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Abdul Khader A, Pons A, Palmares A, Booth S, Proli C, De Sousa P, Lim E. Are chest drains routinely required after thoracic surgery? A drainology study of on-table chest-drain removals. JTCVS OPEN 2023; 16:960-964. [PMID: 38204634 PMCID: PMC10774897 DOI: 10.1016/j.xjon.2023.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 04/28/2023] [Accepted: 05/09/2023] [Indexed: 01/12/2024]
Abstract
Objectives Advances in perioperative management for thoracic surgery have accelerated the postoperative recovery of patients by decreasing postoperative pain and the incidence of complications. We aimed to study whether it's safe to remove chest drains on table in selected cases. Methods This was a 5-year retrospective analysis of protocolized chest-drain removal on the operating table. The chest drain was removed in patients undergoing sublobar/wedge lung resection and other minor thoracic procedure (pleural biopsy, mediastinal mass biopsy/resection) via a thoracoscopic approach (video-assisted thoracoscopic surgery). Chest drains were removed at the end of the operation if air leak as documented by the digital drain was less than 20 mL/min. Outcome data on postdrain removal pneumothorax, effusion, and need for further intervention were obtained by reviewing the postoperative chest films, all reported by a radiologist. Results Between 2016 and 2021, 107 patients underwent drain removal in theater. Mean age (standard deviation) was 58 (17) years and 54 (50.5%) were male. Postdrain removal pneumothorax occurred in 22 patients (21%), pleural effusion in 6 (5.6%), and 21 of 22 postoperative pneumothoraces were managed conservatively without reinsertion of chest drain. As it is our standard policy to leave no pneumothorax in patients undergoing surgical management of primary spontaneous pneumothorax, only 1 such patient (0.9%) had a drain reinserted as a result. The median (interquartile) length of hospital stay was 1 day (1-2), and 14 patients (13%) were discharged on surgery day. Conclusions Our results demonstrate that on table chest-drain removal in selected cases is safe and repeatable using a digital drain, challenging the practice of routine drain insertion after thoracic surgery.
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Affiliation(s)
- Ashiq Abdul Khader
- Department of Thoracic Surgery, Royal Brompton and Harefield Hospitals, Part of Guy's and St Thomas NHS Foundation Trust, London, United Kingdom
| | - Aina Pons
- Department of Thoracic Surgery, Royal Brompton and Harefield Hospitals, Part of Guy's and St Thomas NHS Foundation Trust, London, United Kingdom
| | - Abigail Palmares
- Department of Thoracic Surgery, Royal Brompton and Harefield Hospitals, Part of Guy's and St Thomas NHS Foundation Trust, London, United Kingdom
| | - Sarah Booth
- Department of Thoracic Surgery, Royal Brompton and Harefield Hospitals, Part of Guy's and St Thomas NHS Foundation Trust, London, United Kingdom
| | - Chiara Proli
- Department of Thoracic Surgery, Royal Brompton and Harefield Hospitals, Part of Guy's and St Thomas NHS Foundation Trust, London, United Kingdom
| | - Paulo De Sousa
- Department of Thoracic Surgery, Royal Brompton and Harefield Hospitals, Part of Guy's and St Thomas NHS Foundation Trust, London, United Kingdom
| | - Eric Lim
- Department of Thoracic Surgery, Royal Brompton and Harefield Hospitals, Part of Guy's and St Thomas NHS Foundation Trust, London, United Kingdom
- Academic Division of Thoracic Surgery, Imperial College and The Royal Brompton Hospital, London, United Kingdom
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2
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Abdul Khader A, Pons A, Palmares A, Booth S, Smith A, Proli C, De Sousa P, Lim E. Outcomes of chest drain management using only air leak (without fluid) criteria for removal after general thoracic surgery-a drainology study. J Thorac Dis 2023; 15:3776-3782. [PMID: 37559627 PMCID: PMC10407534 DOI: 10.21037/jtd-22-1810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 06/25/2023] [Indexed: 08/11/2023]
Abstract
Background Chest drain management is a variable aspect of postoperative care in thoracic surgery, with different opinion for air and drain volume output. We aim to study if acceptable safety was maintained using air leak criteria alone. Methods A 9-year retrospective analysis of protocolised chest drain management using digital drain air leak cut off less than 20 mL/min for more than 6 h for drain removal in patients undergoing general thoracic surgery. We excluded patients if a chest drain was not required nor removed during admission or if patients underwent volume reduction or pneumonectomy. Withdrawal criteria were suspected bleeding or chylothorax. Postoperative films were reviewed to document post-drain removal pneumothorax, pleural effusion, and reintervention (drain re-insertion). Results Between 2012 and 2021, 1,187 patients had thoracic surgery under a single surgeon. Following exclusion and withdrawal criteria, 797 patients were left for analysis. The mean age [standard deviation (SD)] was 61 [16] years and 383 (48%) were male. Median [interquartile range (IQR)] duration of drain insertion was 1 [1-2] day with a median length of hospital stay of 4 [2-6] days. Post-drain removal pneumothorax was observed in 141 (17.7%), post-drain removal pleural effusion was observed in 75 (9.4%) and re-intervention (reinsertion of chest drain) required in 17 (2.1%). Conclusions Our results demonstrate acceptable levels of safety using digital assessment of air leak as the sole criteria for drain removal in selected patients after general thoracic surgery.
