Evaluation of a new chest tube removal protocol using digital air leak monitoring after lobectomy: a prospective randomised trial

Brunelli, Alessandro; Salati, Michele; Refai, Majed; Nunzio, Luca Di; Xiumé, Francesco; Sabbatini, Armando

doi:10.1016/j.ejcts.2009.05.006

Cited by 132 publications

(115 citation statements)

References 18 publications

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“…Recently digital drainage systems have been developed and these systems facilitate the patients to ambulate without attached to wall suction and also make it easy for physicians to decide when to remove tubes objectively (1). Digital monitoring systems reduced hospital stay and medical expenses (2,3). But with these advantages over traditional drainage systems, physicians still visit the patients to confirm the state of chest drainage systems.…”

Section: Introductionmentioning

confidence: 99%

The usefulness of Wi-Fi based digital chest drainage system in the post-operative care of pneumothorax

et al. 2016

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Section: Introductionmentioning

confidence: 99%

The usefulness of Wi-Fi based digital chest drainage system in the post-operative care of pneumothorax

et al. 2016

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“…[1][2][3][4][5] To date, two randomized studies have shown that DCS was superior to ACS in terms of chest tube management. 6,7) The Thopaz DCS (Medela, Baar, Switzerland) has a screen that displays instantaneous values for pleural pressure and PAL rate, allowing objective, real-time, quantitative assessment of PAL via the chest tube. Data are also recorded continuously and presented as a graph of the PAL over the preceding 24h.…”

mentioning

confidence: 99%

Clinical Evaluation and Outcomes of Digital Chest Drainage after Lung Resection

Fukushima

Takamori

Akamine

et al. 2016

ATCS

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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.

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“…To date, drainage systems have only been compared with relation to postoperative air leak (11)(12)(13)(14)(15). Whilst this is an important aspect of the decision to remove chest tubes, the volume of fluid extracted is another major determinant, that continues to garner increased attention amongst research circles (2,(16)(17)(18).…”

Section: Discussionmentioning

confidence: 99%

“…Our trial attempts to evaluate whether intermittent (as opposed to traditional continuous) controlled suctioning provided via the mechanism of digital drainage decreases pleural irritation and inflammation and therefore decreases the amount of pleural drainage. Previously published reports have demonstrated that digital drainage systems are superior in reducing the incidence of post-operative prolonged air leak (12)(13)(14). Several articles describe the advantage of a digital system in eliminating the inter-observer differences related to air leak grading, as the system quantifies the precise amount of air leak (13)(14)(15).…”

Section: Discussionmentioning

confidence: 99%

“…Previously published reports have demonstrated that digital drainage systems are superior in reducing the incidence of post-operative prolonged air leak (12)(13)(14). Several articles describe the advantage of a digital system in eliminating the inter-observer differences related to air leak grading, as the system quantifies the precise amount of air leak (13)(14)(15). Moreover, the effect of continuous vs. intermittent suction on postoperative air leak may also account for differences in air leak duration.…”

Section: Discussionmentioning

confidence: 99%

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Does the usage of digital chest drainage systems reduce pleural inflammation and volume of pleural effusion following oncologic pulmonary resection?—A prospective randomized trial

Waele¹,

Agzarian²,

Hanna³

et al. 2017

J. Thorac. Dis.

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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 pleural inflammation and postoperative drainage volumes, thus leading to earlier chest tube removal. Methods: One hundred and three [103] patients were enrolled and randomized to either analog (n=50) or digital (n=53) drainage systems following oncologic lung resection. Chest tubes were removed according to standardized, pre-defined protocol. Inflammatory mediators [interleukin-1B (IL-1B), 6, 8, tumour necrosis factor-alpha (TNF-α)] in pleural fluid and serum were measured and analysed. The primary outcome of interest was the difference in total volume of postoperative fluid drainage. Secondary outcome measures included duration of chest tube in-situ, prolonged air-leak incidence, length of hospital stay and the correlation between pleural effusion formation, degree of inflammation and type of drainage system used.Results: There was no significant difference in total amount of fluid drained or length of hospital stay between the two groups. A trend for shorter chest tube duration was found with the digital system when compared to the analog (P=0.055). Comparison of inflammatory mediator levels revealed no significant differences between digital and analog drainage systems. The incidence of prolonged post-operative air leak was significantly higher when using the analog system (9 versus 2 patients; P=0.025). Lobectomy was associated with longer chest tube duration (P=0.001) and increased fluid drainage when compared to sublobar resection (P<0.001), regardless of drainage system. Conclusions: Use of post-lung resection digital drainage does not appear to decrease pleural fluid formation, but is associated with decreased prolonged air leaks. Total pleural effusion volumes did not differ with the type of drainage system used. These findings support previously established benefits of the digital system in decreasing prolonged air leaks, but the advantages do not appear to extend to decreased pleural fluid formation.

show abstract

Evaluation of a new chest tube removal protocol using digital air leak monitoring after lobectomy: a prospective randomised trial

Cited by 132 publications

References 18 publications

The usefulness of Wi-Fi based digital chest drainage system in the post-operative care of pneumothorax

The usefulness of Wi-Fi based digital chest drainage system in the post-operative care of pneumothorax

Clinical Evaluation and Outcomes of Digital Chest Drainage after Lung Resection

Does the usage of digital chest drainage systems reduce pleural inflammation and volume of pleural effusion following oncologic pulmonary resection?—A prospective randomized trial

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