Does the usage of digital chest drainage systems reduce pleural inflammation and volume of pleural effusion following oncologic pulmonary resection?—A prospective randomized trial
Abstract:Background: Prolonged air leak and high-volume pleural drainage are the most common causes for delays in chest tube removal following lung resection. While digital pleural drainage systems have been successfully used in the management of post-operative air leak, their effect on pleural drainage and inflammation has not been studied before. We hypothesized that digital drainage systems (as compared to traditional analog continuous suction), using intermittent balanced suction, are associated with decreased pleu… Show more
“…Five studies evaluated the incidence of prolonged air leak [11, 12, 14, 16, 17]. Digital chest drainage system significantly reduced the risk of prolonged air leak compared with traditional chest drainage system (RR = 0.54, 95%CI 0.40–0.73, p < 0.0001; Fig.…”
Section: Resultsmentioning
confidence: 99%
“…2). Among the five studies, four studies were randomized control trials [11, 12, 16, 17], in this subgroup, the risk of prolonged air leak was still lower in digital group than in traditional group (RR = 0.59, 95%CI 0.43–0.82, p = 0.002). One study was observational study [14], which the risk of prolonged air leak was also lower in digital group than in traditional group (RR = 0.33, 95%CI 0.15–0.75, p = 0.008).Fig.…”
Section: Resultsmentioning
confidence: 99%
“…Some clinicians hypothesized that the intermittent suction pressure provided by the digital system may reduce the pressure gradient for fluid filtration across the pleural membrane and lighten the inflammatory response. However, the study conducted by Waele et al did not find such effect [16].…”
BackgroundSeveral 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.MethodsWe 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.ResultsCompared 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.ConclusionsDigital 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.
“…Five studies evaluated the incidence of prolonged air leak [11, 12, 14, 16, 17]. Digital chest drainage system significantly reduced the risk of prolonged air leak compared with traditional chest drainage system (RR = 0.54, 95%CI 0.40–0.73, p < 0.0001; Fig.…”
Section: Resultsmentioning
confidence: 99%
“…2). Among the five studies, four studies were randomized control trials [11, 12, 16, 17], in this subgroup, the risk of prolonged air leak was still lower in digital group than in traditional group (RR = 0.59, 95%CI 0.43–0.82, p = 0.002). One study was observational study [14], which the risk of prolonged air leak was also lower in digital group than in traditional group (RR = 0.33, 95%CI 0.15–0.75, p = 0.008).Fig.…”
Section: Resultsmentioning
confidence: 99%
“…Some clinicians hypothesized that the intermittent suction pressure provided by the digital system may reduce the pressure gradient for fluid filtration across the pleural membrane and lighten the inflammatory response. However, the study conducted by Waele et al did not find such effect [16].…”
BackgroundSeveral 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.MethodsWe 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.ResultsCompared 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.ConclusionsDigital 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.
“…The effect of digital chest drainage systems on outcomes after pulmonary resection was studied in a trial including 103 patients who were randomized to either analog or digital drainage systems (De Waele et al 2017 ). The use of digital systems had no significant effect on pleural fluid formation, but was associated with a significantly lower incidence of prolonged air leakage, compared with analog systems (3.8% versus 18%, respectively, P = 0.025).…”
Introduction
Anesthetic care in patients undergoing thoracic surgery presents specific challenges that require a multidisciplinary approach to management. There remains a need for standardized, evidence-based, continuously updated guidelines for perioperative care in these patients.
Methods
A multidisciplinary expert group, the Perioperative Anesthesia in Thoracic Surgery (PACTS) group, was established to develop recommendations for anesthesia practice in patients undergoing elective lung resection for lung cancer. The project addressed three key areas: preoperative patient assessment and preparation, intraoperative management (surgical and anesthesiologic care), and postoperative care and discharge. A series of clinical questions was developed, and literature searches were performed to inform discussions around these areas, leading to the development of 69 recommendations. The quality of evidence and strength of recommendations were graded using the United States Preventive Services Task Force criteria.
Results
Recommendations for intraoperative care focus on airway management, and monitoring of vital signs, hemodynamics, blood gases, neuromuscular blockade, and depth of anesthesia. Recommendations for postoperative care focus on the provision of multimodal analgesia, intensive care unit (ICU) care, and specific measures such as chest drainage, mobilization, noninvasive ventilation, and atrial fibrillation prophylaxis.
Conclusions
These recommendations should help clinicians to improve intraoperative and postoperative management, and thereby achieve better postoperative outcomes in thoracic surgery patients. Further refinement of the recommendations can be anticipated as the literature continues to evolve.
“…In these and other studies, the digital drainage systems were shown to be safe, consistent, and reliable in the detection of air leaks, allowing for earlier removal of chest tubes in the postoperative patient population. 20 However, the cost effectiveness remained unanswered.…”
Placement of a chest tube drains intrapleural fluid and air. The tube should be attached to a drainage system, such as one-, two-, or three-compartment devices, a one-way (Heimlich) valve for ambulatory drainage, a digital system, or a vacuum bottle. The frequently employed three-compartment systems, currently integrated disposable units, allow adjustment of negative pressure or no suction (water seal), and include an air leak meter on the water seal chamber to be used for demonstrating and quantifying air leak. These readings are subjective and prone to interobserver variability. Digital pleural drainage systems offer the benefits of quantification of any air leak and pleural pressure. Indwelling pleural catheters, typically utilized for malignant pleural effusion, can be drained using vacuum bottles. Knowledge of the design and functionality of each device in the setting of an individual patient's specific pleural process facilitates the selection of practical and financially prudent chest tube drainage strategies.
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