Routine Chest X-ray After Chest Tube Removal Is Not Indicated for Minimally Invasive Lung Resection

e20059 Background: The predicted post-operative forced expiratory volume after 1 second (FEV1) and the diffusing capacity of the lung for carbon monoxide (DLCO) are predictors of postoperative complications and survival. Despite the benefits of minimally invasive surgery in patients with marginal lung function current practice guidelines advocates non-surgical approach for treatment from evidence derived from patients undergoing thoracotomy. It is necessary to define what should be minimum acceptable lung function for resection in the era of minimally invasive surgery. Methods: Single institution retrospective study of 61 patients with pre-operative predicted FEV1 and DLCO < 60% that underwent lung resection for pulmonary lung nodules suspected to be malignant between January 2017 to June 2018. Patient demographic and clinical data were collected and the 30-day or in-hospital morbidity and mortality were assessed. Results: 28 (46%) patients with pre-operative predicted FEV1 < 60% and 33 (54%) with DLCO < 60% were reviewed. 10 patients had both FEV1 and DLCO < 60%. There were 12 patients (28% in FEV1, 12% in DLCO group) who had < 40% of pre-operative predicted values. 15 (65%) of FEV1 group and 15 (45%) of DLCO group had anatomic lung resections with either a lobectomy or a segmentectomy. 24 (39%) of cases were done robotically and the remaining with VATS. 80% of patients had cancer in their final pathology. Patients were 68± 7 years old, 34 (56%) were male. Significant baseline clinical findings include high incidence of smoking (82% in FEV1, 97% in DLCO group), HTN (71% in FEV1, 81% in DLCO group), COPD (61% in FEV1, 48% in DLCO group), CAD (25% in FEV1, 30% in DLCO group), and a total of 2 patients suffered previous CVD. Most common complications included persistent air leak > 5 days (21% in FEV1 and DLCO group) and arrhythmia (14% in FEV1, 15% in DLCO group). Of those with an air leak, 50% in the FEV1 group and 29% in the DLCO group had predicted values < 40%. Three patients developed pneumothorax post chest tube removal necessitating chest tube replacement, all of whom had predicted values < 40%. One patient developed acute DVT and PE and another patient required mechanical ventilation for > 48 hours. There were no 30-day mortalities. Conclusions: Lung resection using minimally invasive technique had low rates of 30-day morbidity in patients with reduced pulmonary function. Majority of complications observed were minor. Minimally invasive lung resection is possible and may be extended to selected patients with pre-operative predicted DLCO or FEV1 < 40% suspected of malignancy.

Download Full-text

Is routine chest radiograph necessary after chest tube removal?

Journal of Pediatric Surgery ◽

10.1016/j.jpedsurg.2014.01.004 ◽

2014 ◽

Vol 49 (10) ◽

pp. 1493-1495 ◽

Cited By ~ 6

Author(s):

Janine P. Cunningham ◽

E. Marty Knott ◽

Alessandra C. Gasior ◽

David Juang ◽

Charles L. Snyder ◽

...

Keyword(s):

Chest Radiograph ◽

Chest Tube ◽

Tube Removal ◽

Chest Tube Removal ◽

Routine Chest

Download Full-text

Are routine chest X-rays following chest tube removal necessary in asymptomatic pediatric patients?

Pediatric Surgery International ◽

10.1007/s00383-020-04809-7 ◽

2021 ◽

Author(s):

Lauren M. Kanamori ◽

Yigit Guner ◽

David Gibbs ◽

John Schomberg

Keyword(s):

Chest Tube ◽

Pediatric Patients ◽

X Rays ◽

Tube Removal ◽

Chest Tube Removal ◽

Routine Chest

Download Full-text

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

Journal of Cardiothoracic Surgery ◽

10.1186/s13019-021-01485-z ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Suguru Mitsui ◽

Shunsuke Tauchi ◽

Takahiro Uchida ◽

Hisashi Ohnishi ◽

Toshio Shimokawa ◽

...

Keyword(s):

Chest Tube ◽

Pulmonary Resection ◽

Lung Resection ◽

Low Pressure ◽

Volume Of Fluid ◽

Suction Pressure ◽

Air Leaks ◽

Tube Removal ◽

Chest Tube Removal ◽

Pressure Suction

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

Download Full-text

Early postoperative day 0 chest tube removal using a digital drainage device protocol after thoracoscopic major pulmonary resection

Interactive CardioVascular and Thoracic Surgery ◽

10.1093/icvts/ivaa170 ◽

2020 ◽

Vol 31 (5) ◽

pp. 657-663

Author(s):

Karel Pfeuty ◽

Bernard Lenot

Keyword(s):

Chest Tube ◽

Pulmonary Resection ◽

Enhanced Recovery ◽

Enhanced Recovery After Surgery ◽

Lung Resection ◽

Postoperative Recovery ◽

Cardiopulmonary Complication ◽

Drainage Device ◽

Tube Removal ◽

Chest Tube Removal

Abstract OBJECTIVES The aim of this study was to assess the safety of early chest tube removal on postoperative day 0 (POD 0) on the basis of a digital drainage device protocol in patients undergoing thoracoscopic major lung resection and its contribution as a component of an enhanced recovery after surgery programme. METHODS One hundred consecutive patients who underwent thoracoscopic lobectomy or segmentectomy were submitted to the following criteria for chest tube removal: Air flow ≤20 ml/min for at least 4 h without fluid threshold, except if haemorrhagic or chylous. Two groups were defined according to chest tube removal on POD 0 (G0) or POD ≥1 (G1). Primary outcome was pleural complication and secondary outcomes were cardiopulmonary complication, length of drainage, length of stay (LOS), compliance with opioid-free analgesic protocol and readmission. The follow-up was 90 days from discharge. RESULTS The chest tube was removed on POD 0 in 45% of patients (G0). None of them required tube reinsertion for pneumothorax and 1 patient was readmitted for a delayed pleural effusion. Among the 55% remaining patients (G1), the median length of drainage was 2 days, including 3 prolonged air leaks (>5 days). G0 and G1 were not different in terms of cardiopulmonary complication and readmission (6.6% vs 9% and 4.4% vs 7.2%, respectively). The median LOS was 1 day in G0 and 2 days in G1. The compliance with opioid-free analgesic protocol was significantly higher (75% vs 45%, P = 0.004) in G0 compared to G1. CONCLUSIONS Early POD 0 chest tube removal after thoracoscopic major pulmonary resection is safe in selected patients on the basis of a digital drainage device protocol. Also, it may contribute, by reducing early postoperative pain, to enhance postoperative recovery as part of an advanced enhanced recovery after surgery programme.

Download Full-text

Routine Chest X-ray After Chest Tube Removal Is Not Indicated for Minimally Invasive Lung Resection

Omission of routine chest x-ray after chest tube removal is safe in selected trauma patients

Efficacy of Routine Chest X-ray after Chest Tube Removal in Patients Undergoing Cardiac Surgeries

The use of routine chest x-ray films after chest tube removal in postoperative cardiac patients

Is Routine Chest X-Ray Necessary Before Chest Tube Removal?

Comparison of Chest X-ray and Clinical Findings in Trauma Patients after Chest Tube Removal

When is a patient high risk for resection? A changing paradigm with minimally invasive lung surgery.

Is routine chest radiograph necessary after chest tube removal?

Are routine chest X-rays following chest tube removal necessary in asymptomatic pediatric patients?

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

Early postoperative day 0 chest tube removal using a digital drainage device protocol after thoracoscopic major pulmonary resection

Export Citation Format