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Affiliation(s)
- Ashiq Abdul Khader
- Department of Thoracic Surgery, Royal Brompton and Harefield Hospitals, Part of Guy’s and St Thomas NHS Foundation Trust, London, UK
| | - Aina Pons
- Department of Thoracic Surgery, Royal Brompton and Harefield Hospitals, Part of Guy’s and St Thomas NHS Foundation Trust, London, UK
| | - Abigail Palmares
- Department of Thoracic Surgery, Royal Brompton and Harefield Hospitals, Part of Guy’s and St Thomas NHS Foundation Trust, London, UK
| | - Sarah Booth
- Department of Thoracic Surgery, Royal Brompton and Harefield Hospitals, Part of Guy’s and St Thomas NHS Foundation Trust, London, UK
| | - Alexander Smith
- Department of Thoracic Surgery, Royal Brompton and Harefield Hospitals, Part of Guy’s and St Thomas NHS Foundation Trust, London, UK
| | - Chiara Proli
- Department of Thoracic Surgery, Royal Brompton and Harefield Hospitals, Part of Guy’s and St Thomas NHS Foundation Trust, London, UK
| | - Paulo De Sousa
- Department of Thoracic Surgery, Royal Brompton and Harefield Hospitals, Part of Guy’s and St Thomas NHS Foundation Trust, London, UK
| | - Eric Lim
- Department of Thoracic Surgery, Royal Brompton and Harefield Hospitals, Part of Guy’s and St Thomas NHS Foundation Trust, London, UK
- Academic Division of Thoracic Surgery, Imperial College and The Royal Brompton Hospital, London, UK
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3
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Aprile V, Bacchin D, Calabrò F, Korasidis S, Mastromarino MG, Ambrogi MC, Lucchi M. Intraoperative prevention and conservative management of postoperative prolonged air leak after lung resection: a systematic review. J Thorac Dis 2023; 15:878-892. [PMID: 36910073 PMCID: PMC9992588 DOI: 10.21037/jtd-22-736] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 02/06/2023] [Indexed: 02/28/2023]
Abstract
Background Prolonged air leak (PAL) due to an alveolar-pleural fistula (APF) is the most common complication after lung surgery. PAL is associated with an increased risk of morbidity and mortality, a longer chest tube duration, hence a prolonged hospitalization. Management of PAL may be challenging, and the thoracic surgeon should be aware of the possible therapeutic strategies. Methods A systematic literature review was performed in PubMed, Cochrane Library, EMBASE, Ovid and Google Scholar. Title, abstract and full-text screening was performed, followed by structured data extraction, methodological quality assessment and Cochrane risk of bias assessment. Inclusion criteria were: case-control studies/randomized controlled trials (RCTs) comparing the new tested method with the standard of care to manage PAL after lung surgery; PAL due to APF; at least 10 patients; English-written papers. Results A total of 942 initial papers from literature search, resulted in 43 papers after the selection. This systematic review found that the use of intraoperative measures as surgical sealants or pleural tenting, as well as a proper management of the chest drain and the use of blood patch or sclerosant agents seem to reduce postoperative air leaks incidence and/or duration and length of chest drain stay and hospitalization. Conclusions Different measures have been described in literature to manage or prevent postoperative PAL. Most of them seem to be safe and efficient if compared to the "wait and see" strategy, even if large comparative studies that standardize the intra- and post-operative management of APF after lung resection are lacking and, actually, hard to conceptualize. However, there is a large consensus on the value of a preoperative PAL-risk stratification and on the necessity of tailoring PAL management or prevention's strategy and its timing on each patient's features.
