Suction vs Water Seal After Pulmonary Resection

Marshall, M. Blair; Deeb, Maher; Bleier, Joshua I. S.; Kucharczuk, John C.; Friedberg, Joseph S.; Kaiser, Larry R.; Shrager, Joseph B.

doi:10.1378/chest.121.3.831

Cited by 158 publications

(93 citation statements)

References 11 publications

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“…Further, the use of suction has also historically, been associated with reduced patient mobilization, particularly if wall suction is used. On the other hand, the so called "no suction" or "alternate suction" approaches have been shown to be effective in some circumstances to reduce the duration of air leak (2,3,4), presumably by decreasing the air flow, whilst also favoring mobilization (since the patient is not attached to the wall suction). Nonetheless, the absence of suction makes this approach ineffective in case of medium to large air leaks (particularly in the presence of a large pneumothorax) (2) and to be associated with an increased risk of other complications (particularly pneumonia and arrhythmia) (5).…”

Section: Management Of Chest Tubes After Lung Resection a Suction Vsmentioning

confidence: 99%

Chest Tube Management after Surgery for Pneumothorax

Pompili

Salati

Brunelli

2017

Thoracic Surgery Clinics

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Key Points: management of chest tubes after lung resection; Suction vs. no suction; regulated suction; management of chest tube after surgery for pneumothorax; regulated suction and recurrence 2 Synopsis:There is scant evidence on the management of chest tubes after surgery for pneumothorax. Most of the current knowledge is extrapolated from studies performed on lung cancer patients.We reviewed the existing literature on this subject with particular focus on the effect of suction and no suction on the duration of air leak after lung resection and surgery for pneumothorax.Moreover, we discussed the role of regulated suction, which seems to provide some benefit in reducing pneumothorax recurrence after bullectomy and pleurodesis.Finally we provided a personal view on the management of chest tubes after surgery for pneumothorax. 3 Management of chest tubes after lung resection A. Suction vs. no suctionThere are relative pros and cons in using suction versus no suction.Theoretically, suction promotes pleura-pleural apposition favoring the sealing of air leak and certainly favoring the drainage of large air leaks. However, suction has also been shown to increase the flow through the chest tube proportional to the level of suction applied (1) and it is assumed that this increased airflow increases the duration of drainage. Further, the use of suction has also historically, been associated with reduced patient mobilization, particularly if wall suction is used. On the other hand, the so called "no suction" or "alternate suction" approaches have been shown to be effective in some circumstances to reduce the duration of air leak (2,3,4), presumably by decreasing the air flow, whilst also favoring mobilization (since the patient is not attached to the wall suction). Nonetheless, the absence of suction makes this approach ineffective in case of medium to large air leaks (particularly in the presence of a large pneumothorax) (2) and to be associated with an increased risk of other complications (particularly pneumonia and arrhythmia) (5). Table 1 summary of the findings of the randomized trials published on suction versus no suction in lung resection patients.As evident from the table, these trials yielded mixed results. Some authors found a benefit by using "water seal" (2,3,7), others did not find any difference between the two modalities (5,6). 4The lack of objective data for more sensitive measurement of air leak severity has prevented the standardization of studies, and even test and control groups within studies, resulting in a lack of accurate quantification and reproducibility. B. Regulated SuctionSome new electronic chest drainage systems are now able to measure the pleural pressure. There is scant evidence on the role of pleural pressure on the healing of the lung parenchyma after surgery and duration of air leak.A recent paper has shown that the difference between minimum pressure and maximum pressure calculated from measurements taken during the 6 th postoperative hour following lobectomy was associated with the...

