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Ali NY, Uchikov P, Uchikov A, Paunov L, Ilieva A, Koev N, Atliev K. Conventional and digital pleural drainage systems - advantages and disadvantages. Folia Med (Plovdiv) 2023; 65:753-759. [PMID: 38351757 DOI: 10.3897/folmed.65.e97825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 02/14/2023] [Indexed: 02/16/2024] Open
Abstract
INTRODUCTION Pleural cavity drainage is a crucial component of the surgical management of patients with various chest diseases. Digital drainage systems are increasingly used in contemporary thoracic surgical procedure, which is likely a result of their effectiveness in achieving early postoperative ambulation, cutting down on hospital stays and lowering costs. The vast majority of thoracic surgeons worldwide prefer digital drainage systems to traditional ones. The advantages of the former, however, are disputed by some researchers.
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Affiliation(s)
| | | | | | | | | | - Nikolay Koev
- Medical University of Plovdiv, Plovdiv, Bulgaria
| | - Kiril Atliev
- Medical University of Plovdiv, Plovdiv, Bulgaria
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Malík M, Dzian A, Števík M, Vetešková Š, Al Hakim A, Hliboký M, Magyar J, Kolárik M, Bundzel M, Babič F. Lung Ultrasound Reduces Chest X-rays in Postoperative Care after Thoracic Surgery: Is There a Role for Artificial Intelligence?-Systematic Review. Diagnostics (Basel) 2023; 13:2995. [PMID: 37761362 PMCID: PMC10527627 DOI: 10.3390/diagnostics13182995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 08/16/2023] [Accepted: 08/26/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Chest X-ray (CXR) remains the standard imaging modality in postoperative care after non-cardiac thoracic surgery. Lung ultrasound (LUS) showed promising results in CXR reduction. The aim of this review was to identify areas where the evaluation of LUS videos by artificial intelligence could improve the implementation of LUS in thoracic surgery. METHODS A literature review of the replacement of the CXR by LUS after thoracic surgery and the evaluation of LUS videos by artificial intelligence after thoracic surgery was conducted in Medline. RESULTS Here, eight out of 10 reviewed studies evaluating LUS in CXR reduction showed that LUS can reduce CXR without a negative impact on patient outcome after thoracic surgery. No studies on the evaluation of LUS signs by artificial intelligence after thoracic surgery were found. CONCLUSION LUS can reduce CXR after thoracic surgery. We presume that artificial intelligence could help increase the LUS accuracy, objectify the LUS findings, shorten the learning curve, and decrease the number of inconclusive results. To confirm this assumption, clinical trials are necessary. This research is funded by the Slovak Research and Development Agency, grant number APVV 20-0232.
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Affiliation(s)
- Marek Malík
- Department of Thoracic Surgery, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava and University Hospital in Martin, Kollárova 4248/2, 036 59 Martin, Slovakia
| | - Anton Dzian
- Department of Thoracic Surgery, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava and University Hospital in Martin, Kollárova 4248/2, 036 59 Martin, Slovakia
| | - Martin Števík
- Radiology Department, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava and University Hospital in Martin, Kollárova 4248/2, 036 59 Martin, Slovakia
| | - Štefánia Vetešková
- Radiology Department, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava and University Hospital in Martin, Kollárova 4248/2, 036 59 Martin, Slovakia
| | - Abdulla Al Hakim
- Department of Thoracic Surgery, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava and University Hospital in Martin, Kollárova 4248/2, 036 59 Martin, Slovakia
| | - Maroš Hliboký
- Department of Cybernetics and Artificial Intelligence, Faculty of Electrical Engineering and Informatics, Technical University of Košice, Letná 9, 040 01 Košice, Slovakia
| | - Ján Magyar
- Department of Cybernetics and Artificial Intelligence, Faculty of Electrical Engineering and Informatics, Technical University of Košice, Letná 9, 040 01 Košice, Slovakia
| | - Michal Kolárik
- Department of Cybernetics and Artificial Intelligence, Faculty of Electrical Engineering and Informatics, Technical University of Košice, Letná 9, 040 01 Košice, Slovakia
| | - Marek Bundzel
- Department of Cybernetics and Artificial Intelligence, Faculty of Electrical Engineering and Informatics, Technical University of Košice, Letná 9, 040 01 Košice, Slovakia
| | - František Babič
- Department of Cybernetics and Artificial Intelligence, Faculty of Electrical Engineering and Informatics, Technical University of Košice, Letná 9, 040 01 Košice, Slovakia
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Yap JA, Gummalla KM, H'ng MWC. High-Vacuum Drainage System in Percutaneous Image-Guided Thoracocentesis for Complex Pleural Effusions. Journal of Clinical Interventional Radiology ISVIR 2023. [DOI: 10.1055/s-0043-1761629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023] Open
Abstract
Abstract
Purpose Our retrospective study is aimed to analyze the efficacy and outcomes between high-vacuum suction drain (HVSD) over passive drainage in the setting of percutaneous image-guided thoracocentesis, with a secondary aim to determine if preprocedural computed tomography (CT) can aid decision-making.
Materials and Methods Clinical and imaging details of patients using HVSD between November 2012 and October 2018, who had a preceding CT within a month before drainage, were collated. The control group was selected from patients who had thoracocentesis with passive drainage performed between November 2017 and October 2018. Cases where HVSD was the sole device were compared with those using only a chest bottle.
Results The HVSD was the only device in 17 cases compared to chest bottle in 47 cases. Mean duration being on a drain for these two arms were 5.5 and 7.3 days, respectively (p = 0.170). Fewer from the HVSD arm needed a repeat procedure (p = 0.424). Patients in the HVSD arm had significantly smaller volumes (p = 0.013) of higher density (p = 0.016), associated with a more encapsulating wall (p = 0.013) but not septations (p = 0.922). Density of contents on CT was useful in distinguishing between straw-colored effusion versus hemoserous fluid or pus (p = 0.008).
Conclusions HVSD was not inferior to the chest bottle in the setting of thoracocentesis. Considering its potential adjunctive benefits, it should be an option for draining smaller volume complex effusions. Due to poor correlation with preprocedural CT, decision to insert a HVSD should be made by the procedurist at the time of thoracentesis.
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Affiliation(s)
- Jiawei Alexander Yap
- Department of Diagnostic Imaging, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore
| | - Krishna Mohan Gummalla
- Department of Diagnostic Imaging, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore
| | - Martin Weng Chin H'ng
- Department of Diagnostic Imaging, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore
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Andreas MN, Dziodzio T, Hillebrandt KH, Elsner A, Strauchmann J, Aydin M, Pratschke J, Rückert JC, Neudecker J. Aktuelle ERAS-Implementierung in der Thoraxchirurgie an deutschen Kliniken. Zentralbl Chir 2022; 147:S21-S28. [DOI: 10.1055/a-1759-4375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Zusammenfassung
Einleitung In den letzten Jahren haben sich zunehmend ERAS-Behandlungspfade in vielen chirurgischen Bereichen etabliert, da sie allgemeine Komplikationen reduzieren und die Genesung
von Patienten erheblich beschleunigen können. Für die Thoraxchirurgie wurden 2019 erstmals ERAS-Guidelines von der ERAS Society in Zusammenarbeit mit der European Society of Thoracic
Surgeons (ESTS) veröffentlicht. Inwieweit sich ERAS-Maßnahmen im klinischen Alltag in der Thoraxchirurgie in Deutschland etabliert haben, wurde anhand eines Online-Fragebogens evaluiert.
Material und Methoden Es wurde eine Onlineumfrage zur aktuellen ERAS-Implementierung an deutschen Kliniken durchgeführt. Zeitraum der Umfrage war vom 12.05.2021 bis zum 01.06.2021.
Im Fragebogen, der 22 Fragen umfasste, wurde die aktuelle Umsetzung verschiedener perioperativer Maßnahmen (u. a. Mobilisation, Thoraxdrainagen-Management, Schmerzmanagement) als wesentliche
Items des ERAS-Pathways erfragt. Anschließend wurden die Resultate zusammengefasst, beschreibend analysiert und in den Kontext der aktuellen Literatur gesetzt.
Ergebnisse Von 155 angeschriebenen leitenden Thoraxchirurgen beantworteten 32 den Fragebogen. Bei 28,1% (n = 9) der Kliniken war ein ERAS-Kernteam etabliert, eine Datenbank zur
Erfassung der ERAS-Items gab es in 15,6% (n = 5). Zudem bekamen die Patienten meist kein ERAS-Tagebuch (96,9%, n = 31) ausgehändigt. Ein präoperatives Carboloading wurde von 15,6% (n = 5)
durchgeführt. Eine PONV-Prophylaxe wurde bei 59,4% (n = 19) der Befragten standardmäßig durchgeführt. In der Regel wurde bei elektiven anatomischen Resektionen eine Thoraxdrainage (84,4%,
n = 27) eingelegt. Bei 3% (n = 1) der Zentren wurden 2 Drainagen eingelegt, bei 12,5% (n = 4) wurde keine Drainage intraoperativ eingebracht. Meist wurden digitale Drainagesysteme verwendet
(90,6%, n = 29). Der am häufigsten angewendete initiale Drainagensog war –10 cm H2O (75%, n = 24). Einen Sog von ≤ 2 cmH2O verwendeten lediglich 2 Befragte. Die
Drainageentfernung erfolgte in 50% (n = 16) der Fälle am 1. oder 2. postoperativen Tag (POD), in 34,4% (n = 11) am 3. und 4. POD und bei 9,4% (n = 3) verblieb die Drainage über den 4. Tag
hinaus. Bei 71,9% (n = 23) der Befragten erfolgte die erste Mobilisation postoperativ noch am OP-Tag.
Diskussion Die Implementierung der ERAS-Guidelines ist in Deutschland interindividuell noch sehr variabel. Bestimmte perioperative Prozesse werden bereits gut abgedeckt, allerdings
ist eine vollständige Umsetzung von ERAS-Items noch nicht gänzlich in der klinischen Praxis angekommen. Erste Schritte in diese Richtung wurden bereits gemacht und legen die Grundlage für
eine weitere zentrumsübergreifende Zusammenarbeit.