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Affiliation(s)
- Vittorio Aprile
- Division of Thoracic Surgery, Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Diana Bacchin
- Division of Thoracic Surgery, Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Fabrizia Calabrò
- Division of Thoracic Surgery, Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Stylianos Korasidis
- Thoracic Surgery Unit, Cardiac-Thoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy
| | | | - Marcello Carlo Ambrogi
- Division of Thoracic Surgery, Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Marco Lucchi
- Division of Thoracic Surgery, Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy.,Thoracic Surgery Unit, Cardiac-Thoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy
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4
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Nakada T, Ohtsuka T. Thoracic drain management using a digital system. J Thorac Dis 2023; 15:219-222. [PMID: 36910099 PMCID: PMC9992604 DOI: 10.21037/jtd-22-1692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 12/23/2022] [Indexed: 01/12/2023]
Affiliation(s)
- Takeo Nakada
- Department of Surgery, Division of Thoracic Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Takashi Ohtsuka
- Department of Surgery, Division of Thoracic Surgery, The Jikei University School of Medicine, Tokyo, Japan
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5
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Guerrera F, Costardi L, Rosboch GL, Lyberis P, Ceraolo E, Solidoro P, Filippini C, Verri G, Brazzi L, Albera C, Ruffini E. Awake or intubated surgery in diagnosis of interstitial lung diseases? A prospective study. ERJ Open Res 2021; 7:00630-2020. [PMID: 34235209 PMCID: PMC8255540 DOI: 10.1183/23120541.00630-2020] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 04/29/2021] [Indexed: 11/21/2022] Open
Abstract
Background Risks associated with video-assisted surgical lung biopsy (VASLB) for interstitial lung disease (ILD) with endotracheal intubation and mechanical ventilation are not nil. Awake video-assisted surgical lung biopsy (Awake-VASLB) has been proposed as a method to obtain a precise diagnosis in several different thoracic diseases. Objectives To compare clinical outcomes of Awake-VASLB and Intubated-VASLB in patients with suspected ILDs. Methods From June 2016 to February 2020, all patients submitted to elective VASLB for suspected ILD were included. Differences in outcomes between Awake-VASLB and Intubated-VASLB were assessed through univariable, multivariable-adjusted, and a propensity score-matched analysis. Results Awake-VASLB was performed in 66 out of 100 patients, while 34 underwent Intubated-VASLB. The Awake-VASLB resulted in a lower post-operative morbidity (OR 0.025; 95% CI 0.001–0.35; p=0.006), less unexpected intensive care unit admission, less need for rescue therapy for pain, a reduced surgical and anaesthesiologic time, a reduced chest drain duration, and a lower post-operative length of stay. Conclusion Awake-VASLB in patients affected by ILD is feasible and seems safer than Intubated-VASLB. Awake surgical lung biopsy in patients affected by ILD is feasible and safer than intubated surgical lung biopsyhttps://bit.ly/2SnMATh
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Affiliation(s)
- Francesco Guerrera
- Dept of Surgical Science, University of Torino, Turin, Italy.,Dept of Thoracic Surgery, Azienda Ospedaliera Universitaria Città Della Salute e Della Scienza di Torino, Turin, Italy.,These authors contributed equally to this work
| | - Lorena Costardi
- Dept of Surgical Science, University of Torino, Turin, Italy.,Dept of Thoracic Surgery, Azienda Ospedaliera Universitaria Città Della Salute e Della Scienza di Torino, Turin, Italy.,These authors contributed equally to this work
| | - Giulio L Rosboch
- Dept of Anesthesia, Intensive Care and Emergency, Azienda Ospedaliera Universitaria Città Della Salute e Della Scienza di Torino, Turin, Italy.,These authors contributed equally to this work
| | - Paraskevas Lyberis
- Dept of Thoracic Surgery, Azienda Ospedaliera Universitaria Città Della Salute e Della Scienza di Torino, Turin, Italy
| | - Edoardo Ceraolo
- Dept of Anesthesia, Intensive Care and Emergency, Azienda Ospedaliera Universitaria Città Della Salute e Della Scienza di Torino, Turin, Italy
| | - Paolo Solidoro
- Division of Pulmonology, Azienda Ospedaliera Universitaria Città Della Salute e Della Scienza di Torino, Turin, Italy.,Dept of Medical Sciences, University of Torino, Turin, Italy
| | | | - Giulia Verri
- Division of Pulmonology, Azienda Ospedaliera Universitaria Città Della Salute e Della Scienza di Torino, Turin, Italy
| | - Luca Brazzi
