scholarly journals Multicenter randomized study on the comparison between electronic and traditional chest drainage systems

Trials ◽  
2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Giuseppe Marulli ◽  
Giovanni M. Comacchio ◽  
Mario Nosotti ◽  
Lorenzo Rosso ◽  
Paolo Mendogni ◽  
...  
Keyword(s):  
Interobserver Variability ◽  
Chest Drain ◽  
Chest Drainage ◽  
Drainage Systems ◽  
Traditional System ◽  
Air Leaks ◽  
Tube Removal ◽  
Space Effect ◽  
Digital Chest ◽  
Chest Tube Removal

Abstract Background In patients submitted to major pulmonary resection, the postoperative length of stay is mainly influenced by the duration of air leaks and chest tube removal. The measurement of air leaks largely relies on traditional chest drainage systems which are prone to subjective interpretation. Difficulty in differentiating between active air leaks and bubbles due to a pleural space effect may also lead to tentative drain clamping and prolonged time for chest drain removal. New digital systems allow continuous monitoring of air leaks, identifying subtle leakage that may be not visible during daily patient evaluation. Moreover, an objective assessment of air leaks may lead to a reduced interobserver variability and to an optimized timing for chest tube removal. Methods This study is a prospective randomized, interventional, multicenter trial designed to compare an electronic chest drainage system (Drentech™ Palm Evo) with a traditional system (Drentech™ Compact) in a cohort of patients undergoing pulmonary lobectomy through a standard three-port video-assisted thoracic surgery approach for both benign and malignant disease. The study will enroll 382 patients in three Italian centers. The duration of chest drainage and the length of hospital stay will be evaluated in the two groups. Moreover, the study will evaluate whether the use of a digital chest system compared with a traditional system reduces the interobserver variability. Finally, it will evaluate whether the digital drain system may help in distinguishing an active air leak from a pleural space effect, by the digital assessment of intrapleural differential pressure, and in identifying potential predictors of prolonged air leaks. Discussion To date, few studies have been performed to evaluate the clinical impact of digital drainage systems. The proposed prospective randomized trial will provide new knowledge to this research area by investigating and comparing the difference between digital and traditional chest drain systems. In particular, the objectives of this project are to evaluate the feasibility and usefulness of digital chest drainages and to provide new tools to identify patients at higher risk of developing prolonged air leaks. Trial registration ClinicalTrials.gov, NCT03536130. Retrospectively registered on 24 May 2018.

scholarly journals Multicenter randomized study on comparison between electronic and traditional chest drainage systems

2019 ◽  
Author(s):  
Giuseppe Marulli ◽  
Giovanni Maria Comacchio ◽  
Mario Nosotti ◽  
Lorenzo Rosso ◽  
Paolo Mendogni ◽  
...  
Keyword(s):  
Interobserver Variability ◽  
Chest Drain ◽  
Chest Drainage ◽  
Drainage Systems ◽  
Traditional System ◽  
Air Leaks ◽  
Tube Removal ◽  
Space Effect ◽  
Digital Chest ◽  
Chest Tube Removal