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Affiliation(s)
- Marco Nicolas Andreas
- Chirurgische Klinik, Thoraxchirurgie, Charité Universitätsmedizin Berlin, Berlin, Deutschland
| | - Tomasz Dziodzio
- Charité Clinician Scientist Program, Berlin Institute of Health, Berlin, Deutschland
- Chirurgische Klinik, Thoraxchirurgie, Charité Universitätsmedizin Berlin, Berlin, Deutschland
| | - Karl-Herbert Hillebrandt
- Chirurgische Klinik, Thoraxchirurgie, Charité Universitätsmedizin Berlin, Berlin, Deutschland
- BIH Charité Clinician Scientist Program, Berlin Institute of Health, Berlin, Deutschland
| | - Aron Elsner
- Chirurgische Klinik, Thoraxchirurgie, Charité Universitätsmedizin Berlin, Berlin, Deutschland
| | - Julia Strauchmann
- Chirurgische Klinik, Thoraxchirurgie, Charité Universitätsmedizin Berlin, Berlin, Deutschland
| | - Mustafa Aydin
- Chirurgische Klinik, Thoraxchirurgie, Charité Universitätsmedizin Berlin, Berlin, Deutschland
| | - Johann Pratschke
- Chirurgische Klinik, Thoraxchirurgie, Charité Universitätsmedizin Berlin, Berlin, Deutschland
| | - Jens-Carsten Rückert
- Chirurgische Klinik, Thoraxchirurgie, Charité Universitätsmedizin Berlin, Berlin, Deutschland
| | - Jens Neudecker
- Chirurgische Klinik, Thoraxchirurgie, Charité Universitätsmedizin Berlin, Berlin, Deutschland
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Abstract
Chest tubes are placed in the pleural space to evacuate abnormal fluid or air accumulations. Various types and sizes of chest tubes are available. Imaging including ultrasound, computed tomography, and fluoroscopy should be used to guide chest tube placement. Understanding the anatomy of the pleural space, along with the etiology and classification of pleural space disease, can help optimize chest tube management. This article will review the indications, contraindications, techniques, and postprocedure follow-up of chest tube placement as well as discuss the management and prevention of complications.
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Affiliation(s)
- Ifechi Ukeh
- Division of Vascular and Interventional Radiology, Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Adam Fang
- Division of Vascular and Interventional Radiology, Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Sandhya Patel
- Naval Medical Center, Aviation Medicine, San Diego, California
| | - Kwaku Opoku
- Division of Vascular and Interventional Radiology, Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Nariman Nezami
- Division of Vascular and Interventional Radiology, Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland
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Yaftian N, Dunne B, Ferrari I, Antippa P. -8 cm H 2 O, the new paradigm in chest drain management following thoracoscopic lung resection? ANZ J Surg 2022; 92:1056-1059. [PMID: 35352444 PMCID: PMC9310860 DOI: 10.1111/ans.17645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 02/24/2022] [Accepted: 03/04/2022] [Indexed: 11/28/2022]
Abstract
Background Chest drain suction of −20 cm H2O has been used universally after lung resection. After introducing new guidelines,−8 cm H2O was used routinely for all non‐pneumonectomy, thoracoscopic lung resections. We conducted a review to determine outcomes and safety. Methods After introduction of the guidelines data were collected in the study institutions' thoracic surgical database and subsequently analysed. Results A total of 155 patients underwent thoracoscopic lung resection. Mean patient age was 61.5 ± 13.6 years. Video‐assisted thoracoscopic surgery was performed in 92.2% (144/155) of patients and robotically‐assisted thoracoscopic surgery was performed in 7.8% (12/155) of patients. Lobectomy was performed in 56.8% (88/155) of patients, segmentectomy was performed in 11.6% (18/155) of patients and wedge resection was performed in 31.6% (49/155) of patients. Median ICC duration time was 1 day (IQR 1–3). Median length of stay was 3 days (IQR 2–6). For patients undergoing lobectomy median ICC time was 2 days (IQR 1–4.5) and median length of stay was 3.5 days (IQR 2–7), for segmentectomy median ICC time was 1 day (IQR 1–5) and median length of stay was 2 days (IQR 1–5) and for wedge resection median ICC time was 1 day (IQR 1–1) and median admission time was 2 days (IQR 1–4). Conclusion A suction level −8 cm H2O is safe to use for thoracoscopic lung resections from day 0 post‐operatively. A dedicated, prospective study comparing levels of suction should be performed.
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Affiliation(s)
- Nima Yaftian
- Department of Cardiothoracic Surgery, Royal Melbourne Hospital, Melbourne, Australia
| | - Benjamin Dunne
- Department of Cardiothoracic Surgery, Royal Melbourne Hospital, Melbourne, Australia
| | - Isabelle Ferrari
- Department of Cardiothoracic Surgery, Royal Melbourne Hospital, Melbourne, Australia
| | - Phillip Antippa
- Department of Cardiothoracic Surgery, Royal Melbourne Hospital, Melbourne, Australia.,Department of Surgery, University of Melbourne, Melbourne, Australia
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Nguyen YL, Maiolino E, De Pauw V, Prieto M, Mazzella A, Peretout JB, Dechartres A, Baillard C, Bobbio A, Daffré E, Alifano M. Enhanced Recovery Pathway in Lung Resection Surgery: Program Establishment and Results of a Cohort Study Encompassing 1243 Consecutive Patients. Cancers (Basel) 2022; 14:cancers14071745. [PMID: 35406517 PMCID: PMC8997103 DOI: 10.3390/cancers14071745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 03/26/2022] [Accepted: 03/28/2022] [Indexed: 12/10/2022] Open
Abstract
Simple Summary Enhanced Recovery Pathways (ERP) have been scarcely assessed in lung cancer surgery. We performed a two-step audit for our experience: the first dealing with our initial experience focusing on patients undergoing segmentectomies and lobectomies, the second including all subsequent consecutive patients undergoing all kind of lung resections for NSCLC. The first step aimed at auditing results of ERP on occurrence of postoperative complications and at assessing which ERP components were associated with improved short-term outcomes. We also audited late results by assessing long-term survival of patients in the first step of our study. The second step aimed at auditing on large-scale short-term results of the ERP in a real-life setting. In total, 166 patients were included in the first period. No postoperative death occurred. The overall adverse events rate was 30%. In multivariate analyzes, the only element associated with reduced adverse postoperative events was chest tube withdrawal within POD2. The 1-, 3- and 5-year survival rates were 97%, 86.1%, and 76.3%, respectively. In the second period, 1077 patients were included; 11 patients died during the postoperative period. The overall postoperative adverse event rate was 30.3%. Thoracoscore independently predicted postoperative death, the occurrence of complications (all-kind, minor, major, or respiratory ones). We conclude that compliance to ERP procedures and early chest tube removal are associated with reduced postoperative events in patients with lung resection surgery. Thoracoscore is a useful tool in predicting mortality and postoperative adverse events. Abstract Introduction: In spite of increasing diffusion, Enhanced Recovery Pathways (ERP) have been scarcely assessed in large scale programs of lung cancer surgery. The aim of this study was auditing our practice. Methods: A two-step audit program was established: the first dealing with our initial ERP experience in patients undergoing non-extended anatomical segmentectomies and lobectomies, the second including all consecutive patients undergoing all kind of lung resections for NSCLC. The first step aimed at auditing results of ERP on occurrence of postoperative complications and at assessing which ERP components are associated with improved short-term outcomes. We also audited late results by assessing long-term survival of patients in the first step of our study. The second step aimed at auditing on large-scale short-term results of the ERP in a real-life setting. Results: Over a one-year period, 166 patients were included. The median number of ERP procedures per patient was three (IQR 3–4). No postoperative death occurred. The overall adverse events rate was 30%. In multivariate analyzes, the only element associated with reduced adverse postoperative events was chest tube withdrawal within POD2 (OR = 0.21, 95% CI (0.10–0.46)). The 1-, 3-, and 5-year survival rates were 97%, 86.1%, and 76.3%, respectively. In the second period, 1077 patients were included in our ERP; 11 patients died during the postoperative period or within 30 days of operation (1.02%). The overall postoperative adverse event rate was 30.3%, major complication occurring in 134 (12.4%), and minor ones in 192 (17.8%). Respiratory complications occurred in 64 (5.9%). Thoracoscore independently predicted postoperative death, the occurrence of complications (all-kind, minor, major, or respiratory ones). Conclusions: Compliance to ERP procedures and early chest tube removal are associated with reduced postoperative events in patients with lung resection surgery. In a large setting scale, ERP can be applied with satisfactory results in terms of mortality and morbidity. Thoracoscore is a useful tool in predicting mortality and postoperative adverse events.
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Affiliation(s)
- Yen-Lan Nguyen
- Anesthesiology and Critical Care Medicine Department, Cochin Academic Hospital, APHP, Université de Paris, 75014 Paris, France; (Y.-L.N.); (J.-B.P.); (C.B.)
| | - Elena Maiolino
- Thoracic Surgical Department, Cochin Academic Hospital, APHP, Université de Paris, 75014 Paris, France; (E.M.); (V.D.P.); (M.P.); (A.M.); (A.B.); (E.D.)
| | - Vincent De Pauw
- Thoracic Surgical Department, Cochin Academic Hospital, APHP, Université de Paris, 75014 Paris, France; (E.M.); (V.D.P.); (M.P.); (A.M.); (A.B.); (E.D.)
| | - Mathilde Prieto
- Thoracic Surgical Department, Cochin Academic Hospital, APHP, Université de Paris, 75014 Paris, France; (E.M.); (V.D.P.); (M.P.); (A.M.); (A.B.); (E.D.)
| | - Antonio Mazzella
- Thoracic Surgical Department, Cochin Academic Hospital, APHP, Université de Paris, 75014 Paris, France; (E.M.); (V.D.P.); (M.P.); (A.M.); (A.B.); (E.D.)
| | - Jean-Baptiste Peretout
- Anesthesiology and Critical Care Medicine Department, Cochin Academic Hospital, APHP, Université de Paris, 75014 Paris, France; (Y.-L.N.); (J.-B.P.); (C.B.)
| | - Agnès Dechartres
- Département Biostatistique Santé Publique et Information Médicale, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique, Sorbonne Université, Hôpitaux Universitaires Pitié Salpêtrière-Charles Foix, AP-HP, 75013 Paris, France;
| | - Christophe Baillard
- Anesthesiology and Critical Care Medicine Department, Cochin Academic Hospital, APHP, Université de Paris, 75014 Paris, France; (Y.-L.N.); (J.-B.P.); (C.B.)
| | - Antonio Bobbio
- Thoracic Surgical Department, Cochin Academic Hospital, APHP, Université de Paris, 75014 Paris, France; (E.M.); (V.D.P.); (M.P.); (A.M.); (A.B.); (E.D.)
| | - Elisa Daffré
- Thoracic Surgical Department, Cochin Academic Hospital, APHP, Université de Paris, 75014 Paris, France; (E.M.); (V.D.P.); (M.P.); (A.M.); (A.B.); (E.D.)
| | - Marco Alifano
- Thoracic Surgical Department, Cochin Academic Hospital, APHP, Université de Paris, 75014 Paris, France; (E.M.); (V.D.P.); (M.P.); (A.M.); (A.B.); (E.D.)
