Suction or non-suction to the underwater seal drains following pulmonary operation: meta-analysis of randomised controlled trials

Deng, Bo; Tan, Qunyou; Zhao, Yuhai; Wang, Ruwen; Jiang, Yao‐Guang

doi:10.1016/j.ejcts.2010.01.050

Cited by 65 publications

(40 citation statements)

References 13 publications

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“…In a meta-analysis, Deng et al 18 demonstrated that pulmonary patients with chest tubes placed to wall suction had a longer time to chest tube removal and longer length of hospital stay than did patients with chest tubes placed to water seal. Our fi ndings did not indicate that same difference for time to chest tube removal.…”

Section: Discussionmentioning

confidence: 99%

“…18 Cerfolio et al 15 stopped their randomized control trial because of the clinical benefi ts and statistically signifi cant results for postoperative pulmonary patients with chest tubes placed to water seal.…”

Section: Discussionmentioning

confidence: 99%

“…Cerfolio et al determined that water seal was superior to wall suction for eliminating air leaks. Deng et al 18 concluded in a meta-analysis of outcomes of wall suction versus water seal after pulmonary surgery that in most cases use of wall suction was of no benefit as a strategy to reduce the incidence of prolonged air leaks. More specifically, the analysis of multiple studies in this meta-analysis indicated that patients with chest tubes with continuous negative-pressure wall suction had longer duration of tube placement before removal of the tubes than did patients with chest tubes with a water seal, a situation that ultimately increased the hospital length of stay.…”

Section: Introductionmentioning

confidence: 99%

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Place Atrium to Water Seal (PAWS): Assessing Wall Suction Versus No Suction for Chest Tubes After Open Heart Surgery

Kruse

Wahl

Guthrie

et al. 2017

Critical Care Nurse

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BACKGROUND Traditionally chest tubes are set to −20 cm H2O wall suctioning until removal to facilitate drainage of blood, fluid, and air from the pleural or mediastinal space in patients after open heart surgery. However, no clear evidence supports using wall suction in these patients. Some studies in patients after pulmonary surgery indicate that using chest tubes with a water seal is safer, because this practice decreases duration of chest tube placement and eliminates air leaks. OBJECTIVE To show that changing chest tubes to a water seal after 12 hours of wall suction (intervention) is a safe alternative to using chest tubes with wall suction until removal of the tubes (usual care) in patients after open heart surgery. METHODS A before-and-after quality improvement design was used to evaluate the differences between the 2 chest tube management approaches in chest tube complications, output, and duration of placement. RESULTS A total of 48 patients received the intervention; 52 received usual care. The 2 groups (intervention vs usual care) did not differ significantly in complications (0 vs 2 events; P = .23), chest tube output (H1 = 0.001, P = .97), or duration of placement (median, 47 hours for both groups). CONCLUSION Changing chest tubes from wall suction to water seal after 12 hours of wall suction is a safe alternative to using wall suctioning until removal of the tubes.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Place Atrium to Water Seal (PAWS): Assessing Wall Suction Versus No Suction for Chest Tubes After Open Heart Surgery

Kruse

Wahl

Guthrie

et al. 2017

Critical Care Nurse

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“…The intraoperative information included the size of the incision, continuous rinsing with adrenaline saline, regional blockade with intercostal nerve block or intravenous morphine, and persistent negative pressure aspiration (7,8). The postoperative data included the time of chest tube placement, volume of pleural fluid drainage, and the incidence of complications.…”

Section: Data Collectionmentioning

confidence: 99%

Outcomes after implementing the enhanced recovery after surgery protocol for patients undergoing tuberculous empyema operations

et al. 2017

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Background: Enhanced recovery after surgery (ERAS) protocols provide recommendations for care in various surgical fields. However, there is scarce information on the application of these protocols in tuberculous empyema surgery. The purpose of this research is to evaluate the outcomes of ERAS recommendations for patients who received tuberculous empyema surgery. Methods: A retrospective analysis was performed on patients who underwent tuberculous empyema surgery in our hospital from March 2011 to March 2016. The patients were divided into an ERAS group and a conventional control group. The main outcome measure was the postoperative median length of stay (including readmissions). Principles related to ERAS were documented, and the postoperative median hospital stay was analyzed statistically between the two groups. Results: A total of 92 patients underwent 93 consecutive tuberculous empyema surgical treatments. The postoperative fasting time, chest tube duration, and length of stay were shorter in the ERAS group compared with the control group. The volume of chest tube drainage in the ERAS group was significantly smaller than that of the control group. No statistical differences were observed in the postoperative complications and reasons for readmission between the two groups. Conclusions: Application of ERAS recommendations in patients receiving tuberculous empyema operations decreased the length of stay and chest tube drainage compared to the control group. Enhanced recovery after surgery (ERAS) protocols are currently applied for the care for subjects undergoing lung resection surgery (2). High-rank evidence retains to sustain their applications (3). ERAS involves preoperative optimization, minimization of preoperative fasting, and normal physiological restoration. However, there is relatively scarce data on the application of ERAS protocols in patients undergoing tuberculous empyema operations. Nevertheless, further studies are needed to identify differences in these specific outcomes. In addition, no investigations have yet evaluated the effect of ERAS protocols on quality of life outcomes (4). Moreover, a previous report noted heterogeneity in the characterizations of ERAS programs (5).Real-time clinical practice usually incorporates advancements over time as new evidence becomes available. Therefore, the purpose of this study was to evaluate the recommendations of an ERAS program for tuberculous empyema patients undergoing VATS. The study was conducted over a 5-year period to determine whether the introduction of ERAS protocols shortens the length of hospital stay for patients and improves their quality of life. Methods Subject enrollmentAll subjects were diagnosed with tuberculous empyema based on the following criteria: patients exhibited fever, emaciation, fatigue, chest pain, cough, and shortness of breath with a history of tuberculosis pleurisy. Local chest percussion demonstrated dullness or flatness, and auscultation indicated that breath sounds were absent or diminished. Thoracentesis obtained str...

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“…Based on anecdotal experience, it is generally accepted that negative pressure suction is required for effective drainage of post-operative effusions, adequate control of parenchymal air leaks, and expansion of the remaining lung (4,5). Two different pleural suction modalities are approved for use in Canada: a traditional analog constant suction system and a digital intermittent suction system.…”

Section: Introductionmentioning

confidence: 99%

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.

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Suction or non-suction to the underwater seal drains following pulmonary operation: meta-analysis of randomised controlled trials

Cited by 65 publications

References 13 publications

Place Atrium to Water Seal (PAWS): Assessing Wall Suction Versus No Suction for Chest Tubes After Open Heart Surgery

Place Atrium to Water Seal (PAWS): Assessing Wall Suction Versus No Suction for Chest Tubes After Open Heart Surgery

Outcomes after implementing the enhanced recovery after surgery protocol for patients undergoing tuberculous empyema operations

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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