- Dept of Surgical Science, University of Torino, Turin, Italy.,Dept of Anesthesia, Intensive Care and Emergency, Azienda Ospedaliera Universitaria Città Della Salute e Della Scienza di Torino, Turin, Italy
| | - Carlo Albera
- Division of Pulmonology, Azienda Ospedaliera Universitaria Città Della Salute e Della Scienza di Torino, Turin, Italy.,Dept of Medical Sciences, University of Torino, Turin, Italy
| | - Enrico Ruffini
- Dept of Surgical Science, University of Torino, Turin, Italy.,Dept of Thoracic Surgery, Azienda Ospedaliera Universitaria Città Della Salute e Della Scienza di Torino, Turin, Italy
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Abstract
Introduction: The management of empyema thoracis has evolved over the years. After all lung surgeries chest drain is required, however they suffer from inter observer variability and impair mobility of the patient. However, the newer digital thoracic drain system are portable and have alarms for various situations, furthermore they eliminate inter-observer variability. One such device is Thopaz™ (Medela inc, Switzerland). We wanted to compare efficacy of Thopaz™ with our conventional intercostal chest tube drain in patients undergoing decortications for empyema thoracis. Materials and Methods: One hundred patients were enrolled in study and were randomized into conventional and thopaz group with 50 patients in each group with help of opaque envelopes. Results: Both the groups were comparable in demographic parameters. Majority of the patients in our study were children and young adults. Majority of empyema thoracis involved right side with nontubercular empyema thoracis being the most common cause of decorticartion. Patients managed with Thopaz had a significantly shorter air leak duration, shorter duration of postdecortication chest tube placement and shorter postoperative hospital stay. All postoperative complications were less in Thopaz group. Conclusions: Patients with empyema thoracis undergoing open decortications when managed with digital chest drainage system (Thopaz) experienced faster reduction in air leak, a shorter duration of chest tube placement and in hospital stay. Thopaz usage is also associated with reduction in rate of postoperative complications. We recommend that this digital chest tube drainage system is a very useful tool in armamentarium of thoracic surgeon after lung surgeries.
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Affiliation(s)
| | - Mohd Azam Haseen
- Department of Cardiothoracic Surgery, JNMC, AMU, Aligarh, Uttar Pradesh, India
| | - Mohd Aslam
- Department of Surgery, JNMC, AMU, Aligarh, Uttar Pradesh, India
| | - Mohd Hanif Beg
- Department of Cardiothoracic Surgery, JNMC, AMU, Aligarh, Uttar Pradesh, India
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7
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Moon Y. Treatment of postoperative air leak with fresh frozen plasma. J Thorac Dis 2020; 11:5655-5657. [PMID: 32030292 DOI: 10.21037/jtd.2019.12.77] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Youngkyu Moon
- Department of Thoracic & Cardiovascular Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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8
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Wang H, Hu W, Ma L, Zhang Y. Digital chest drainage system versus traditional chest drainage system after pulmonary resection: a systematic review and meta-analysis. J Cardiothorac Surg 2019; 14:13. [PMID: 30658680 PMCID: PMC6339372 DOI: 10.1186/s13019-019-0842-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 01/14/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Several randomized controlled trials (RCTs) and observational studies have compared the efficacy of digital chest drainage system versus traditional chest drainage system. However, the results were inconsistent. METHODS We searched the Web of Science and Pubmed for observational studies and RCTs that compared the effect of digital chest drainage system with traditional chest drainage system after pulmonary resection. Eight studies (5 randomized control trails and 3 observational studies) comprising 1487 patients met the eligibility criteria. RESULTS Compared with the traditional chest drainage system, digital chest drainage system reduced the risk of prolonged air leak (PAL) (RR = 0.54, 95%CI 0.40-0.73, p < 0.0001), and shortened the duration of chest drainage (SMD = - 0.35, 95%CI -0.60 - -0.09, p = 0.008) and length of hospital stay (SMD = - 0.35, 95%CI -0.61 - -0.09, p = 0.007) in patients after pulmonary resection. CONCLUSIONS Digital chest drainage system is expected to benefit patients to attain faster recovery and higher life quality as well as to reduce the risk of postoperative complications. Further RCTs with larger sample size are still needed to more clearly elucidate the advantages of digital chest drainage system.
