Ambulant treatment with a digital chest tube for prolonged air leak is safe and effective

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.

Download Full-text

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.

Download Full-text

Autologous fibrin sealant reduces the incidence of prolonged air leak and duration of chest tube drainage after lung volume reduction surgery: A prospective randomized blinded study

Journal of Thoracic and Cardiovascular Surgery ◽

10.1016/j.jtcvs.2008.02.079 ◽

2008 ◽

Vol 136 (4) ◽

pp. 843-849 ◽

Cited By ~ 33

Author(s):

C. Moser ◽

I. Opitz ◽

W. Zhai ◽

V. Rousson ◽

E.W. Russi ◽

...

Keyword(s):

Lung Volume ◽

Chest Tube ◽

Fibrin Sealant ◽

Chest Tube Drainage ◽

Lung Volume Reduction Surgery ◽

Air Leak ◽

Lung Volume Reduction ◽

Tube Drainage ◽

Prolonged Air Leak ◽

Blinded Study

Download Full-text

To determine whether the powered endopath stapler device reduces the incidence of prolonged air leak and duration of chest tube drainage after lung volume reduction surgery

http://isrctn.com/ ◽

10.1186/isrctn13216935 ◽

2014 ◽

Author(s):

Katarzyna Furrer

Keyword(s):

Lung Volume ◽

Chest Tube ◽

Volume Reduction ◽

Chest Tube Drainage ◽

Lung Volume Reduction Surgery ◽

Air Leak ◽

Lung Volume Reduction ◽

Tube Drainage ◽

Prolonged Air Leak ◽

Stapler Device

Download Full-text

Digital Devices Improve Chest Tube Management: Results from a Prospective Randomized Trial

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0037-1607443 ◽

2017 ◽

Vol 66 (07) ◽

pp. 595-602 ◽

Cited By ~ 2

Author(s):

Filippo Lococo ◽

Dania Nachira ◽

Leonardo Ciavarella ◽

Maria Congedo ◽

Venanzio Porziella ◽

...

Keyword(s):

Randomized Trial ◽

Roc Curve ◽

Chest Tube ◽

Prospective Randomized Trial ◽

Chest Drain ◽

Air Leak ◽

Digital Devices ◽

Prolonged Air Leak ◽

Group D ◽

Persistent Air Leak

Background Digital devices could help clinical practice measuring the air leak, but their role is still debated. Aim of this study is to test advantages using these devices. Methods From June 2012 to May 2015, we enrolled 95 patients undergoing lobectomy or wedge resection in a prospective randomized trial. Patients were divided into two groups: group D (digital, 50 patients) evaluated with digital device and group E (empirical, 45 patients) evaluated with water seal. Logistic regression analysis and receiver operating characteristic (ROC) curve analysis were used to select and assess predictors of persistent air leak. In group D, chest drain was removed if the air leak was absent or < 0.5 L/h for 12 consecutive hours and in group E if clinical signs of air leak were absent. Results Mean hospitalization and mean chest tube stay was 6.0 ± 3.3 and 4.4 ± 3.2 days, respectively, prolonged air leak occurred in nine (8%). Hospitalization was 5.8 ± 2.5 versus 6.2 ± 4.2 days (p = 0.5), while mean chest tube stay was 4.1 ± 2.0 versus 4.6 ± 3.5 days (p = 0.4) in group D and group E, respectively. Clamping test was needed in one patient in group D and in seven in group E (p = 0.019). At multivariate analysis, heart disease (p < 0.0001), lobectomy (p < 0.0001), fused fissure (p < 0.0001), and air leakage in first postoperative (p.o.) day were predictors of persistent air leak (AUC on the ROC curve of 69.7%, sensibility: 77.8%). In group D, an air leak value > 0.2 L/h with spikes over 0.5 L/h in third p.o. was predictive of persistent air leak, with chest tube duration of 7.73 ± 5.20 versus 4.32 ± 1.33 days (AUC: 83%, sensitivity: 80%, p < 0.0001). Conclusion In our experience, digital devices reduced observer variability and mistakes in chest tube management, thus identifying patients at risk for prolonged air leak.

Download Full-text

Multicenter randomized controlled trial comparing digital and traditional chest drain in a VATS pulmonary lobectomy cohort: interim analysis

Journal of Cardiothoracic Surgery ◽

10.1186/s13019-021-01567-y ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Paolo Mendogni ◽

Davide Tosi ◽

Giuseppe Marulli ◽

Giovanni Maria Comacchio ◽

Sara Pieropan ◽

...

Keyword(s):

Hospital Stay ◽

Chest Tube ◽

Interim Analysis ◽

Controlled Trial ◽

Trial Registration ◽

Chest Drain ◽

Air Leak ◽

Traditional System ◽

Multicenter Randomized Controlled Trial ◽

Prolonged Air Leak

Abstract Background The usefulness of digital chest drain is still debated. We are carrying out a study to determine if the use of a digital system compared with a traditional system reduces the duration of chest drainage. To evaluate safety, benefit, or futility of this trial we planned the current interim analysis. Methods An interim analysis on preliminary data from ongoing investigator-initiated, multicenter, interventional, prospective randomized trial. Original protocol number: (NCT03536130). The interim main endpoint was overall complications; secondary endpoints were the concordance between the two primary endpoints of the RCT (chest tube duration and length of hospital stay). We planned the interim analysis when half of the patients have been randomised and completed the study. Data were described using mean and standard deviation or absolute frequencies and percentage. T-test for unpaired samples, Chi-square test, Poisson regression and absolute standardized mean difference (ASMD) were used. P-value < 0.05 was considered significant. Results From April 2017 to November 2018, out of 317 patients enrolled by 3 centers, 231 fulfilled inclusion criteria and were randomized. Twenty-two of them dropped out after randomization. Finally, 209 patients were analyzed: among them 94 used the digital device and 115 the traditional one. The overall postoperative complications were 35 (16.8%) including prolonged air leak (1.9%). Mean chest tube duration was 3.6 days (SD = 1.8), with no differences between two groups (p = 0.203). The overall difference between hospital stay and chest tube duration was 1.4 days (SD = 1.4). Air leak at first postoperative day detected by digital and traditional devices predicted increasing in tube duration of 1.6 day (CI 95% 0.8–2.5, p < 0.001) and 2.0 days (CI 95% 1.0–3.1, p < 0.001), respectively. Conclusions This interim analysis supported the authors’ will to continue with the enrollment and to analyze data once the estimated sample size will be reached. Trial registration Trial registration number NCT03536130, Registered 24 May 2018 - Retrospectively registered.

