Low suction on digital drainage devices promptly improves post-operative air leaks following lung resection operations: a retrospective study

Abstract

Background We investigated the most effective suction pressure for preventing or promptly improving postoperative air leaks on digital drainage devices after lung resection. Methods We retrospectively analyzed the postoperative data of 242 patients who were monitored with a digital drainage system after pulmonary resection in our institution between December 2017 and June 2020. We divided the patients into three groups according to the suction pressure used: A (low-pressure suction group: − 5 cm H2O), B (intermediate-pressure group: − 10 cm H2O), and C (high-pressure suction group: − 20 cm H2O). We evaluated the duration of air leaks, timing of chest tube replacement, the amount of postoperative air leak, volume of fluid drained before chest tube removal, and the total number of air leaks during drainage. Results In total, 217 patients were included in this study. The duration of air leaks gradually decreased with significant difference between the groups, the highest decrease in A, the lowest decrease in C (P = 0.019). Timing of chest tube replacement, on the other hand, did not significantly differ between the three groups (P = 0.126). The number of postoperative air leaks just after surgery did not significantly differ between the three groups (P = 0.175), but the number of air leaks on postoperative day 1 were fewest in group A, then B, and greatest in group C (P = 0.033). The maximum amount of air leaks during drainage was lowest in A, then B, and highest in C (P = 0.036). Volume of fluid drained before chest tube removal did not significantly differ between the three groups (P = 0.986). Conclusion Low-pressure suction after pulmonary resection seems to avoid or promptly improve postoperative air leaks in digital drainage devices after lung resection. Trial registration This is a single-institution, retrospective analysis-based study of data from an electronic database. Study protocol was approved by the Akashi Medical Center Institutional Research Ethics Board (approval number: 2020–9).

Intraoperative prevention and conservative management of postoperative prolonged air leak after lung resection: a systematic review

“…For this reason, most of literature is about postoperative PAL conservative management, that can rely on fewer options than intraoperative air leak treatment. To date, in case of completely expansible residual lung parenchyma, PAL treatment may be safely attempted by autologous blood patch or chemical pleurodesis (37)(38)(39)(40)(41)(42), whereas in case of residual pleural space, applying suction to the chest drain is still the most effective option available (43)(44)(45)(46)(47)(48). In all cases, digital drainage systems are useful since they allow early patients' mobilization and a real time quantification of air flow (49)(50)(51).…”

“…Alphonso et al in their paper written in 2005 (44) declared to be in favor of a no-suction policy, while Holbek et al, in their randomized controlled trial of 2018 (47) compared water seal to a low suction (−10 cmH 2 O), encountering a significantly shorter chest drain duration in the second group. Finally, Mitsui and coauthors highlighted, in their retrospective report of 2021 (48), as a low-pressure suction (−10 cmH 2 O) promptly improve postoperative air leaks if compared to lower negative pressures (−20 cmH 2 O).…”

A proposed improvised pleural drainage system for veterinary use

“…Lower pressures within this range are recommended for pediatric patients and can potentially improve outcomes following lung resections in people. [1][2][3]7 Suction pressures up to 40 cm H 2 O may be required for viscous fluid drainage. 2 The suction pressure of the proposed designs is limited by the length of the straw and depth of the canister.…”

“…The recommended initial pressures for pleural suction are generally between 5 and 20 cm H 2 O. Lower pressures within this range are recommended for pediatric patients and can potentially improve outcomes following lung resections in people 1–3,7 . Suction pressures up to 40 cm H 2 O may be required for viscous fluid drainage 2 .…”

Advancements in the Management of Postoperative Air Leak following Thoracic Surgery: From Traditional Practices to Innovative Therapies

“…Further investigations, including a randomized controlled trial published by Holbek et al, revealed that low suction (−10 cm H 2 O) notably decreased the duration of chest drainage in comparison to water seal [35]. Additionally, retrospective analyses reported by Mitsui et al have suggested that a low-pressure suction (−10 cm H 2 O) is more effective at improving postoperative air leaks than lower negative pressures (−20 cm H 2 O) [36]. These divergent findings highlight the ongoing debate and need for conclusive research to establish standardized guidelines for chest drain management following thoracic surgery to minimize air leak durations [2,15].…”