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Section: Management Of Chest Tubes After Lung Resection a Suction Vsmentioning

confidence: 99%

Chest Tube Management after Surgery for Pneumothorax

Pompili

Salati

Brunelli

2017

Thoracic Surgery Clinics

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“…11,15 Studies on chest tubes in patients after open heart surgery have primarily focused on the duration of placement of chest tubes and not on the use of suctioning in the association of these factors with postoperative complications.…”

Section: Introductionmentioning

confidence: 99%

“…10,17 Studies on the use of wall suction have been done in patients after pulmonary surgery in whom chest tubes are also placed to prevent pneumothorax and to remove excess fluid or air or both. Specifically, Cerfolio et al 15 and Marshal et al 11 found that for pulmonary surgery patients, placing chest tubes to water seal was potentially a better practice than using wall suction. Cerfolio et al determined that water seal was superior to wall suction for eliminating air leaks.…”

Section: Introductionmentioning

confidence: 99%

“…Because of the risk for complications, traditional management of chest tubes for patients after open heart surgery includes use of up to -20 cm H 2 O of wall suction to help remove potentially large amounts of drainage and, in patients with pleural tubes, to allow air to leave the chest. 2,10 Marshall et al 11 indicated that for pulmonary patients, no clear evidence supports managing chest tubes with the use of wall suction and that a water seal is a safe alternative. Whether the same alternative would be safe for patients who have pleural chest tubes after open heart surgery has not been studied.…”

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confidence: 99%

“…7,11,13 Thus, an evidence-based approach for the type of suctioning used in managing chest tubes is important for achieving the best outcomes.…”

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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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Comprehensive Review of Chest Tube Management

et al. 2022

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horacostomy tube, otherwise known as chest tube, insertion can be traced back to the fifth century BCE when Hippocrates described using a hollow tin tube to drain what was likely an empyema. 1 In 1889, valved tubes with air-tight seals were first reported to prevent outside atmospheric pressure from collapsing the lung on inspiration. 2 In 1922, chest tubes were first documented in the postoperative care of patients undergoing modern thoracic surgery. 3 They were used throughout World War II to restore lung function after traumatic thoracotomies, were used during the Korean War, and later became the standard of care for drainage of the pleural space for trauma during the Vietnam War. 4 Chest tubes and their management continue to evolve and are modified to fit modern needs, including clinical conditions associated with the COVID-19 pandemic. IndicationsThe potential space between the visceral pleura that envelops the lungs and the parietal pleura covering the chest wall, diaphragm, and mediastinum is the pleural cavity, which contains lubricating pleural fluid secreted by the parietal pleural capillaries. Air and abnormal fluid can accumulate in this space, causing mass effect and disruptions in the normal negative intrathoracic pressure.When air fills the pleural cavity, it is called a pneumothorax, which is further categorized according to its etiology as primary spontaneous, secondary spontaneous, or traumatic. [5][6][7] Chest tubes are used to evacuate air in the pleural cavity and reestablish the negative in-trathoracic pressure, allowing the lung to reexpand and restore physiologic ventilation and cardiac function. [6][7][8][9] A tension pneumothorax develops when air enters on inspiration and is unable to escape on expiration. This leads to effective mass effect on intrathoracic structures, such as the lung itself; mediastinal structures, such as the venae cavae; and cardiac chambers, resulting in hemodynamic compromise from restricted venous return and cardiac output. This is a medical emergency and should initially be managed with immediate needle thoracentesis to decompress trapped and expanding pleural air before the placement of a formal chest tube.Chest tubes are also used to evacuate excessive fluid from the pleural cavity, which is known as a pleural effusion. When there is pus in the pleural cavity, then it is considered an empyema. There are several ways to evacuate fluid from the pleural cavity and chest tubes are only one of the many options. A Cochrane review from 2017 10 compared the surgical option of video-assisted thoracic surgery (VATS) with chest tube drainage of pleural empyema and found no difference in mortality or complications between the groups, but early VATS reduced the hospital length of stay. VATS has been considered the first-line treatment for retained hemothorax and empyemas with other modalities, such as intrapleural lytic therapy, reserved for poor operative candidates or as a second line treatment. 11 However, a meta-analysis by Hendriksen et al 11 found that treating ret...

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Suction vs Water Seal After Pulmonary Resection

Cited by 158 publications

References 11 publications

Chest Tube Management after Surgery for Pneumothorax

Chest Tube Management after Surgery for Pneumothorax

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

Comprehensive Review of Chest Tube Management

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