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Affiliation(s)
- Hong Wang
- Department of Surgery, Zhejiang University Hospital, Zhejiang University, Hangzhou, China
| | - Wenbin Hu
- Department of Cardiothoracic Surgery, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China
| | - Liang Ma
- Department of Cardiothoracic Surgery, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China
| | - Yiran Zhang
- Department of Cardiothoracic Surgery, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China.
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9
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Yeung C, Gilbert S. Digital pleural drainage technology is here to stay-time to realize its potential. J Thorac Dis 2019; 10:S3882-S3883. [PMID: 30631505 DOI: 10.21037/jtd.2018.09.71] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Ching Yeung
- Division of Thoracic Surgery, University of Ottawa, Ottawa, Ontario, Canada
| | - Sebastien Gilbert
- Division of Thoracic Surgery, University of Ottawa, Ottawa, Ontario, Canada.,The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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10
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Shintani Y, Funaki S, Ose N, Kanou T, Kanzaki R, Minami M, Okumura M. Chest tube management in patients undergoing lobectomy. J Thorac Dis 2018; 10:6432-6435. [PMID: 30746183 DOI: 10.21037/jtd.2018.11.47] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Yasushi Shintani
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Soichiro Funaki
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Naoko Ose
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Takashi Kanou
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Ryu Kanzaki
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Masato Minami
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Meinoshin Okumura
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
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11
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French DG, Gilbert S. Technology and evidence-based care enhance postoperative management of chest drains. J Thorac Dis 2018; 10:6399-6403. [PMID: 30746174 DOI: 10.21037/jtd.2018.11.99] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Daniel G French
- Division of Thoracic Surgery, Dalhousie University, Queen Elizabeth II Hospital-Victoria Campus, Halifax, NS, Canada
| | - Sebastien Gilbert
- Division of Thoracic Surgery, University of Ottawa, The Ottawa Hospital-General Campus, Ottawa, ON, Canada
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12
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French DG, Plourde M, Henteleff H, Mujoomdar A, Bethune D. Optimal management of postoperative parenchymal air leaks. J Thorac Dis 2018; 10:S3789-S3798. [PMID: 30505566 DOI: 10.21037/jtd.2018.10.05] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Air leaks are the most common complication after pulmonary resection. Enhanced recovery after surgery (ERAS) programs must be designed to manage parenchymal air leaks. ERAS programs should consider two components when creating protocols for air leaks: assessment and management. Accurate assessment of air leaks using traditional analogues devices, newer digital drainage systems, portable devices and chest X-rays (CXR) are reviewed. Published data suggests that digital drainage systems result in a more confident assessment of air leaks. The literature regarding the management of postoperative air leaks, including the number of chest tubes, the role of applied external suction, invasive maneuvers and discharge with a portable device is reviewed. The key findings are that a single chest drain is adequate in the majority of cases to manage an air leak, the use of applied external suction is unlikely to prevent or prolong an air leak, autologous blood patch pleurodesis may potentially shorten postoperative air leaks and there is sufficient data to support that patients can safely be discharged with a portable drainage system. There is also literature to support the design of protocols for management of postoperative air leaks. Standardization of postoperative care through ERAS programs will allow for the design of larger RCTs to better understand some of the controversies around the management of postoperative air leaks.