- Correspondence: ; Tel.: +33-628-336-324
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Zhou J, Li C, Zheng Q, Guo C, Lyu M, Pu Q, Liao H, Liu L. Suction Versus Nonsuction Drainage After Uniportal Video-Assisted Thoracoscopic Surgery: A Propensity Score-Matched Study. Front Oncol 2021; 11:751396. [PMID: 34765556 PMCID: PMC8577848 DOI: 10.3389/fonc.2021.751396] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 09/27/2021] [Indexed: 02/05/2023] Open
Abstract
Background Uniportal video-assisted thoracoscopic surgery (UniVATS) was utilized with a rapid growth. The evidence is sparse, however, on whether to add external suction to water-seal drainage for chest drainage after UniVATS. This retrospective propensity score-matched study aimed to identify the necessity of adding external suction to chest drainage after UniVATS. Methods Patients with lung cancer who underwent UniVATS were included from our prospectively maintained database. Patients were divided into two cohorts based on the addition of external suction to postoperative water-seal drainage or not. Propensity score-matched analysis was performed to identify the impact of suction on chest tube duration, incidence of persistent air leak, hospital stay, and hospitalization cost. Multivariable model with interaction terms was constructed to identify impact of covariables on effect of suction. Results The two cohorts matched well on baseline characteristics (nonsuction: 173; suction: 96). Compared with nonsuction group, suction group showed longer median chest tube duration (3 vs. 2 days, p = 0.003), higher incidences of persistent air leak (9.4% vs. 1.2%, p = 0.003), persistent drainage (16.8% vs. 5.8%, p = 0.007), and reduced drainage volume within first 3 postoperative days (386.90 vs. 504.78 ml, p = 0.011). Resection extent was identified to mediate the relationship between suction and chest tube drainage. Conclusions These findings discouraged adding external suction to water-seal drainage after UniVATS regarding longer chest tube duration and more persistent air leak. Patients undergoing lobectomy would benefit more from water-seal drainage without external suction compared with those doing sublobectomy.
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Affiliation(s)
- Jian Zhou
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Chuan Li
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Quan Zheng
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China.,West China School of Medicine, Sichuan University, Chengdu, China
| | - Chenglin Guo
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Mengyuan Lyu
- Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Qiang Pu
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Hu Liao
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Lunxu Liu
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
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Hoeijmakers F, Hartemink KJ, Verhagen AF, Steup WH, Marra E, Röell WFB, Heineman DJ, Schreurs WH, Tollenaar RAEM, Wouters MWJM. Variation in incidence, prevention and treatment of persistent air leak after lung cancer surgery. Eur J Cardiothorac Surg 2021; 61:110-117. [PMID: 34410339 PMCID: PMC8715850 DOI: 10.1093/ejcts/ezab376] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 06/15/2021] [Accepted: 07/14/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Persistent air leak (PAL; >5 days after surgery) is the most common complication after pulmonary resection and associated with prolonged hospital stay and increased morbidity. Literature is contradictory about the prevention and treatment of PAL. Variation is therefore hypothesized. The aim of this study is to understand the variation in the incidence, preventive management and treatment of PAL. METHODS Data from the Dutch Lung Cancer Audit for Surgery were combined with results of an online survey among Dutch thoracic surgeons. The national incidence of PAL and case-mix corrected between-hospital variation were calculated in patients who underwent an oncological (bi)lobectomy or segmentectomy between January 2012 and December 2018. By multivariable logistic regression, factors associated with PAL were assessed. A survey was designed to assess variation in (preventive) management and analysed using descriptive statistics. Hospital-level associations between management strategies and PAL were assessed by univariable linear regression. RESULTS Of 12 382 included patients, 9.0% had PAL, with a between-hospital range of 2.6–19.3%. Factors associated with PAL were male sex, poor lung function, low body mass index, high American Society of Anesthesiologists (ASA) score, pulmonary comorbidity, upper lobe resection, (bi)lobectomy (vs segmentectomy), right-sided tumour and robotic-assisted thoracic surgery. Perioperative (preventive) management of PAL differed widely between hospitals. When using water seal compared to suction drainage, the average incidence of PAL decreased 2.9%. CONCLUSIONS In the Netherlands, incidence and perioperative (preventive) management of PAL vary widely. Using water seal instead of suction drainage and increasing awareness are potential measures to reduce this variation.
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Affiliation(s)
- Fieke Hoeijmakers
- Department of Surgery, Leiden University Medical Center, Leiden, Netherlands.,Scientific Bureau, Dutch Institute for Clinical Auditing, Leiden, Netherlands
| | - Koen J Hartemink
- Department of Surgical Oncology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands
| | - Ad F Verhagen
- Department of Cardiothoracic Surgery, Radboud University Medical Center, Nijmegen, Netherlands
| | - Willem H Steup
- Department of Surgery, HAGA Hospital, Den Haag, Netherlands
| | - Elske Marra
- Scientific Bureau, Dutch Institute for Clinical Auditing, Leiden, Netherlands
| | | | - David J Heineman
- Department of Surgery, Amsterdam UMC, VU University Medical Center, Amsterdam, Netherlands.,Department of Cardiothoracic Surgery, Amsterdam UMC, VU University Medical Center, Amsterdam, Netherlands
| | | | - Rob A E M Tollenaar
- Department of Surgery, Leiden University Medical Center, Leiden, Netherlands.,Scientific Bureau, Dutch Institute for Clinical Auditing, Leiden, Netherlands
| | - Michel W J M Wouters
- Scientific Bureau, Dutch Institute for Clinical Auditing, Leiden, Netherlands.,Department of Surgical Oncology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands
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10
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Liu L, Zhang J, Wang G, Guo C, Chen Y, Huang C, Li S. Delayed Discharge after Thoracic Surgery under the Guidance of ERAS Protocols. Thorac Cardiovasc Surg 2021; 70:405-412. [PMID: 34176111 DOI: 10.1055/s-0041-1727232] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Enhanced recovery after surgery (ERAS) protocols have been applied in thoracic surgery and are beneficial to patients. However, some issues about ERAS are still pending. METHODS A total of 1,654 patients who underwent thoracic surgery under the guidance of ERAS protocols were enrolled in this study. We set the length of postoperative stay (LOPS) as our key research indicator. Patients were divided into routine discharge group and delayed discharge group based on LOPS. Causes of delayed discharge were analyzed to improve management of postoperative recovery. RESULTS Male, old age, underlying disease (coronary artery disease, chronic kidney disease, old cerebral infarction, chronic obstructive pulmonary disease, and arrhythmia), intensive care unit (ICU) stay, type of insurance, and lower forced expiratory volume in one second (FEV1) are the independent impact factors causing delayed discharge. Increased nonchylous drainage (INCD) and prolonged air leakage were the two leading causes for delayed discharge. CONCLUSION Patients should have personalized recovery goal under the same ERAS protocols. We should accept that patients in poor general condition have a prolonged LOPS. More stringent ICU stay indications should be developed to increase postoperative patients' ERAS protocols compliance. Further research on chest tube management will make a contribution to ERAS protocols.
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Affiliation(s)
- Lei Liu
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Dongcheng-qu, Beijing, People's Republic of China
| | - Jiaqi Zhang
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Dongcheng-qu, Beijing, People's Republic of China
| | - Guige Wang
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Dongcheng-qu, Beijing, People's Republic of China
| | - Chao Guo
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Dongcheng-qu, Beijing, People's Republic of China
| | - Yeye Chen
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Dongcheng-qu, Beijing, People's Republic of China
| | - Cheng Huang
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Dongcheng-qu, Beijing, People's Republic of China
| | - Shanqing Li
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Dongcheng-qu, Beijing, People's Republic of China
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11
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Zurich H, Preda A, Dhanasopon AP. A Comprehensive Overview of Chest Tubes. Physician Assistant Clinics 2021. [DOI: 10.1016/j.cpha.2020.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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12
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Berna P, Quesnel C, Assouad J, Bagan P, Etienne H, Fourdrain A, Le Guen M, Leone M, Lorne E, Nguyen YNL, Pages PB, Roz H, Garnier M. Guidelines on enhanced recovery after pulmonary lobectomy. Anaesth Crit Care Pain Med 2021; 40:100791. [PMID: 33451912 DOI: 10.1016/j.accpm.2020.100791] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To establish recommendations for optimisation of the management of patients undergoing pulmonary lobectomy, particularly Enhanced Recovery After Surgery (ERAS). DESIGN A consensus committee of 13 experts from the French Society of Anaesthesia and Intensive Care Medicine (Soci,t, franOaise d'anesth,sie et de r,animation, SFAR) and the French Society of Thoracic and Cardiovascular Surgery (Soci,t, franOaise de chirurgie thoracique et cardiovasculaire, SFCTCV) was convened. A formal conflict-of-interest policy was developed at the onset of the process and enforced throughout. The entire guidelines process was conducted independently of any industry funding. The authors were advised to follow the principles of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system to guide assessment of quality of evidence. METHODS Five domains were defined: 1) patient pathway and patient information; 2) preoperative management and rehabilitation; 3) anaesthesia and analgesia for lobectomy; 4) surgical strategy for lobectomy; and 5) enhanced recovery after surgery. For each domain, the objective of the recommendations was to address a number of questions formulated according to the PICO model (Population, Intervention, Comparison, Outcome). An extensive literature search on these questions was carried out and analysed using the GRADE® methodology. Recommendations were formulated according to the GRADE® methodology, and were then voted by all experts according to the GRADE grid method. RESULTS The SFAR/SFCTCV guideline panel provided 32 recommendations on the management of patients undergoing pulmonary lobectomy. After two voting rounds and several amendments, a strong consensus was reached for 31 of the 32 recommendations and a moderate consensus was reached for the last recommendation. Seven of these recommendations present a high level of evidence (GRADE 1+), 23 have a moderate level of evidence (18 GRADE 2+ and 5 GRADE 2-), and 2 correspond to expert opinions. Finally, no recommendation was provided for 2 of the questions. CONCLUSIONS A strong consensus was expressed by the experts to provide recommendations to optimise the whole perioperative management of patients undergoing pulmonary lobectomy.