Abstract Background In patients submitted to major pulmonary resection, post-operative length of stay is mainly influenced by duration of air leaks and chest tube removal. The measurement of air leaks largely relies on traditional chest drainage systems which are prone to subjective interpretation. Difficulty to differentiate between active air leaks and bubbles due to a pleural space effect may also lead to tentative drain clamping and prolonged time for chest drain removal. New digital systems allow continuous monitoring of air leaks, identifying subtle leakage that may be not visible during daily patient evaluation. Moreover, an objective assessment of air leaks may lead to a reduced interobserver variability and to an optimized timing of chest tube removal. Methods This study is a prospective randomized, interventional, multicenter trial designed to compare the electronic chest drainage system (Drentech™ Palm Evo) with the traditional system (Drentech™ Compact) in a cohort of patients undergoing pulmonary lobectomy through a standard 3-ports VATS approach for benign or malignant disease. It will enroll 382 patients in 3 Italian centers. Duration of chest drainage and length of hospital stay will be evaluated in the two groups. Moreover, it will be evaluated if the use of a digital chest system compared with a traditional system reduces the interobserver variability. Finally, it will be evaluated the possible advantages of the digital drain system to distinguish an active air leak from a pleural space effect, by the evaluation of intrapleural differential pressure, and to identify potential predictors of prolonged air leaks. Discussion To date few studies have been performed to evaluate clinical impact of digital drainage systems. The proposed prospective randomized trial will provide new knowledge to this research area by investigating and comparing the difference between digital and traditional chest drain systems. In particular, the objectives of this project are to evaluate the feasibility and usefulness of utilizing the digital chest drain and to provide new tools to identify patients at higher risk of developing prolonged air leaks. Trial registration number NCT03536130, Registered 24 May 2018 - Retrospectively registered, https://clinicaltrials.gov/ct2/results?cond=&term=NCT03536130&cntry=&state=&city=&dist=

scholarly journals Multicenter randomized study on comparison between electronic and traditional chest drainage systems

2019 ◽  
Author(s):  
Giuseppe Marulli ◽  
Giovanni Maria Comacchio ◽  
Mario Nosotti ◽  
Lorenzo Rosso ◽  
Paolo Mendogni ◽  
...  
Keyword(s):  
Chest Tube ◽  
Pleural Space ◽  
Chest Drain ◽  
Chest Drainage ◽  
Drainage Systems ◽  
Air Leaks ◽  
Tube Removal ◽  
Space Effect ◽  
Digital Chest ◽  
Chest Tube Removal

Abstract Background: In patients submitted to major pulmonary resection, post-operative length of stay is mainly influenced by duration of air leaks and chest tube removal. The measurement of air leaks largely relies on traditional chest drainage systems which are prone to subjective interpretation. Difficulty in differentiating between active air leaks and bubbles due to a pleural space effect may also lead to tentative drain clamping and prolonged time for chest drain removal. New digital systems allow continuous monitoring of air leaks, identifying subtle leakage that may be not visible during daily patient evaluation. Moreover, an objective assessment of air leaks may lead to a reduced interobserver variability and to an optimized timing of chest tube removal. Methods: This study is a prospective randomized, interventional, multicenter trial designed to compare the electronic chest drainage system (Drentech™ Palm Evo) with the traditional one (Drentech™ Compact) in a cohort of patients undergoing pulmonary lobectomy through a standard 3-ports VATS approach both for benign or malignant disease. It will enroll 382 patients in 3 Italian centers. Duration of chest drainage and length of hospital stay will be evaluated in the two groups. Moreover, it will be evaluated if the use of a digital chest system compared with a traditional system reduces theinterobserver variability. Finally, it will be evaluated if the digital drain system may help in distinguishing an active air leak from a pleural space effect, by the digital assessment of intrapleural differential pressure, and in identifying potential predictors of prolonged air leaks. Discussion : To date, few studies have been performed to evaluate clinical impact of digital drainage systems. The proposed prospective randomized trial will provide new knowledge to this research area by investigating and comparing the difference between digital and traditional chest drain systems. In particular, the objectives of this project are to evaluate the feasibility and usefulness of digital chest drainages and to provide new tools to identify patients at higher risk of developing prolonged air leaks.

scholarly journals Complications after Chest Tube Removal and Reinterventions in Patients with Digital Drainage Systems

2019 ◽  
Vol 8 (12) ◽  
pp. 2092
Author(s):  
Yi-Ying Lee ◽  
Po-Kuei Hsu ◽  
Chien-Sheng Huang ◽  
Yu-Chung Wu ◽  
Han-Shui Hsu
Keyword(s):  
Predictive Factors ◽  
Lung Resection ◽  
Drainage System ◽  
Drainage Tube ◽  
Air Leak ◽  
Chest Drainage ◽  
Drainage Systems ◽  
Air Leaks ◽  
Thoracic Drainage ◽  
Tube Removal