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Affiliation(s)
- Daniel G French
- Division of Thoracic Surgery, Department of Surgery, Queen Elizabeth II Hospital - Victoria Campus, Dalhousie University, Halifax, NS, Canada
| | - Madelaine Plourde
- Division of Thoracic Surgery, Department of Surgery, Queen Elizabeth II Hospital - Victoria Campus, Dalhousie University, Halifax, NS, Canada
| | - Harry Henteleff
- Division of Thoracic Surgery, Department of Surgery, Queen Elizabeth II Hospital - Victoria Campus, Dalhousie University, Halifax, NS, Canada
| | - Aneil Mujoomdar
- Division of Thoracic Surgery, Department of Surgery, Queen Elizabeth II Hospital - Victoria Campus, Dalhousie University, Halifax, NS, Canada
| | - Drew Bethune
- Division of Thoracic Surgery, Department of Surgery, Queen Elizabeth II Hospital - Victoria Campus, Dalhousie University, Halifax, NS, Canada
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13
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Igai H, Kamiyoshihara M, Yoshikawa R, Osawa F, Yazawa T. Invited editorial on "Fissureless fissure-last video-assisted thoracoscopic lobectomy for all lung lobes: a better alternative to decrease the incidence of prolonged air leak?". J Thorac Dis 2018; 10:S2183-S2185. [PMID: 30123555 DOI: 10.21037/jtd.2018.06.100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Hitoshi Igai
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital, Maebashi, Gunma, Japan
| | - Mitsuhiro Kamiyoshihara
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital, Maebashi, Gunma, Japan
| | - Ryohei Yoshikawa
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital, Maebashi, Gunma, Japan
| | - Fumi Osawa
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital, Maebashi, Gunma, Japan
| | - Tomohiro Yazawa
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital, Maebashi, Gunma, Japan
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14
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Shintani Y, Funaki S, Ose N, Kawamura T, Kanzaki R, Minami M, Okumura M. Air leak pattern shown by digital chest drainage system predict prolonged air leakage after pulmonary resection for patients with lung cancer. J Thorac Dis 2018; 10:3714-3721. [PMID: 30069369 DOI: 10.21037/jtd.2018.05.150] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background A common cause of complications after a pulmonary resection procedure is prolonged air leakage. Recently introduced digital drainage systems provide accurate recording of air leak data for later review. We investigated the clinical usefulness of the continuous stream of data recorded by such a device. Methods We analyzed data obtained from 299 patients with pulmonary malignancy who underwent a pulmonary resection procedure for lung cancer patients with use of a digital chest drainage system. Postoperative air leak patterns were divided into 4 groups and their correlation with prolonged air leakage after pulmonary resection was evaluated. Results The incidence of prolonged air leak was 10% (30/299). The postoperative air leak patterns noted in the present patients were divided into none (n=217, 73%), intermittent (n=21, 7%), decrease (n=40, 13%), and variable (n=21, 7%). The incidence of prolonged air leak in each group was 0.5% (1/217) in the none group, 24% (5/21) in the intermittent group, 20% (8/40) in the decrease group, and 76% (16/21) in the variable group. The amount of air leakage immediately after surgery was highest in the variable group. Patients in the intermittent and variable groups had longer durations of air leakage and chest tube placement. The frequency of postoperative interventional treatment was significantly higher in the variable group as compared to the others. Chest tube reinsertion for pneumothorax and increased subcutaneous emphysema after the initial chest tube removal was only seen in the intermittent group. Conclusions Advantages of digital drainage system use are continuous monitoring and recording capabilities, which show the detailed air leak pattern after pulmonary resection. That pattern can be used to predict the durations of air leakage and chest tube drainage, as well as for producing an air leak management algorithm.
