In patients undergoing video-assisted thoracic surgery for pleurodesis in primary spontaneous pneumothorax, how long should chest drains remain in place prior to safe removal and subsequent discharge from hospital?

Abstract

A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was how long chest drains should be left in place following video-assisted thoracic surgery (VATS) pleurodesis for primary spontaneous pneumothorax. Altogether, a total of 730 papers were found using the reported search, of which eight represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. We report that the main determining factor for the length of hospital stay following VATS pleurodesis is chest-drain duration. Providing no postoperative complications occur, and chest X-ray appearances of lung inflation are satisfactory, there is no documented contraindication to removing chest drains as early as 2 days postoperatively, with discharge the following day. Furthermore, leaving chest drains on water seal after a brief period of suction has been shown to benefit in reducing postoperative chest-drain duration and subsequent hospital stay. There is a paucity of literature directly addressing early vs late chest-drain removal protocols in this patient group. Hence, we conclude that, in clinical practice, the decision of when to remove chest drains postoperatively should remain guided empirically towards the individual patient.

Mechanical Pleurodesis Does Not Reduce Recurrence of Spontaneous Pneumothorax: A Randomized Trial

“…Special emphasis was placed on including the nearby normal lung parenchyma in the wedge resection, so as not to miss potential weak points in the visceral pleura capable of future regeneration of blebs. The recurrence rate is equal to that of previous reports [2,3,5,9,15]. In addition, in recurrence cases after the initial operation, identification of new blebs and surgical ease improved.…”

“…However, there is no gold standard due to clinical diversity and variation in surgeons' technical skill. Mechanical pleurodesis by pleural abrasion is one of the most widely used techniques but there is little evidence that it actually reduces PSP recurrence [7][8][9][10]; thus, its use should be reconsidered. We did a prospective, randomized controlled trail to evaluate the role of mechanical pleurodesis in thoracoscopic procedures, and to determine possible related risk factors for recurrence.…”

Evaluation of the relationship between primary spontaneous pneumothorax and exercise and patient return to previous activities in patients after treatment

“…Its incidence in men is 7 to 18 cases per 100,000 population per year and in women 1 to 6 cases per 100,000 population per year . Other risk factors include smoking, tall, young men aged 10 to 30 years [13][14]. Moreover, 10% of PSP cases have a positive family history [7][8].…”

“…Moreover, 10% of PSP cases have a positive family history [7][8]. Climate change including pressure and temperature reductions have also been identified as a contributing factor to PSP [14][15]. Symptoms of pneumothorax include sudden onset of severe chest pain in the affected side, dry cough and cyanosis, and even the patient may die of suffocation or acute cardiovascular failure [16].…”

Evaluation of the Relationship between Primary Spontaneous Pneumothorax and Exercise and Patient Return to Previous Activities in Patients Referring to Razi and Poursina and Aria Hospitals of Rasht du

“…Its incidence in men is 7 to 18 cases per 100,000 population per year and in women 1 to 6 cases per 100,000 population per year [10][11][12]. Other risk factors include smoking, tall, young men aged 10 to 30 years [13][14]. Moreover, 10% of PSP cases have a positive family history [7][8].…”