Influence of timing of chest tube removal on early outcome of patients underwent lung resection

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).

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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.

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Early Identification of Patients Who Will Meet 24-Hour Fluid Output Threshold for Chest Tube Removal After Lung Resection

Seminars in Thoracic and Cardiovascular Surgery ◽

10.1053/j.semtcvs.2019.02.023 ◽

2019 ◽

Vol 31 (4) ◽

pp. 861-867 ◽

Cited By ~ 1

Author(s):

Jayson L. Azzi ◽

Bram Gottlieb ◽

Donna E. Maziak ◽

Andrew J.E. Seely ◽

Farid M. Shamji ◽

...

Keyword(s):

Early Identification ◽

Chest Tube ◽

Lung Resection ◽

Tube Removal ◽

Chest Tube Removal

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

The Annals of Thoracic Surgery ◽

10.1016/j.athoracsur.2021.10.024 ◽

2021 ◽

Author(s):

Aaron R. Dezube ◽

Ashley Deeb ◽

Luis E. De Leon ◽

Suden Kucukak ◽

M. Blair Marshall ◽

...

Keyword(s):

Minimally Invasive ◽

Chest Tube ◽

Lung Resection ◽

X Ray ◽

Tube Removal ◽

Chest X Ray ◽

Chest Tube Removal ◽

Routine Chest

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Autologous Blood Pleurodesis: What Is the Optimal Time Interval and Amount of Blood?

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0041-1727129 ◽

2021 ◽

Author(s):

Alessio Campisi ◽

Andrea Dell'Amore ◽

Yonghui Zhang ◽

Zhitao Gu ◽

Angelo Paolo Ciarrocchi ◽

...

Keyword(s):

Chest Tube ◽

Autologous Blood ◽

Optimal Time ◽

Time Interval ◽

Air Leak ◽

Increased Risk ◽

Tube Removal ◽

Blood Patch ◽

Prolonged Air Leak ◽

Chest Tube Removal

Abstract Background Air leak is the most common complication after lung resection and leads to increased length of hospital (LOH) stay or patient discharge with a chest tube. Management by autologous blood patch pleurodesis (ABPP) is controversial because few studies exist, and the technique has yet to be standardized. Methods We retrospectively reviewed patients undergoing ABPP for prolonged air leak (PAL) following lobectomy in three centers, between January 2014 and December 2019. They were divided into two groups: Group A, 120 mL of blood infused; Group B, 60 mL. Propensity score-matched (PSM) analysis was performed, and 23 patients were included in each group. Numbers and success rates of blood patch, time to cessation of air leak, time to chest tube removal, reoperation, LOH, and complications were examined. Univariate and multivariate analysis of variables associated with an increased risk of air leak was performed. Results After the PSM, 120 mL of blood is statistically significant in reducing the number of days before chest tube removal after ABPP (2.78 vs. 4.35), LOH after ABPP (3.78 vs. 10.00), and LOH (8.78 vs. 15.17). Complications (0 vs. 4) and hours until air leak cessation (6.83 vs. 3.91, range 1–13) after ABPP were also statistically different (p < 0.05). Air leaks that persisted for up to 13 hours required another ABPP. No patient had re-operation or long-term complications related to pleurodesis. Conclusion In our experience, 120 mL is the optimal amount of blood and the procedure can be repeated every 24 hours with the chest tube clamped.

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“Chest Tube” Removal after Liver Transgression

Journal of Vascular and Interventional Radiology ◽

10.1016/j.jvir.2011.10.010 ◽

2012 ◽

Vol 23 (2) ◽

pp. 275 ◽

Cited By ~ 6

Author(s):

Chris Hegarty ◽

Jan F. Gerstenmaier ◽

David Brophy

Keyword(s):

Chest Tube ◽

Tube Removal ◽

Chest Tube Removal

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The use of cold therapy, music therapy and lidocaine spray for reducing pain and anxiety following chest tube removal

Complementary Therapies in Clinical Practice ◽

10.1016/j.ctcp.2018.12.001 ◽

2019 ◽

Vol 34 ◽

pp. 179-184 ◽

Cited By ~ 3

Author(s):

Yeşim Yaman Aktaş ◽

Neziha Karabulut

Keyword(s):

Music Therapy ◽

Chest Tube ◽

Cold Therapy ◽

Tube Removal ◽

Chest Tube Removal ◽

Lidocaine Spray

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Technique for chest tube removal

ASVIDE ◽

10.21037/asvide.2017.226 ◽

2017 ◽

Vol 4 ◽

pp. 226-226

Author(s):

Kyung Soo Kim

Keyword(s):

Chest Tube ◽

Tube Removal ◽

Chest Tube Removal

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Chest tube removal after cardiac surgery

Critical Care Nurse ◽

10.4037/ccn1997.17.1.34 ◽

1997 ◽

Vol 17 (1) ◽

pp. 34-38 ◽

Cited By ~ 6

Author(s):

SC Thomson ◽

S Wells ◽

M Maxwell

Keyword(s):

Cardiac Surgery ◽

Quality Of Care ◽

Length Of Stay ◽

Chest Tube ◽

Chest Tubes ◽

Tube Removal ◽

Chest Tube Removal

Prompt remove of chest tubes by RNs has allowed earlier and more aggressive ambulation of our patients and, along with other interventions, has decreased length of stay by 1.5 days while improving quality of care. Proper education, both didactic and clinical, is the key component in preparing RNs to safely and effectively perform this procedure.

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Safety of early discharge with a chest tube after pulmonary segmentectomy

European Journal of Cardio-Thoracic Surgery ◽

10.1093/ejcts/ezaa097 ◽

2020 ◽

Vol 58 (3) ◽

pp. 613-618

Author(s):

Feichao Bao ◽

Natasha Toleska Dimitrovska ◽

Shoujun Hu ◽

Xiao Chu ◽

Wentao Li

Keyword(s):

Chest Tube ◽

Enhanced Recovery ◽

Enhanced Recovery After Surgery ◽

Early Discharge ◽

Air Leak ◽

Tube Removal ◽

Prolonged Air Leak ◽

Life Threatening ◽

Chest Tube Removal ◽

Hospital Days

Abstract OBJECTIVES Early removal of chest tube is an important step in enhanced recovery after surgery protocols. However, after pulmonary resection with a wide dissection plane, such as pulmonary segmentectomy, prolonged air leak, a large volume of pleural drainage and the risk of developing empyema in patients can delay chest tube removal and result in a low rate of completion of the enhanced recovery after surgery protocol. In this study, we aimed to assess the safety of discharging patients with a chest tube after pulmonary segmentectomy. METHODS We retrospectively reviewed a single surgeon’s experience of pulmonary segmentectomy from May 2019 to September 2019. Patients who fulfilled the criteria for discharging with a chest tube were discharged and provided written instructions. They returned for chest tube removal after satisfactory resolution of air leak or fluid drainage. RESULTS In total, 126 patients underwent pulmonary segmentectomy. Ninety-five (75%) patients were discharged with a chest tube postoperatively. The mean time to chest tube removal after discharge was 5.6 (range 2–32) days, potentially saving 532 inpatient hospital days. Overall, 90 (95%) patients experienced uneventful and successful outpatient chest tube management. No life-threatening complications were observed. No patient experienced complications resulting from chest tube malfunction. Five (5%) patients experienced minor complications. Overall, all patients reported good-to-excellent mobility with a chest tube. CONCLUSIONS Successful postoperative outpatient chest tube management after pulmonary segmentectomy can be accomplished in selected patients without a major increase in morbidity or mortality.

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