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Affiliation(s)
- Pascal Berna
- Department of Thoracic Surgery, Amiens University Hospital, 80000 Amiens, France
| | - Christophe Quesnel
- Sorbonne Universit,, APHP, DMU DREAM, Service d'Anesth,sie-R,animation et M,decine P,riop,ratoire, H"pital Tenon, 75020 Paris, France
| | - Jalal Assouad
- Department of Thoracic Surgery, Tenon University Hospital, Sorbonne Universit,, 75020 Paris, France
| | - Patrick Bagan
- Department of Thoracic and Vascular Surgery, Victor Dupouy Hospital, 95100 Argenteuil, France
| | - Harry Etienne
- Department of Thoracic Surgery, Tenon University Hospital, Sorbonne Universit,, 75020 Paris, France
| | - Alex Fourdrain
- Department of Thoracic Surgery, Amiens University Hospital, 80000 Amiens, France
| | - Morgan Le Guen
- D,partement d'Anesth,sie, H"pital Foch, Universit, Versailles Saint Quentin, 92150 Suresnes, France; INRA UMR 892 VIM, 78350 Jouy-en-Josas, France
| | - Marc Leone
- Aix Marseille Universit, - Assistance Publique H"pitaux de Marseille - Service d'Anesth,sie et de R,animation - H"pital Nord - 13005 Marseille, France
| | - Emmanuel Lorne
- Departement d'Anesth,sie-R,animation, Clinique du Mill,naire, 34000 Montpellier, France
| | - Y N-Lan Nguyen
- Anaesthesiology and Critical Care Department, APHP Centre, Paris University, 75000 Paris, France
| | - Pierre-Benoit Pages
- Department of Thoracic Surgery, Dijon Burgundy University Hospital, 21000 Dijon, France; INSERM UMR 1231, Dijon Burgundy University Hospital, University of Burgundy, 21000 Dijon, France
| | - Hadrien Roz
- Unit, d'Anesth,sie R,animation Thoracique, H"pital Haut Leveque, CHU de Bordeaux, 33000 Bordeaux, France
| | - Marc Garnier
- Sorbonne Universit,, APHP, DMU DREAM, Service d'Anesth,sie-R,animation et M,decine P,riop,ratoire, H"pital Tenon, 75020 Paris, France.
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13
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Malík M, Dzian A, Skaličanová M, Hamada Ĺ, Zeleňák K, Grendár M. Chest Ultrasound Can Reduce the Use of Roentgenograms in Postoperative Care After Thoracic Surgery. Ann Thorac Surg 2020; 112:897-904. [PMID: 33186604 DOI: 10.1016/j.athoracsur.2020.10.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 09/16/2020] [Accepted: 10/12/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Roentgenography remains the standard imaging modality after thoracic surgery. Trials from intensive medicine proved a high accuracy of ultrasound examination in the diagnosis of various conditions. The assumption was that ultrasound examination could reduce the number of roentgenograms after thoracic surgery. METHODS This prospective study compared ultrasound examinations performed by thoracic surgeons with roentgenograms in the diagnosis of pneumothorax and pleural effusion after noncardiac thoracic surgery. Patients received 2 ultrasound scans, the first on the day of surgery and the second before chest tube removal. RESULTS A total of 297 patients underwent 545 examinations; 336 ultrasound scans (61.6%) showed neither pneumothorax nor pleural effusion. Pneumothorax was detected on 69 roentgenograms and 51 ultrasound scans. Both modalities showed positive results in 32 cases and negative results in 395 cases (Cohen's κ, 53.4%). Ultrasound missed 37 clinically irrelevant pneumothoraces. Roentgenograms missed 19 pneumothoraces; 15 of them were clinically irrelevant. Sensitivity and specificity were 59.4% and 95.9% in the first examination and 50.0% and 94.8% in the second examination, respectively. Pleural effusion was detected on 169 roentgenograms and 117 ultrasound scans. Both modalities showed positive results in 88 cases and negative results in 336 cases (Cohen's κ, 49.6%). Ultrasound scans missed 81 pleural effusions; except for 5 cases, the clinical decisions would not have changed. Roentgenograms missed 29 clinically irrelevant pleural effusions. Sensitivity and specificity were 44.4% and 92.6% in the first examination and 60.9% and 91.3% in the second examination, respectively. CONCLUSIONS Given high specificities, a large share of results without pneumothorax and pleural effusion, and mismatch analysis, we could reduce the number of roentgenograms by 61.6% by using ultrasound as a primary imaging modality.
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Affiliation(s)
- Marek Malík
- Department of Thoracic Surgery, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava and University Hospital in Martin, Martin, Slovakia
| | - Anton Dzian
- Department of Thoracic Surgery, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava and University Hospital in Martin, Martin, Slovakia.
| | - Michaela Skaličanová
- Department of Thoracic Surgery, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava and University Hospital in Martin, Martin, Slovakia
| | - Ĺuboš Hamada
- Department of Thoracic Surgery, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava and University Hospital in Martin, Martin, Slovakia
| | - Kamil Zeleňák
- Department of Radiology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava and University Hospital in Martin, Slovakia, Martin, Slovakia
| | - Marián Grendár
- Biomedical Centre Martin, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia
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14
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Piccioni F, Droghetti A, Bertani A, Coccia C, Corcione A, Corsico AG, Crisci R, Curcio C, Del Naja C, Feltracco P, Fontana D, Gonfiotti A, Lopez C, Massullo D, Nosotti M, Ragazzi R, Rispoli M, Romagnoli S, Scala R, Scudeller L, Taurchini M, Tognella S, Umari M, Valenza F, Petrini F. Recommendations from the Italian intersociety consensus on Perioperative Anesthesa Care in Thoracic surgery (PACTS) part 2: intraoperative and postoperative care. Perioper Med (Lond) 2020; 9:31. [PMID: 33106758 PMCID: PMC7582032 DOI: 10.1186/s13741-020-00159-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 09/22/2020] [Indexed: 02/08/2023] Open
Abstract
Introduction Anesthetic care in patients undergoing thoracic surgery presents specific challenges that require a multidisciplinary approach to management. There remains a need for standardized, evidence-based, continuously updated guidelines for perioperative care in these patients. Methods A multidisciplinary expert group, the Perioperative Anesthesia in Thoracic Surgery (PACTS) group, was established to develop recommendations for anesthesia practice in patients undergoing elective lung resection for lung cancer. The project addressed three key areas: preoperative patient assessment and preparation, intraoperative management (surgical and anesthesiologic care), and postoperative care and discharge. A series of clinical questions was developed, and literature searches were performed to inform discussions around these areas, leading to the development of 69 recommendations. The quality of evidence and strength of recommendations were graded using the United States Preventive Services Task Force criteria. Results Recommendations for intraoperative care focus on airway management, and monitoring of vital signs, hemodynamics, blood gases, neuromuscular blockade, and depth of anesthesia. Recommendations for postoperative care focus on the provision of multimodal analgesia, intensive care unit (ICU) care, and specific measures such as chest drainage, mobilization, noninvasive ventilation, and atrial fibrillation prophylaxis. Conclusions These recommendations should help clinicians to improve intraoperative and postoperative management, and thereby achieve better postoperative outcomes in thoracic surgery patients. Further refinement of the recommendations can be anticipated as the literature continues to evolve.
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Affiliation(s)
- Federico Piccioni
- Department of Critical and Supportive Care, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Alessandro Bertani
- Division of Thoracic Surgery and Lung Transplantation, Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS ISMETT - UPMC, Palermo, Italy
| | - Cecilia Coccia
- Department of Anesthesia and Critical Care Medicine, National Cancer Institute "Regina Elena"-IRCCS, Rome, Italy
| | - Antonio Corcione
- Department of Critical Care Area Monaldi Hospital, Ospedali dei Colli, Naples, Italy
| | - Angelo Guido Corsico
- Division of Respiratory Diseases, IRCCS Policlinico San Matteo Foundation and Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
| | - Roberto Crisci
- Department of Thoracic Surgery, University of L'Aquila, L'Aquila, Italy
| | - Carlo Curcio
- Thoracic Surgery, AORN dei Colli Vincenzo Monaldi Hospital, Naples, Italy
| | - Carlo Del Naja
- Department of Thoracic Surgery, IRCCS Casa Sollievo della Sofferenza Hospital, San Giovanni Rotondo, FG Italy
| | - Paolo Feltracco
- Department of Medicine, Anaesthesia and Intensive Care, University Hospital of Padova, Padova, Italy
| | - Diego Fontana
- Thoracic Surgery Unit - San Giovanni Bosco Hospital, Turin, Italy
| | | | - Camillo Lopez
- Thoracic Surgery Unit, 'V Fazzi' Hospital, Lecce, Italy
| | - Domenico Massullo
- Anesthesiology and Intensive Care Unit, Azienda Ospedaliero Universitaria S. Andrea, Rome, Italy
| | - Mario Nosotti
- Thoracic Surgery and Lung Transplant Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Riccardo Ragazzi
- Department of Morphology, Surgery and Experimental Medicine, Azienda Ospedaliero-Universitaria Sant'Anna, Ferrara, Italy
| | - Marco Rispoli
- Anesthesia and Intensive Care, AORN dei Colli Vincenzo Monaldi Hospital, Naples, Italy
| | - Stefano Romagnoli
- Department of Health Science, Section of Anesthesia and Critical Care, University of Florence, Florence, Italy.,Department of Anesthesia and Critical Care, Careggi University Hospital, Florence, Italy
| | - Raffaele Scala
- Pneumology and Respiratory Intensive Care Unit, San Donato Hospital, Arezzo, Italy
| | - Luigia Scudeller
- Clinical Epidemiology Unit, Scientific Direction, Fondazione IRCCS San Matteo, Pavia, Italy
| | - Marco Taurchini
- Department of Thoracic Surgery, IRCCS Casa Sollievo della Sofferenza Hospital, San Giovanni Rotondo, FG Italy
| | - Silvia Tognella
- Respiratory Unit, Orlandi General Hospital, Bussolengo, Verona, Italy
| | - Marzia Umari
- Combined Department of Emergency, Urgency and Admission, Cattinara University Hospital, Trieste, Italy
| | - Franco Valenza
- Department of Critical and Supportive Care, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.,Department of Oncology and Onco-Hematology, University of Milan, Milan, Italy
| | - Flavia Petrini
- Department of Anaesthesia, Perioperative Medicine, Pain Therapy, RRS and Critical Care Area - DEA ASL2 Abruzzo, Chieti University Hospital, Chieti, Italy
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15
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Budacan AM, Mehdi R, Kerr AP, Kadiri SB, Batchelor TJP, Naidu B. National survey of enhanced recovery after thoracic surgery practice in the United Kingdom and Ireland. J Cardiothorac Surg 2020; 15:95. [PMID: 32410658 PMCID: PMC7227342 DOI: 10.1186/s13019-020-01121-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 04/28/2020] [Indexed: 02/07/2023] Open
Abstract
Background Evidence that Enhanced Recovery After Thoracic Surgery (ERAS) improves clinical outcomes is growing. Following the recent publications of the international ERAS guidelines in Thoracic surgery, the aim of this audit was to capture variation and perceived difficulties to ERAS implementation, thus helping its development at a national level. Methods We designed an anonymous online survey and distributed it via email to all 36 centres that perform lung lobectomy surgery in the UK and Ireland. It included 38 closed, open and multiple-choice questions on the core elements of ERAS and took an average of 10 min to complete. Results Eighty-two healthcare professionals from 34 out of 36 centres completed the survey; majority were completed by consultant thoracic surgeons (57%). Smoking cessation support varied and only 37% of individuals implemented the recommended period for fluid fasting; 59% screen patients for malnutrition and 60% do not give preoperative carbohydrate loading. The compliance with nerve sparing techniques when a thoracotomy is performed was poor (22%). 66% of respondents apply suction on intercostal drains and although 91% refer all lobectomies for physiotherapeutic assessment, the physiotherapy adjuncts varied across centres. Perceived barriers to implementation were staffing levels, lack of teamwork/consistency, limited resources over weekend and the reduced access to smoking cessation services. Conclusion Centres across the UK are working to develop the ERAS pathway. This survey aids this process by providing insight into “real life” ERAS, increasing exposure of staff to the ESTS- ERAS recommendations and identifying barriers to implementation.