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Affiliation(s)
- Yasushi Shintani
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Yamadaoka, Suita, Osaka, Japan
| | - Soichiro Funaki
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Yamadaoka, Suita, Osaka, Japan
| | - Naoko Ose
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Yamadaoka, Suita, Osaka, Japan
| | - Tomohiro Kawamura
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Yamadaoka, Suita, Osaka, Japan
| | - Ryu Kanzaki
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Yamadaoka, Suita, Osaka, Japan
| | - Masato Minami
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Yamadaoka, Suita, Osaka, Japan
| | - Meinoshin Okumura
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Yamadaoka, Suita, Osaka, Japan
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Guerrera F, Filosso PL, Pompili C, Olivetti S, Roffinella M, Imperatori A, Brunelli A. Application of the coaxial smart drain in patients with a large air leak following anatomic lung resection: a prospective multicenter phase II analysis of efficacy and safety. J Vis Surg 2018; 4:26. [PMID: 29445612 DOI: 10.21037/jovs.2018.01.07] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 11/22/2017] [Indexed: 11/06/2022]
Abstract
Background The presence of air leak following lung resection remains a frequent problem, which may prolong hospital stay and increase hospital costs. In the past, some studies documented the efficacy of soft and flexible chest tube in patients who underwent thoracic surgery. Nevertheless, safety in case of post-operative large air or liquid leak remains questionable. The objective of this study was to verify through a multicentre study the safety and the effectiveness of the coaxial chest tube in a consecutive series of selected patients who underwent anatomical pulmonary resection and with an active and large air leak. Methods Between October 2016 and September 2017, data from patients submitted to anatomical lung resection with curative intent and operated in two Department of Thoracic Surgery of two different were prospectively collected. The inclusion criteria consisted in the presence of an air leak greater than 50 mL/min measured with a digital drainage system during the 3 postoperative hours. A descriptive statistic was used to report the incidence of complications assumed to be associated with the use of the coaxial drain. Results Forty-eight consecutive patients (27 males) submitted to lobectomy (37 patients: 77%) or anatomic segmentectomies (11 patients) were included in the analyses. Thirty-four operations (71%) were performed by video-assisted thoracic surgery (VATS). The median duration of chest tubes was 13 days [interquartile range (IQR), 4-19] and the median duration of air leak was 9 days (IQR, 2-17.5). No patient had undrained postoperative pleural effusion judged to require an additional chest tube placement. There were 12 (25%) cases of clinically or radiologically significant surgical emphysema; in none of these patients any additional procedure or re-operation was required, and they were treated conservatively by increasing the level of suction. Conclusions Our experience with this novel Coaxial Drain was satisfactory with no clinically relevant complication caused using this drain, no need to insert additional drain or replace the existing one with another drain a duration of air leak and chest tubes as well as the incidence of subcutaneous emphysema that was in line with what observed in the daily practice in similar highly selected patients with large air leak.
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Affiliation(s)
- Francesco Guerrera
- Department of Surgical Science, University of Torino, Torino, Italy.,Department of Thoracic Surgery, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Pier Luigi Filosso
- Department of Surgical Science, University of Torino, Torino, Italy.,Department of Thoracic Surgery, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Cecilia Pompili
- Section of Patient Centered Outcomes Research, Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
| | - Stefania Olivetti
- Department of Surgical Science, University of Torino, Torino, Italy.,Department of Thoracic Surgery, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Matteo Roffinella
- Department of Surgical Science, University of Torino, Torino, Italy.,Department of Thoracic Surgery, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Andrea Imperatori
- Department of Thoracic Surgery, St. James's University Hospital, Leeds, UK
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Chen D, Kadeer X, Shi Z, Jin Y, Chen C. [Application of Digital Drainage System in Postoperative Refractory Prolonged Air Leaks after Pulmonary Surgery]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2017; 20:833-836. [PMID: 29277182 PMCID: PMC5973386 DOI: 10.3779/j.issn.1009-3419.2017.12.07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