Introduction: Digital thoracic drainage systems are a new technology in minimally invasive thoracic surgery. However, the criteria for chest tube removal in digital thoracic drainage systems have never been evaluated. We aim to investigate the incidence and predictive factors of complications and reinterventions after drainage tube removal in patients with a digital drainage system. Method: Patients who received lung resection surgery and had their chest drainage tubes connected with a digital drainage system were retrospectively reviewed. Results: A total of 497 patients were monitored with digital drainage systems after lung resection surgery. A total of 175 (35.2%) patients had air leak-related complications after drainage tube removals, whereas 25 patients (5.0%) required reintervention. We identified that chest drainage duration of five days was an optimal cut-off value in predicting air leak-related complications and reinterventions. In multiple logistic regression analysis, previous chest surgery history; small size (16 Fr.) drainage tubes; the presence of initial air leaks, defined as air leaks recorded by the digital drainage system immediately after operation; and duration of chest drainage ≥5 days were independent factors of air leak-related complications, whereas the presence of initial air leaks and duration of chest drainage ≥5 days were independent predictive factors of reintervention after drainage tube removal. Conclusion: Air leak-related complications and reinterventions after drainage tube removals happened in 35.2% and 5.0% of patients with digital thoracic drainage systems. The management of chest drainage tubes in patients with predictive factors, i.e., the presence of initial air leaks and duration of chest drainage of more than five days, should be treated with caution.

scholarly journals Intrabronchial Valve Treatment for Prolonged Air Leak: Can We Justify the Cost?

2016 ◽  
Vol 2016 ◽  
pp. 1-6 ◽  
Author(s):  
Eitan Podgaetz ◽  
Felix Zamora ◽  
Heidi Gibson ◽  
Rafael S. Andrade ◽  
Eric Hall ◽  
...  
Keyword(s):  
Individual Patient Data ◽  
Cost Effective ◽  
Air Leak ◽  
Levels Of Care ◽  
Air Leaks ◽  
Limited Experience ◽  
Tube Removal ◽  
Prolonged Air Leak ◽  
Chest Tube Removal ◽  
The Cost

Background.Prolonged air leak is defined as an ongoing air leak for more than 5 days. Intrabronchial valve (IBV) treatment is approved for the treatment of air leaks.Objective.To analyze our experience with IBV and valuate its cost-effectiveness.Methods.Retrospective analysis of IBV from June 2013 to October 2014. We analyzed direct costs based on hospital and operating room charges. We used average costs in US dollars for the analysis not individual patient data.Results.We treated 13 patients (9 M/4 F), median age of 60 years (38 to 90). Median time from diagnosis to IBV placement was 9.8 days, time from IBV placement to chest tube removal was 3 days, and time from IBV placement to hospital discharge was 4 days. Average room and board costs were $14,605 including all levels of care. IBV cost is $2750 per valve. The average number of valves used was 4. Total cost of procedure, valves, and hospital stay until discharge was $13,900.Conclusion.In our limited experience, the use of IBV to treat prolonged air leaks is safe and appears cost-effective. In pure financial terms, the cost seems justified for any air leak predicted to last greater than 8 days.

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

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).

scholarly journals Postoperative Air Leaks With Prompt Improvement of Low Suction on Digital Drainage Devices: a Retrospective Study

2020 ◽  
Author(s):  
Suguru Mitsui ◽  
Shunsuke Tauchi ◽  
Takahiro Uchida ◽  
Hisashi Ohnishi ◽  
Toshio Shimokawa ◽  
...  
Keyword(s):  
Chest Tube ◽  
Pulmonary Resection ◽  
Maximum Amount ◽  
Fluid Volume ◽  
Suction Pressure ◽  
Air Leak ◽  
Air Leaks ◽  
Tube Removal ◽  
Chest Tube Removal ◽  
Pressure Suction