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Affiliation(s)
- Alina-Maria Budacan
- Department of Thoracic Surgery, Heartlands Hospital, Bordesley Green East, Birmingham, B9 5SS, UK
| | - Rana Mehdi
- Department of Thoracic Surgery, Heartlands Hospital, Bordesley Green East, Birmingham, B9 5SS, UK
| | - Amy Pamela Kerr
- Department of Thoracic Surgery, Heartlands Hospital, Bordesley Green East, Birmingham, B9 5SS, UK
| | - Salma Bibi Kadiri
- Department of Thoracic Surgery, Heartlands Hospital, Bordesley Green East, Birmingham, B9 5SS, UK
| | - Timothy J P Batchelor
- Department of Thoracic Surgery, University Hospitals Bristol NHS Foundation Trust, Upper Maudlin Street, Bristol, BS2 8HW, UK
| | - Babu Naidu
- Department of Thoracic Surgery, Heartlands Hospital, Bordesley Green East, Birmingham, B9 5SS, UK. .,Institute of Inflammation and Ageing, College of Medical and Dental Sciences, Centre for Translational Inflammation Research, University of Birmingham Laboratories, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
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16
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Aldaghlawi F, Kurman JS, Lilly JA, Hogarth DK, Donington J, Ferguson MK, Murgu SD. A Systematic Review of Digital vs Analog Drainage for Air Leak After Surgical Resection or Spontaneous Pneumothorax. Chest 2020; 157:1346-1353. [PMID: 31958444 DOI: 10.1016/j.chest.2019.11.046] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Revised: 10/27/2019] [Accepted: 11/21/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The concerns regarding air leak after lung surgery or spontaneous pneumothorax include detection and duration. Prior studies have suggested that digital drainage systems permit shorter chest tube duration and hospital length of stay (LOS) by earlier detection of air leak cessation. We conducted a systematic review to assess the impact of digital drainage on chest tube duration and hospital LOS after pulmonary surgery and spontaneous pneumothorax. METHODS Ovid MEDLINE, PubMed, Embase, the Cochrane Library, Scopus, and Google Scholar were searched from inception through January 2019. We included randomized controlled trials, cohort studies, and case series of adult patients, using digital or traditional drainage devices for air leaks of either postsurgical or spontaneous pneumothorax origin. RESULTS Of 1,272 references reviewed, 23 articles were included. Nineteen articles addressed postoperative air leak, and four articles pertained to air leak after spontaneous pneumothorax. Thirteen studies were randomized controlled trials. Digital drainage resulted in significantly shorter chest tube duration in eight of 18 studies and shorter hospital LOS in six of 14 studies for postoperative air leak. For postpneumothorax air leak, digital drainage resulted in significantly shorter chest tube duration in two of three studies and hospital LOS in one of two studies with an analog control group. CONCLUSIONS Most studies show no significant differences in chest tube duration and hospital LOS with digital vs analog drainage systems for patients with air leak after pulmonary resection. For post-spontaneous pneumothorax air leak, the limited published evidence suggests shorter chest tube duration and hospital LOS with digital drainage systems.
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Affiliation(s)
- Fadi Aldaghlawi
- Department of Medicine, Indiana University Goshen Health, Goshen, IN
| | - Jonathan S Kurman
- Division of Pulmonary and Critical Care, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Jason A Lilly
- Ruth Lilly Medical Library, Indiana University School of Medicine, Indianapolis, IN
| | - D Kyle Hogarth
- Section of Pulmonary and Critical Care, Department of Medicine, University of Chicago, Chicago, IL
| | - Jessica Donington
- Section of Thoracic Surgery, Department of Surgery, University of Chicago, Chicago, IL
| | - Mark K Ferguson
- Section of Thoracic Surgery, Department of Surgery, University of Chicago, Chicago, IL
| | - Septimiu D Murgu
- Section of Pulmonary and Critical Care, Department of Medicine, University of Chicago, Chicago, IL.
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17
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Gowing SD, Resende VF, Gilbert S. Less is more: the benefits of low suction for digital pleural drainage devices after pulmonary resection. J Thorac Dis 2019; 11:S1999-S2001. [PMID: 31632809 DOI: 10.21037/jtd.2019.06.74] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Stephen Donald Gowing
- Division of Thoracic Surgery, Department of Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Virginia Ferreira Resende
- Division of Thoracic Surgery, Department of Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Sebastien Gilbert
- Division of Thoracic Surgery, Department of Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
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18
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DeArmond DT, Das NA, Restrepo CS, Katona MA, Johnson SB, Hernandez BS, Michalek JE. Intrapleural Impedance Sensor Real-Time Tracking of Pneumothorax in a Porcine Model of Air Leak. Semin Thorac Cardiovasc Surg 2019; 32:357-366. [PMID: 31610232 DOI: 10.1053/j.semtcvs.2019.10.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 10/03/2019] [Indexed: 11/11/2022]
Abstract
In patients with alveolar-to-pleural air leak due to recent surgery or trauma, clinicians tend to manage chest tubes with suction therapy. Nonsuction therapy is associated with shorter chest tube duration but also a higher risk of pneumothorax. We sought to develop an intrapleural electrical impedance sensor for continuous, real-time monitoring of pneumothorax development in a porcine model of air leak as a means of promoting nonsuction therapy. Using thoracoscopy, 2 chest tubes and the pleural impedance sensor were introduced into the pleural space of 3 pigs. Continuous air leak was introduced through 1 chest tube by carbon dioxide insufflation. The second chest tube was placed to suction then transitioned to no suction at increasingly higher air leaks until pneumothorax developed. Simultaneously, real-time impedance measurements were obtained from the pleural sensor. Fluoroscopy spot images were captured to verify the presence or absence of pneumothorax. Statistical Analysis Software was used throughout. With the chest tube on suction, a fully expanded lung was identified by a distinct pleural electrical impedance respiratory waveform. With transition of the chest tube to water seal, loss of contact of the sensor with the lung resulted in an immediate measurement of infinite electrical impedance. Pneumothorax resolution by restoring suction therapy was detected in real time by a return of the normal respiratory impedance waveform. Pleural electrical impedance monitoring detected pneumothorax development and resolution in real time. This simple technology has the potential to improve the safety and quality of chest tube management.
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Affiliation(s)
- Daniel T DeArmond
- Department of Cardiothoracic Surgery, University of Texas Health Science Center at San Antonio (UTHSCSA), San Antonio, Texas.
| | - Nitin A Das
- Department of Cardiothoracic Surgery, University of Texas Health Science Center at San Antonio (UTHSCSA), San Antonio, Texas
| | | | - Mitch A Katona
- Department of Cardiothoracic Surgery, University of Texas Health Science Center at San Antonio (UTHSCSA), San Antonio, Texas
| | - Scott B Johnson
- Department of Cardiothoracic Surgery, University of Texas Health Science Center at San Antonio (UTHSCSA), San Antonio, Texas
| | - Brian S Hernandez
- Department of Epidemiology & Biostatistics, UTHSCSA, San Antonio, Texas
| | - Joel E Michalek
- Department of Epidemiology & Biostatistics, UTHSCSA, San Antonio, Texas
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19
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Zhou J, Chen N, Hai Y, Lyu M, Wang Z, Gao Y, Pang L, Liao H, Liu L. External suction versus simple water-seal on chest drainage following pulmonary surgery: an updated meta-analysis. Interact Cardiovasc Thorac Surg 2019; 28:29-36. [PMID: 30052997 DOI: 10.1093/icvts/ivy216] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 06/12/2018] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES The decision to apply simple water-seal drainage or the addition of an external suction to the simple water-seal drainage following pulmonary surgery is made based on the surgeon's experience or preference and has remained controversial. This meta-analysis aimed to assess the effects of the addition of suction to simple water-seal on the postoperative outcomes. METHODS PubMed, EMBASE and Web of Science were searched from their inception to 30 August 2017. The risk ratio and the weight mean difference were calculated for dichotomous and continuous outcomes, respectively, each with 95% confidence intervals (CIs). The heterogeneity and risk of bias were also assessed. RESULTS A total of 10 randomized controlled trials enrolling 1601 patients were included. Overall, compared with simple water-seal, the addition of external suction reduced the occurrence of postoperative pneumothorax (risk ratio 0.35, 95% CI 0.13-0.93; P = 0.04) and other cardiopulmonary complications (risk ratio 0.65, 95% CI 0.48-0.89; P = 0.008), and increased the duration of chest tube drainage (weight mean difference 0.92 days, 95% CI 0.04-1.81, P = 0.04). However, the effect difference between the 2 groups was not significant regarding air leak duration, length of hospital stay and the occurrence of prolonged air leak. The stability of these studies was strong. No evidence of publication bias was detected. CONCLUSIONS The addition of suction to simple water-seal made no difference to air leak duration, hospital stay or the occurrence of prolonged air leak following pulmonary surgery. In patients where there is concern about a residual or increasing pneumothorax, the addition of suction may be applied selectively.
