lung resection, using propensity score matching. Results: Mean maximum and minimum PAL rates during DCS chest drainage were 48.9 ml/min (range: 2.0-868.6 ml/min) and 0.1 ml/min (0.0-1.2 ml/min), respectively. Mean PAL rate at DCS removal was 1.3 ml/min (0.0-10.0 ml/min). After propensity score matching, mean duration of chest drainage was significantly shorter with DCS than ACS (2.7 days, range: 1-9 days, compared with 3.7 days, range: 1-21 days, respectively; P = 0.031). Conclusions: Managing PAL with DCS after pulmonary resection appears to reduce the duration of chest drainage.

Assessment of pleural air leakage using digital chest drainage system after surgical pulmonary resection: Comparison of visible alveolar air leakage with the digital value measured by a digital chest drainage system

“…Patients who use the ACS sometimes complain of its weight and size, reporting that it is too heavy to carry (the ACS we use weighs about 5 kg (11 lb)), and indicate that the bubbling sound is bothersome [ 1 , 6 , 7 ]. After switching to the DCS, these complaints ceased at our institution, as in other reports [ 1 , 4 , 6 , 10 , 11 ]. The DCS does not use water for management and therefore does not need to be maintained in an upright position.…”

“…The clinical usefulness and benefits of the DCS have been reported in many recent studies [ 1 – 6 , 10 , 13 ]. To clarify the relationship between the ACS and DCS, we thought that it was important to simultaneously examine the bubbles of the ACS and the numeric volume of the DCS in the same patient because all previous studies compared these parameters separately [ 4 – 7 , 11 , 12 ]. We also considered that the use of two study arms did not allow for strict comparison.…”

“…Some clinical trials have shown advantages of the DCS. After the present study, we evaluated 233 patients who underwent lung resection and compared the PAL volume, duration of chest drainage, and incidence of complications between patients managed with the DCS versus ACS using propensity score matching [ 11 ]. The drainage duration was 2.7 days for the DCS and 3.7 days for the ACS with a statistically significant difference (p = 0.031).…”

Thopaz+ Portable Digital System for Managing Chest Drains: A NICE Medical Technology Guidance

“…Of the 13 included studies, there were six RCTs [ 7 , 12 , 14 – 16 , 18 ], three observational comparative studies that used propensity matching for their analysis [ 20 – 22 ], three observational studies with no comparative element [ 9 , 13 , 17 ] and one prospective comparative study [ 19 ]. The comparators in almost all of the RCTs and comparative observational studies were traditional analogue chest drainage systems that used wall-mounted suction.…”

“…One of the RCTs used Thopaz at two different suction settings, and compared outcomes for these settings [ 12 ]. Eleven of the studies used the device in a patient population that had undergone pulmonary resection [ 7 , 12 – 14 , 16 – 22 ]. Two studies used the device in a patient population with pneumothorax [ 9 , 15 ].…”