Abstract Purpose: The aim was to investigate the most effective suction pressure for preventing or promptly improving postoperative air leaks.Methods: We retrospectively analyzed the postoperative data of 242 patients who were monitored with a digital drainage system after pulmonary resection between December 2017 and June 2020. We divided the patients into 3 of group by suction pressure, A (Low-pressure suction group: -5 cm H₂O), B (Intermediate-pressure group: -10 cm H₂O), C (High-pressure suction group: -20 cm H₂O). Duration of air leaks, duration of chest tube replacement, the amount of postoperative air leak, fluid volume drained before chest tube removal, and the maximum amount of air leaks during drainage were evaluated.Results: A total 217 patients were included. In the order of A, B, and C groups, duration of air leaks gradually decreased and significant trend was observed (p=0.019). Duration of chest tube replacement did not significantly differ among the three groups (p=0.126). The amount of postoperative air leak just after surgery did not significantly differ among the three groups (p=0.175), however, the amount of postoperative day 1 air leak gradually decreased with statistical significance in order of A, B, and C groups (p=0.033). The maximum amount of air leaks during drainage gradually decreased in order of A, B and C groups (p=0.036). Fluid volume drained before chest tube removal did not significantly differ among the three groups (p=0.986).Conclusion: Low-pressure suction after pulmonary resection would be useful for preventing or promptly improving postoperative air leaks.

Digital and Smart Chest Drainage Systems to Monitor Air Leaks: The Birth of a New Era?

2010 ◽  
Vol 20 (3) ◽  
pp. 413-420 ◽  
Author(s):  
Robert J. Cerfolio ◽  
Gonzalo Varela ◽  
Alessandro Brunelli
Keyword(s):  
Chest Drainage ◽  
Drainage Systems ◽  
New Era ◽  
Air Leaks

Effect of lidocaine cream analgesia for chest drain tube removal after video-assisted thoracoscopic surgery for lung cancer: a randomized clinical trial

2019 ◽  
Vol 45 (1) ◽  
pp. 16-21
Author(s):  
Shin-nosuke Watanabe ◽  
Kazuhiro Imai ◽  
Tetsu Kimura ◽  
Yoshitaro Saito ◽  
Shinogu Takashima ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Clinical Trial ◽  
Chest Tube ◽  
Thoracoscopic Surgery ◽  
Chest Drain ◽  
Drain Removal ◽  
Tube Removal ◽  
Vas Scores ◽  
Chest Tube Removal ◽  
Video Assisted Thoracoscopic Surgery

Background and objectivesPain management makes an important contribution to good respiratory care and early recovery after thoracic surgery. Although the development of video-assisted thoracoscopic surgery (VATS) has led to improved patient outcomes, chest tube removal could be distressful experience for many patients. The aim of this trial was to test whether the addition of lidocaine cream would have a significant impact on the pain treatment during chest tube removal from patients who had undergone VATS for lung cancer.MethodsThis clinical trial was a double-blind randomized study. Forty patients with histologically confirmed lung cancer amenable to lobectomy/segmentectomy were enrolled. All patients had standard perioperative care. Patients were randomly assigned to receive either epidural anesthesia plus placebo cream (placebo, Group P) or epidural anesthesia plus 7% lidocaine cream cutaneously around the chest tube insertion site and on the skin over the tube’s course 20 min (Group L) before chest drain removal.ResultsVisual analog scale (VAS) scores were higher in Group P (median 5, IQR, 3.25-8) than in Group L (median 2, IQR, 1-3). Pain intensities measured using a PainVision system were also higher in Group P (median 296.7, IQR, 216.9–563.5) than Group L (median 41.2, IQR, 11.8–97.0). VAS scores and the pain intensity associated with chest drain removal were significantly lower in Group L than Group P (p=0.0002 vs p<0.0001).ConclusionAnalgesia using lidocaine cream is a very simple way to reduce the pain of chest tube removal after VATS.Trial registration numberUMIN000013824.

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