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Affiliation(s)
- Jian Zhou
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China.,West China School of Medicine, Sichuan University, Chengdu, China
| | - Nan Chen
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China.,West China School of Medicine, Sichuan University, Chengdu, China
| | - Yang Hai
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China.,West China School of Medicine, Sichuan University, Chengdu, China
| | - Mengyuan Lyu
- West China School of Medicine, Sichuan University, Chengdu, China.,Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Zihuai Wang
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China.,West China School of Medicine, Sichuan University, Chengdu, China
| | - Yuanjing Gao
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Long Pang
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Hu Liao
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China.,Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung Cancer, Sichuan University, Chengdu, China
| | - Lunxu Liu
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China.,Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung Cancer, Sichuan University, Chengdu, China
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20
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Parker MH, Newcomb AB, Liu C, Michetti CP. Chest Tube Management Practices by Trauma Surgeons. J Surg Res 2019; 244:225-230. [PMID: 31301478 DOI: 10.1016/j.jss.2019.06.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 04/30/2019] [Accepted: 06/07/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Chest tube (CT) placement is among the most common procedures performed by trauma surgeons; evidence guiding CT management is limited and tends toward thoracic surgery patients. The study goal was to identify current CT management practices among trauma providers. MATERIALS AND METHODS We designed a Web-based multiple-choice survey to assess CT management practices of trauma providers who were active, senior, or provisional members (n = 1890) of the Eastern Association for the Surgery of Trauma and distributed via e-mail. Descriptive statistics were used. RESULTS The response rate was 39% (n = 734). Ninety-one percent of respondents were attending surgeons, the remainder fellows or residents. Regarding experience, 36% of respondents had five or fewer years of practice, 54% 10 y or fewer, and 79% 20 y or fewer. Attendings were more likely than trainees to place pigtail catheters for stable patients with pneumothorax (PTX). Attendings with experience of <5 y were more likely to choose a pigtail than more experienced surgeons for elderly patients with PTX. Respondents preferred standard size CTs for hemothorax and unstable patients with PTX, and larger tubes for unstable patients with hemothorax. Most respondents (53%) perceived the quality of evidence for trauma CT management to be low and cited personal experience and training as the main factors driving their practice. CONCLUSIONS Trauma CT management is variable and nonstandardized, depending mostly on clinician training and personal experience. Few surgeons identify their practice as evidence based. We offer compelling justification for the need for trauma CT management research to determine best practices.
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Affiliation(s)
- Michael H Parker
- Department of Surgery, Inova Fairfax Medical Campus, Falls Church, Virginia
| | - Anna B Newcomb
- Department of Surgery, Inova Fairfax Medical Campus, Falls Church, Virginia
| | - Chang Liu
- Department of Surgery, Inova Fairfax Medical Campus, Falls Church, Virginia
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21
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Treasure T. Thoracotomy: Gain With Less Pain? Semin Thorac Cardiovasc Surg 2019; 31:593-594. [PMID: 31153994 DOI: 10.1053/j.semtcvs.2019.05.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Accepted: 05/28/2019] [Indexed: 11/11/2022]
Affiliation(s)
- Tom Treasure
- UCL, Clinical Operational Research Unit, London, United Kingdom.
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22
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Lijkendijk M, Licht PB, Neckelmann K. The Influence of Suction on Chest Drain Duration After Lobectomy Using Electronic Chest Drainage. Ann Thorac Surg 2019; 107:1621-5. [DOI: 10.1016/j.athoracsur.2018.12.059] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 11/18/2018] [Accepted: 12/10/2018] [Indexed: 11/23/2022]
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23
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Filosso PL, Guerrera F, Lausi PO, Ruffini E. How should we manage the chest drainage after a video-assisted thoracoscopic surgery lobectomy? J Thorac Dis 2019; 11:2212-2214. [PMID: 31372255 DOI: 10.21037/jtd.2019.05.44] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Pier Luigi Filosso
- Unit of Thoracic Surgery, Department of Surgical Sciences, University of Turin, Turin, TO, Italy
| | - Francesco Guerrera
- Unit of Thoracic Surgery, Department of Surgical Sciences, University of Turin, Turin, TO, Italy
| | - Paolo Olivo Lausi
- Unit of Thoracic Surgery, Department of Surgical Sciences, University of Turin, Turin, TO, Italy
| | - Enrico Ruffini
- Unit of Thoracic Surgery, Department of Surgical Sciences, University of Turin, Turin, TO, Italy
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24
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Pischik VG, Maslak OS, Obornev AD, Zinchenko EI, Kovalenko AI. Risk factors and outcomes of prolonged air leak after pulmonary resections. Indian J Thorac Cardiovasc Surg 2019; 35:564-8. [PMID: 33061052 DOI: 10.1007/s12055-019-00827-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 03/21/2019] [Accepted: 03/22/2019] [Indexed: 10/26/2022] Open
Abstract
Purpose Prolonged air leak (PAL) is a challenging complication in thoracic surgery. The aim of this study was to analyze the incidence, risk factors, and outcomes of PAL. Methods We retrospectively analyzed 319 patients treated in a single center submitted to lobectomy, bilobectomy, segmentectomy, and wedge resections from January 2012 until August 2015. PAL was defined as air leak lasting more than 7 days after surgery. Results The incidence of PAL was 14.7%. Bronchial obstruction (p < 0.05), low body mass index (BMI, p < 0.05), and hypoproteinemia (p < 0.001) were identified as independent preoperative risk factors of PAL. Intraoperative risk factors were lob- (p < 0.01) and bilobectomies (p < 0.05), pleural adhesions (p < 0.001), and length of stapler line (p < 0.001). Among the postoperative risk factors, we identified the use of active drainage (p < 0.01), the presence of subcutaneous emphysema (p < 0.001), massive air leak on the first postoperative day (POD 1, p < 0.001), and an incomplete re-expansion of the lung (p < 0.001). PAL was not associated with more complications in the postoperative period. One patient required reoperation due to a massive air leak. Twenty-six patients were discharged with a Heimlich valve with no complications and no need for re-admission. Conclusions Bronchial obstruction, low BMI, hypoproteinemia, lob- and bilobectomies, pleural adhesions, length of stapler line, use of active drainage, the presence of subcutaneous emphysema, massive air leak on POD 1, and incomplete re-expansion of the lung were identified as independent risk factors of PAL. It had no influence on outcomes.
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25
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Bowman JA, Utter GH. Electronic chest tube drainage devices and low suction following video-assisted thoracoscopic pulmonary lobectomy. J Thorac Dis 2019; 11:1738-1741. [PMID: 31285862 PMCID: PMC6588738 DOI: 10.21037/jtd.2019.05.26] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 05/06/2019] [Indexed: 11/06/2022]
Affiliation(s)
- Jessica A. Bowman
- Department of Surgery, Division of Trauma and Acute Care Surgery, University of California, Davis, CA, USA
| | - Garth H. Utter
- Department of Surgery, Division of Trauma and Acute Care Surgery, University of California, Davis, CA, USA
- Department of Surgery Outcomes Research Group, University of California, Davis, CA, USA
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26
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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27
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Holbek BL, Christensen M, Hansen HJ, Kehlet H, Petersen RH. The effects of low suction on digital drainage devices after lobectomy using video-assisted thoracoscopic surgery: a randomized controlled trial†. Eur J Cardiothorac Surg 2018; 55:673-681. [DOI: 10.1093/ejcts/ezy361] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 09/12/2018] [Accepted: 09/25/2018] [Indexed: 11/14/2022] Open
Affiliation(s)
- Bo Laksáfoss Holbek
- Department of Cardiothoracic Surgery, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Unit of Surgical Pathophysiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Merete Christensen
- Department of Cardiothoracic Surgery, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Henrik Jessen Hansen
- Department of Cardiothoracic Surgery, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Henrik Kehlet
- Unit of Surgical Pathophysiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - René Horsleben Petersen
- Department of Cardiothoracic Surgery, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
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28
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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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29
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DeArmond DT, Das NA, Restrepo CS, Johnson SB, Michalek JE, Hernandez BS. Pleural electrical impedance is a sensitive, real-time indicator of pneumothorax. J Surg Res 2018; 231:15-23. [PMID: 30278922 DOI: 10.1016/j.jss.2018.05.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 02/21/2018] [Accepted: 05/04/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Chest tube management protocols, particularly in patients with alveolar-pleural air leak due to recent surgery or trauma, are limited by concerns over safety, especially concerns about rapid and occult development of pneumothorax. A continuous, real-time monitor of pneumothorax could improve the quality and safety of chest tube management. We developed a rat model of pneumothorax to test a novel approach of measuring electrical impedance within the pleural space as a monitor of lung expansion. MATERIALS AND METHODS Anesthetized Sprague-Dawley rats underwent right thoracotomy. A novel impedance sensor and a thoracostomy tube were introduced into the right pleural space. Pneumothorax of varying volumes ranging from 0.2 to 20 mL was created by syringe injection of air via the thoracostomy tube. Electrical resistance measurements from the pleural sensor and fluoroscopic images were obtained at baseline and after the creation of pneumothorax and results compared. RESULTS A statistically significant, dose-dependent increase in electrical resistance was observed with increasing volume of pneumothorax. Resistance measurement allowed for continuous, real-time monitoring of pneumothorax development and the ability to track pneumothorax resolution by aspiration of air via the thoracostomy tube. Pleural resistance measurement demonstrated 100% sensitivity and specificity for all volumes of pneumothorax tested and was significantly more sensitive for pneumothorax detection than fluoroscopy. CONCLUSIONS The electrical impedance-based pleural space sensor described in this study provided sensitive and specific pneumothorax detection, which was superior to radiographic analysis. Real-time, continuous monitoring for pneumothorax has the potential to improve the safety, quality, and efficiency of postoperative chest tube management.
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Affiliation(s)
- Daniel T DeArmond
- Department of Cardiothoracic Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas.
| | - Nitin A Das
- Department of Cardiothoracic Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Carlos S Restrepo
- Department of Radiology, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Scott B Johnson
- Department of Cardiothoracic Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Joel E Michalek
- Department of Epidemiology & Biostatistics, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Brian S Hernandez
- Department of Epidemiology & Biostatistics, University of Texas Health Science Center at San Antonio, San Antonio, Texas
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30
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Zhou J, Lyu M, Chen N, Wang Z, Hai Y, Hao J, Liu L. Digital chest drainage is better than traditional chest drainage following pulmonary surgery: a meta-analysis. Eur J Cardiothorac Surg 2018; 54:635-643. [PMID: 29659768 DOI: 10.1093/ejcts/ezy141] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Accepted: 03/06/2018] [Indexed: 02/05/2023] Open
Affiliation(s)
- Jian Zhou
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Mengyuan Lyu
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Nan Chen
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Zihuai Wang
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Yang Hai
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Jianqi Hao
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Lunxu Liu
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
- Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung Cancer, Sichuan University, Chengdu, China
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31
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Feenstra TM, Dickhoff C, Deunk J. Systematic review and meta-analysis of tube thoracostomy following traumatic chest injury; suction versus water seal. Eur J Trauma Emerg Surg 2018; 44:819-827. [PMID: 29546613 PMCID: PMC6267148 DOI: 10.1007/s00068-018-0942-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2017] [Accepted: 03/12/2018] [Indexed: 12/29/2022]
Abstract
Purpose Tube thoracostomy is frequently used in thoracic trauma patients. However, there is no consensus on whether low pressure suction or water seal is the optimal method of tube management. Against this background, we performed a systematic review of studies comparing suction and water seal management of chest tubes placed for traumatic chest injuries in adults. Evaluated outcomes are duration of chest tube treatment, length of stay in hospital, incidence of persistent air leak, clotted hemothorax, and the need for (re-)interventions. Methods A systematic literature search according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines was performed. Included studies were evaluated according to the Cochrane Collaboration’s tool for assessing the risk of bias, and according to Grading of Recommendations Assessment, Development and Evaluation (GRADE) guidelines for assessing the quality of evidence. Results After assessment of 120 identified studies, three RCT’s (randomized controlled trials) were included in this review and meta-analysis. A favorable effect of suction was found for duration of chest tube treatment [MD (mean difference) − 3.38 days, P = 0.005], length of stay in hospital (MD −3.90 days, P = 0.0003), and the incidence of persistent air leak [OR (odds ratio) 0.27, P = 0.001]. No significant difference was found for the incidence of clotted hemothorax and (re-)interventions. The quality of evidence according to GRADE was low, except for persistent air leak (moderate). Conclusions Suction seems to have a positive effect on duration of chest tube treatment, length of stay in hospital and persistent air leakage in chest trauma. However, available data was limited and the quality of evidence was (very) low to moderate according to GRADE.