背景与目的 术后持续性肺漏气是肺部手术后最常见的并发症之一。数字化胸腔引流系统(digital drainage system, DDS)被认为具有准确、客观、舒适、患者耐受性好、经济等优点。本研究旨在总结DDS用于肺部手术后难治性持续性大量漏气的临床疗效。 方法 术后5天和7天分别是胸腔镜和开胸术后持续性肺漏气(prolonged air leak, PAL)的界限;本研究将难治性持续性大量漏气定义为达到PAL时间2倍及以上且漏气持续达2度以上,可伴有明显皮下气肿或纵隔气肿等相关并发症。2016年1月-2016年12月间,应用数字化胸腔引流系统结合胸膜固定术治疗符合上述标准的病例共8例,收集相关临床资料并总结分析。 结果 本组病例中肺叶切除术6例,肺段切除2例。平均术后持续漏气(17.3±5.1)d,DDS平均使用时间(5.6±3.7)d。平均术后引流量(3, 550.6±1, 881.1)mL。应用DDS前后的平均引流量为(2, 615.6±1, 741.2)mL和(935.0±242.7)mL。平均住院时间(18.1±5.0)d。 结论 数字化胸腔引流系统用于肺部手术后难治性持续性大量漏气安全可行,可提供更大的负压吸引值,从而促使患肺复张为后继的胸膜固定术创造条件,并缩短引流天数和住院时间。
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Affiliation(s)
- Donglai Chen
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| | - Xiermaimaiti Kadeer
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| | - Zhe Shi
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| | - Yuxing Jin
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| | - Chang Chen
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
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Abstract
PURPOSE OF REVIEW The method for identification of alveolopleural fistulae (APF) by visual inspection of air bubbles in the chest drainage system has several limitations and suffers from poor accuracy. Here we discuss the use of a novel technique of pleural gas analysis in the identification and management of APF. RECENT FINDINGS We found that pleural gas analysis has higher sensitivity and specificity than visual inspection in identifying APF. Additionally, we demonstrated that intrapleural gas milieu impacts lung healing and reduction of intrapleural carbon dioxide can promote resolution of APF. SUMMARY Pleural gas analysis is a novel technique to identify and manage APF. Integration of gas analysis in chest drainage systems would provide a more objective method for managing chest tubes and providing a favorable pleural gas environment for lung healing.
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Igai H, Kamiyoshihara M, Yoshikawa R, Osawa F, Kawatani N, Ibe T, Shimizu K. The efficacy of thoracoscopic fissureless lobectomy in patients with dense fissures. J Thorac Dis 2016; 8:3691-3696. [PMID: 28149565 DOI: 10.21037/jtd.2016.12.58] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Prolonged air leakage after a lobectomy remains a frequent complication in patients with dense fissures. To avoid postoperative air leakage, we used the "thoracoscopic fissureless technique" for patients with dense fissures. A thoracoscopic approach is useful for the fissureless technique because it gives a good operative view from various angles without dividing the fissure. In this study, we compared the peri- or intraoperative results of thoracoscopic fissureless lobectomies to traditional lobectomies with fissure dissection for pulmonary artery (PA) exposure in order to identify the efficacy of thoracoscopic fissureless lobectomy. METHODS Between April 2012 and November 2015, 175 patients underwent a thoracoscopic lobectomy with three or four ports, of whom 14 underwent a fissureless lobectomy because of dense fissures. We compared the characteristics and perioperative outcomes of the patients who underwent the fissureless technique (fissureless technique group, n=14) and the traditional fissure dissection technique for PA exposure (traditional technique group, n=161). In our department, fissureless lobectomy is indicated for patients with a fused fissure (fissural grade III or IV as proposed by Craig in 1997) or inflammation makes it difficult to expose the PA, while the traditional technique is used for other patients. RESULTS Although the fissureless technique group had longer operation time than the traditional technique group (P=0.0045), there was no significant inter-group difference about blood loss (P=0.85), occurrence rate of intraoperative massive bleeding (P=0.6) or conversion rate to thoracotomy (P=0.31). According to postoperative results, there was no significant inter-group difference in duration of chest tube drainage (P=0.56), length of postoperative hospital stay (P=0.14), or morbidity rate (P=0.16). No mortality occurred in either group. CONCLUSIONS A thoracoscopic fissureless lobectomy is feasible and safe, and useful to avoid postoperative air-leakage in patients with dense fissures.
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Affiliation(s)
- Hitoshi Igai
- Department of General Thoracic Surgery, Maebashi Red Cross Hospital, Maebashi, Japan
| | | | - Ryohei Yoshikawa
- Department of General Thoracic Surgery, Maebashi Red Cross Hospital, Maebashi, Japan
| | - Fumi Osawa
- Department of General Thoracic Surgery, Maebashi Red Cross Hospital, Maebashi, Japan
| | - Natsuko Kawatani
- Department of General Thoracic Surgery, Maebashi Red Cross Hospital, Maebashi, Japan
| | - Takashi Ibe
- Department of General Thoracic Surgery, Maebashi Red Cross Hospital, Maebashi, Japan
| | - Kimihiro Shimizu
- Department of Thoracic and Visceral Organ Surgery, Gunma University Graduate School of Medicine, Maebashi, Japan
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