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Affiliation(s)
- Tim Michael Feenstra
- Department of Trauma Surgery, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Chris Dickhoff
- Department of Thoracic Surgery, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Jaap Deunk
- Department of Trauma Surgery, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
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32
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Gonfiotti A, Viggiano D, Voltolini L, Bertani A, Bertolaccini L, Crisci R, Droghetti A. Enhanced recovery after surgery and video-assisted thoracic surgery lobectomy: the Italian VATS Group surgical protocol. J Thorac Dis 2018; 10:S564-S570. [PMID: 29629203 DOI: 10.21037/jtd.2018.01.157] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Enhanced recovery after surgery (ERAS®) is a strategy that seeks to reduce patients' perioperative stress response, thereby reducing potential complications, decreasing hospital length of stay and enabling patients to return more quickly to their baseline functional status. The concept was introduced in the late 1990s and was first adopted in patients undergoing open colorectal surgery. Since then, the concept of ERAS has been adopted by multiple surgical specialties. The diffusion of video-assisted thoracic surgery lobectomy (VATS-L) sets also the surgical treatment of lung cancer as a new area for ERAS development. In this paper, we present the Italian VATS Group (www.vatsgroup.org) surgical protocol as part of the ERAS clinical pathway belonging to the VATS-L national database.
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Affiliation(s)
| | | | - Luca Voltolini
- Thoracic Surgery Unit, Careggi University Hospital, Florence, Italy
| | - Alessandro Bertani
- Division of Thoracic Surgery and Lung Transplantation, Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS ISMETT-UPMC, Palermo, Italy
| | - Luca Bertolaccini
- Thoracic Surgery Unit, AUSL Bologna, Maggiore-Bellaria Hospital, Bologna, Italy
| | - Roberto Crisci
- Department of Thoracic Surgery, "G. Mazzini" Hospital, University of L'Aquila-Teramo, L'Aquila, Italy
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33
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Gao S, Zhang Z, Aragón J, Brunelli A, Cassivi S, Chai Y, Chen C, Chen C, Chen G, Chen H, Chen JS, Cooke DT, Downs JB, Falcoz PE, Fang W, Filosso PL, Fu X, Force SD, Garutti MI, Gonzalez-Rivas D, Gossot D, Hansen HJ, He J, He J, Holbek BL, Hu J, Huang Y, Ibrahim M, Imperatori A, Ismail M, Jiang G, Jiang H, Jiang Z, Kim HK, Li D, Li G, Li H, Li Q, Li X, Li Y, Li Z, Lim E, Liu CC, Liu D, Liu L, Liu Y, Lobdell KW, Ma H, Mao W, Mao Y, Mou J, Ng CSH, Novoa NM, Petersen RH, Oizumi H, Papagiannopoulos K, Pompili C, Qiao G, Refai M, Rocco G, Ruffini E, Salati M, Seguin-Givelet A, Sihoe ADL, Tan L, Tan Q, Tong T, Tsakiridis K, Venuta F, Veronesi G, Villamizar N, Wang H, Wang Q, Wang R, Wang S, Wright GM, Xie D, Xue Q, Xue T, Xu L, Xu S, Xu S, Yan T, Yu F, Yu Z, Zhang C, Zhang L, Zhang T, Zhang X, Zhao X, Zhao X, Zhi X, Zhou Q. The Society for Translational Medicine: clinical practice guidelines for the postoperative management of chest tube for patients undergoing lobectomy. J Thorac Dis 2017; 9:3255-3264. [PMID: 29221303 PMCID: PMC5708414 DOI: 10.21037/jtd.2017.08.165] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The Society for Translational Medicine and The Chinese Society for Thoracic and Cardiovascular Surgery conducted a systematic review of the literature in an attempt to improve our understanding in the postoperative management of chest tubes of patients undergoing pulmonary lobectomy. Recommendations were produced and classified based on an internationally accepted GRADE system. The following recommendations were extracted in the present review: (I) chest tubes can be removed safely with daily pleural fluid of up to 450 mL (non-chylous and non-sanguinous), which may reduce chest tube duration and hospital length of stay (2B); (II) in rare instances, e.g., persistent abundant fluid production, the use of PrRP/B <0.5 when evaluating fluid output to determine chest tube removal might be beneficial (2B); (III) it is recommended that one chest tube is adequate following pulmonary lobectomy, except for hemorrhage and space problems (2A); (IV) chest tube clearance by milking and stripping is not recommended after lung resection (2B); (V) chest tube suction is not necessary for patients undergoing lobectomy after first postoperative day (2A); (VI) regulated chest tube suction [-11 (-1.08 kPa) to -20 (1.96 kPa) cmH2O depending upon the type of lobectomy] is not superior to regulated seal [-2 (0.196 kPa) cmH2O] when electronic drainage systems are used after lobectomy by thoracotomy (2B); (VII) chest tube removal recommended at the end of expiration and may be slightly superior to removal at the end of inspiration (2A); (VIII) electronic drainage systems are recommended in the management of chest tube in patients undergoing lobectomy (2B).
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Affiliation(s)
- Shugeng Gao
- Department of Thoracic Surgical Oncology, Cancer Institute & Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College; National Cancer Center, Beijing 100021, China
| | - Zhongheng Zhang
- Department of Emergency Medicine, Sir Run-Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China
| | | | | | | | - Ying Chai
- Department of Thoracic Surgery, Second Affiliated Hospital, Medical College of Zhejiang University, Hangzhou 310009, China
| | - Chang Chen
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Shanghai 200433, China
| | - Chun Chen
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fujian 350001, China
| | - Gang Chen
- Department of Thoracic Surgery, Guangdong General Hospital, Guangzhou 510080, China
| | - Haiquan Chen
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai 200030, China
| | - Jin-Shing Chen
- Department of Anesthesiology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei 10002, Taiwan
| | - David Tom Cooke
- Section of General Thoracic Surgery, University of California, Davis Health System, Sacramento, CA, USA
| | - John B. Downs
- Department of Anesthesiology and Critical Care Medicine, University of Florida, Gainesville, FL, USA
| | | | - Wentao Fang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai 200030, China
| | | | - Xiangning Fu
- Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Seth D. Force
- Cardiothoracic Surgery, Emory University, The Emory Clinic, Atlanta, GA, USA
| | - Martínez I. Garutti
- Department of Anaesthesia and Postoperative Care, Hospital General Universitario Gregorio Marañon, Madrid, Spain
| | | | - Dominique Gossot
- Department of Thoracic Surgery, Institut Mutualiste Montsouris, Paris, France
| | - Henrik Jessen Hansen
- Department of Cardiothoracic Surgery, Rigshospitalet (National University Hospital), Copenhagen, Denmark
| | - Jianxing He
- Department of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510000, China
- Guangzhou Institute of Respiratory Disease & China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, Guangzhou 510000, China
| | - Jie He
- Department of Thoracic Surgical Oncology, Cancer Institute & Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College; National Cancer Center, Beijing 100021, China
| | - Bo Laksáfoss Holbek
- Department of Cardiothoracic Surgery and Section for Surgical Pathophysiology, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Jian Hu
- Department of Thoracic Surgery, First Affiliated Hospital, Medical College of Zhejiang University, Hangzhou 310003, China
| | - Yunchao Huang
- Department of Thoracic Surgery, Yunnan Cancer Hospital, Kunming 650100, China
| | - Mohsen Ibrahim
- Division of Thoracic Surgery, Faculty of Medicine and Psychology, Sant’Andrea Hospital, University of Rome ‘Sapienza’, Rome, Italy
| | - Andrea Imperatori
- Center for Thoracic Surgery, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Mahmoud Ismail
- Charité Kompetenzzentrum für Thoraxchirurgie, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Gening Jiang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Shanghai 200433, China
| | - Hongjing Jiang
- Department of Esophageal Oncology, Tianjin Medical University Cancer Institute and Hospital, Tianjin 300060, China
| | - Zhongmin Jiang
- Department of Thoracic Surgery, Shandong Qianfoshan Hospital, Jinan 250014, China
| | - Hyun Koo Kim
- Department of Thoracic and Cardiovascular Surgery, College of Medicine, Korea University Guro Hospital, Seoul, Korea
| | - Danqing Li
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Beijing 100032, China
| | - Gaofeng Li
- Department of Thoracic Surgery, Yunnan Cancer Hospital, Kunming 650100, China
| | - Hui Li
- Department of Thoracic Surgery, Beijing Chaoyang Hospital, Beijing 100049, China
| | - Qiang Li
- Department of Thoracic Surgery, Sichuan Cancer Hospital and Institute, Chengdu 610041, China
| | - Xiaofei Li
- Department of Thoracic Surgery, Tangdu Hospital Fourth Military Medical University, Xi’an 710038, China
| | - Yin Li
- Henan Cancer Hospital, Zhengzhou 450008, China
| | - Zhijun Li
- Department of Thoracic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China
| | - Eric Lim
- Imperial College and The Academic Division of Thoracic Surgery, Royal Brompton Hospital, Sydney Street, London, UK
| | - Chia-Chuan Liu
- Division of Thoracic Surgery, Department of Surgery, Sun Yat-Sen Cancer Center, Taipei, Taiwan
| | - Deruo Liu
- Department of Thoracic Surgery, China and Japan Friendship Hospital, Beijing 100029, China
| | - Lunxu Liu
- Department of Cardiovascular and Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Yongyi Liu
- Department of Thoracic Surgery, Liaoning Cancer Hospital and Institute, Shengyang 110042, China
| | - Kevin W. Lobdell
- Department of Thoracic and Cardiovascular Surgery, Sanger Heart and Vascular Institute, Carolinas Medical Center, Charlotte, NC, USA
| | - Haitao Ma
- Department of Thoracic Surgery, The First Hospital Affiliated to Soochow University, Suzhou 215000, China
| | - Weimin Mao
- Department of Thoracic Surgery, Zhejiang Cancer Hospital, Hangzhou 310000, China
| | - Yousheng Mao
- Department of Thoracic Surgical Oncology, Cancer Institute & Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College; National Cancer Center, Beijing 100021, China
| | - Juwei Mou
- Department of Thoracic Surgical Oncology, Cancer Institute & Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College; National Cancer Center, Beijing 100021, China
| | - Calvin Sze Hang Ng
- Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, N.T., Hong Kong, China
| | - Nuria M. Novoa
- Thoracic Surgery Service, University Hospital of Salamanca, Paseo de San Vicente 58-182, 37007 Salamanca, Spain
| | - René H. Petersen
- Department of Cardiothoracic Surgery, Rigshospitalet (National University Hospital), Copenhagen, Denmark
| | - Hiroyuki Oizumi
- Second Department of Surgery, Yamagata University Faculty of Medicine, Yamagata, Japan
| | | | - Cecilia Pompili
- Department of Thoracic Surgery, St. James’s University Hospital, Leeds, UK
- Leeds Institute of Cancer and Pathology, Leeds, UK
| | - Guibin Qiao
- Department of Thoracic Surgery, Guangzhou General Hospital of Guangzhou Military Area Command, Guangzhou 510000, China
| | - Majed Refai
- Thoracic Surgery Department, United Hospitals of Ancona, Via San Vincenzo 5/f Polverigi, Ancona, Italy
| | - Gaetano Rocco
- Department of Thoracic Surgery and Oncology, National Cancer Institute, Pascale Foundation, Naples, Italy
| | - Erico Ruffini
- Department of Thoracic Surgery, University of Torino, Torino, Italy
| | - Michele Salati
- Unit of Thoracic Surgery, Ospedali Riuniti Ancona, Ancona, Italy
| | | | - Alan Dart Loon Sihoe
- Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Lijie Tan
- Department of Thoracic Surgery, Shanghai Zhongshan Hospital of Fudan University, Shanghai 200032, China
| | - Qunyou Tan
- Department of Thoracic Surgery, Daping Hospital, Research Institute of Surgery Third Military Medical University, Chongqing 400042, China
| | - Tang Tong
- Department of Thoracic Surgery, Second Affiliated Hospital of Jilin University, Changchun 130041, China
| | - Kosmas Tsakiridis
- Cardiac and Thoracic Department, Private Hospital “St.Lukes”, Thessaloniki, Greece
| | - Federico Venuta
- Department of Surgery “Paride Stefanini” - Thoracic Surgery Unit, Policlinico Umberto I, University of Rome SAPIENZA, Rome, Italy
| | - Giulia Veronesi
- Robotic Surgery, Division of Thoracic Surgery, Humanitas Research Hospital, Via Manzoni 56, Rozzano, Italy
| | | | - Haidong Wang
- Department of Thoracic Surgery, Southwest Hospital, Third Military Medical University, Chongqing 400038, China
| | - Qun Wang
- Department of Thoracic Surgery, Shanghai Zhongshan Hospital of Fudan University, Shanghai 200032, China
| | - Ruwen Wang
- Department of Thoracic Surgery, Daping Hospital, Research Institute of Surgery Third Military Medical University, Chongqing 400042, China
| | - Shumin Wang
- Department of Thoracic Surgery, General Hospital of Shenyang Military Area, Shenyang 110015, China
| | - Gavin M. Wright
- Department of Surgical Oncology, St Vincent’s Hospital, Melbourne, Australia
- Department of Surgery, St Vincent’s Hospital, University of Melbourne, Melbourne, Australia
- Division of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Deyao Xie
- Department of Cardiovascular and Thoracic Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Qi Xue
- Department of Thoracic Surgical Oncology, Cancer Institute & Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College; National Cancer Center, Beijing 100021, China
| | - Tao Xue
- Department of Thoracic Surgery, Zhongda Hospital Affiliated to Southeast University, Nanjing 210009, China
| | - Lin Xu
- Department of Thoracic Surgery, Jiangsu Cancer Hospital, Nanjing 210008, China
| | - Shidong Xu
- Department of Thoracic Surgery, Heilongjiang Cancer Hospital, Harbin 150049, China
| | - Songtao Xu
- Department of Thoracic Surgery, Shanghai Zhongshan Hospital of Fudan University, Shanghai 200032, China
| | - Tiansheng Yan
- Department of Thoracic Surgery, Peking University Third Hospital, Beijing 100083, China
| | - Fenglei Yu
- Department of Cardiovascular Surgery, Second Xiangya Hospital of Central South University, Changsha 410011, China
| | - Zhentao Yu
- Department of Esophageal Oncology, Tianjin Medical University Cancer Institute and Hospital, Tianjin 300060, China
| | - Chunfang Zhang
- Department of Thoracic Surgery, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Lanjun Zhang
- Cancer Center, San Yat-sen University, Guangzhou 510060, China
| | - Tao Zhang
- Department of Thoracic Surgery, The First Affiliated Hospital of Xinjiang Medical Hospital, Urumqi 830011, China
| | - Xun Zhang
- Department of Thoracic Surgery, Tanjin Chest Hospital, Tianjin 300300, China
| | - Xiaojing Zhao
- Department of Thoracic Surgery, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200003, China
| | - Xuewei Zhao
- Department of Thoracic Surgery, Shanghai Changzheng Hospital, Shanghai 200000, China
| | - Xiuyi Zhi
- Department of Thoracic Surgery, Xuanwu Hospital of Capital University of Medical Sciences, Beijing 100053, China
| | - Qinghua Zhou
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
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Mokhles S, Takkenberg JJM, Treasure T. Evidence-Based and Personalized Medicine. It’s [AND] not [OR]. Ann Thorac Surg 2017; 103:351-360. [DOI: 10.1016/j.athoracsur.2016.08.100] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Revised: 08/24/2016] [Accepted: 08/25/2016] [Indexed: 10/20/2022]
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Abstract
Despite several randomized trials and meta-analyses, the dilemma as to whether to apply suction after subtotal pulmonary resection has not been solved. The combination of a poorly understood pathophysiology of the air leak phenomenon and the inadequate quality of the published randomized trials is actually preventing thoracic surgeons from abandoning an empirical management of chest drains. Even digital systems do not seem to have made the difference so far. Based on the evidence of the literature, the authors propose a new air leak predictor score (ALPS) as a contributing step toward appropriateness in using intraoperative sealants, opting for an external suction and managing and chest tubes.
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Abstract
Insertion, management, and withdrawal of chest tubes is part of the routine activity of thoracic surgeons. The selection of the chest tube and the strategy for each of these steps is usually built on knowledge, practice, experience, and judgment. The indication to insert a chest tube into the pleural cavity is the presence of air or fluid within it. Various types and sizes of chest tubes are now commercially available.
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Affiliation(s)
- Federico Venuta
- Department of Thoracic Surgery, Policlinico Umberto I, University of Rome Sapienza, V.le del Policlinico, Rome, Italy.
| | - Daniele Diso
- Department of Thoracic Surgery, Policlinico Umberto I, University of Rome Sapienza, V.le del Policlinico, Rome, Italy
| | - Marco Anile
- Department of Thoracic Surgery, Policlinico Umberto I, University of Rome Sapienza, V.le del Policlinico, Rome, Italy
| | - Erino A Rendina
- Department of Thoracic Surgery, University of Rome Sapienza, Ospedale S.Andrea, Rome, Italy
| | - Ilaria Onorati
- Department of Thoracic Surgery, Policlinico Umberto I, University of Rome Sapienza, V.le del Policlinico, Rome, Italy
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French DG, Dilena M, LaPlante S, Shamji F, Sundaresan S, Villeneuve J, Seely A, Maziak D, Gilbert S. Optimizing postoperative care protocols in thoracic surgery: best evidence and new technology. J Thorac Dis 2016; 8:S3-S11. [PMID: 26941968 DOI: 10.3978/j.issn.2072-1439.2015.10.67] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Postoperative clinical pathways have been shown to improve postoperative care and decrease length of stay in hospital. In thoracic surgery there is a need to develop chest tube management pathways. This paper considers four aspects of chest tube management: (I) appraising the role of chest X-rays in the management of lung resection patients with chest drains; (II) selecting of a fluid output threshold below which chest tubes can be removed safely; (III) deciding whether suction should be applied to chest tubes; (IV) and selecting the safest method for chest tube removal. There is evidence that routine use of chest X-rays does not influence the management of chest tubes. There is a lack of consensus on the highest fluid output threshold below which chest tubes can be safely removed. The optimal use of negative intra-pleural pressure has not yet been established despite multiple randomized controlled trials and meta-analyses. When attempting to improve efficiency in the management of chest tubes, evidence in support of drain removal without a trial of water seal should be considered. Inconsistencies in the interpretation of air leaks and in chest tube management are likely contributors to the conflicting results found in the literature. New digital pleural drainage systems, which provide a more objective air leak assessment and can record air leak trend over time, will likely contribute to the development of new evidence-based guidelines. Technology should be combined with continued efforts to standardize care, create clinical pathways, and analyze their impact on postoperative outcomes.
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Affiliation(s)
- Daniel G French
- Division of Thoracic Surgery, University of Ottawa, The Ottawa Hospital-General Campus, Ottawa, ON, Canada
| | - Michael Dilena
- Division of Thoracic Surgery, University of Ottawa, The Ottawa Hospital-General Campus, Ottawa, ON, Canada
| | - Simon LaPlante
- Division of Thoracic Surgery, University of Ottawa, The Ottawa Hospital-General Campus, Ottawa, ON, Canada
| | - Farid Shamji
- Division of Thoracic Surgery, University of Ottawa, The Ottawa Hospital-General Campus, Ottawa, ON, Canada
| | - Sudhir Sundaresan
- Division of Thoracic Surgery, University of Ottawa, The Ottawa Hospital-General Campus, Ottawa, ON, Canada
| | - James Villeneuve
- Division of Thoracic Surgery, University of Ottawa, The Ottawa Hospital-General Campus, Ottawa, ON, Canada
| | - Andrew Seely
- Division of Thoracic Surgery, University of Ottawa, The Ottawa Hospital-General Campus, Ottawa, ON, Canada
| | - Donna Maziak
- Division of Thoracic Surgery, University of Ottawa, The Ottawa Hospital-General Campus, Ottawa, ON, Canada
| | - Sebastien Gilbert
- Division of Thoracic Surgery, University of Ottawa, The Ottawa Hospital-General Campus, Ottawa, ON, Canada
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