Download Full-text

Multicenter randomized controlled trial comparing digital and traditional chest drain in a VATS pulmonary lobectomy cohort: interim analysis

10.21203/rs.3.rs-20620/v1 ◽

2020 ◽

Author(s):

Paolo Mendogni ◽

Davide Tosi ◽

Giuseppe Marulli ◽

Giovanni Maria Comacchio ◽

Sara Pieropan ◽

...

Keyword(s):

Hospital Stay ◽

Chest Tube ◽

Interim Analysis ◽

Controlled Trial ◽

P Value ◽

Chest Drain ◽

Air Leak ◽

Traditional System ◽

Multicenter Randomized Controlled Trial ◽

Prolonged Air Leak

Abstract Background The usefulness of digital chest drain is still discussed. We are carrying out a study to determine if the use of a digital system compared with a traditional system reduces the duration of chest drainage. To evaluate safety, benefit, or futility of this trial we planned the current interim analysis. Methods An interim analysis on preliminary data from ongoing investigator-initiated, multicenter, interventional, prospective randomized trial. Original protocol number: (NCT03536130). The interim main endpoint was overall complications; secondary endpoints were the concordance between the two primary endpoints of the RCT (chest tube duration and length of hospital stay). We planned the interim analysis when half of the patients have been randomised and completed the study. Data were described using mean and standard deviation or absolute frequencies and percentage. T-test for unpaired samples, Chi-square test, Poisson regression and absolute standardized mean difference (ASMD) were used. P-value <0.05 was considered significant. Results From April 2017 to November 2018, out of 317 patients were enrolled by 3 centers, 231 fulfilled inclusion criteria and were randomized. Twenty-two of them dropped out after randomization. Finally, 209 patients were analyzed: among them 94 used the digital device and 115 the traditional one. The overall postoperative complications were 35 (16.8%) including prolonged air leak (1.9%). Mean chest tube duration was 3.6 days (SD=1.8), with no differences between two groups (p=0.203). The overall difference between hospital stay and chest tube duration was 1.4 days (SD=1.4). Air leak at first postoperative day detected by digital and traditional devices predicted increasing in tube duration of 1.6 day (CI 95% 0.8-2.5, p<0.001) and 2.0 days (CI 95% 1.0-3.1, p<0.001), respectively. Conclusions This interim analysis supported the authors’ will to continue with the enrollment and to analyze data once the estimated sample size will be reached.

Download Full-text

Multicenter Randomized Controlled Trial Comparing Digital and Traditional Chest Drain in a VATS Pulmonary Lobectomy Cohort: Interim Analysis

10.21203/rs.3.rs-86692/v1 ◽

2020 ◽

Author(s):

Paolo Mendogni ◽

Davide Tosi ◽

Giuseppe Marulli ◽

Giovanni Maria Comacchio ◽

Sara Pieropan ◽

...

Keyword(s):

Hospital Stay ◽

Chest Tube ◽

Interim Analysis ◽

Controlled Trial ◽

Trial Registration ◽

P Value ◽

Chest Drain ◽

Air Leak ◽

Multicenter Randomized Controlled Trial ◽

Prolonged Air Leak

Abstract Background: The usefulness of digital chest drain is still discussed. We are carrying out a study to determine if the use of a digital system compared with a traditional system reduces the duration of chest drainage. To evaluate safety, benefit, or futility of this trial we planned the current interim analysis.Methods: An interim analysis on preliminary data from ongoing investigator-initiated, multicenter, interventional, prospective randomized trial. Original protocol number: (NCT03536130). The interim main endpoint was overall complications; secondary endpoints were the concordance between the two primary endpoints of the RCT (chest tube duration and length of hospital stay). We planned the interim analysis when half of the patients have been randomised and completed the study. Data were described using mean and standard deviation or absolute frequencies and percentage. T-test for unpaired samples, Chi-square test, Poisson regression and absolute standardized mean difference (ASMD) were used. P-value <0.05 was considered significant. Results: From April 2017 to November 2018, out of 317 patients were enrolled by 3 centers, 231 fulfilled inclusion criteria and were randomized. Twenty-two of them dropped out after randomization. Finally, 209 patients were analyzed: among them 94 used the digital device and 115 the traditional one. The overall postoperative complications were 35 (16.8%) including prolonged air leak (1.9%). Mean chest tube duration was 3.6 days (SD=1.8), with no differences between two groups (p=0.203). The overall difference between hospital stay and chest tube duration was 1.4 days (SD=1.4). Air leak at first postoperative day detected by digital and traditional devices predicted increasing in tube duration of 1.6 day (CI 95% 0.8-2.5, p<0.001) and 2.0 days (CI 95% 1.0-3.1, p<0.001), respectively. Conclusions: This interim analysis supported the authors’ will to continue with the enrollment and to analyze data once the estimated sample size will be reached.Trial registration: Trial registration number NCT03536130, Registered 24 May 2018 - Retrospectively registered, https://clinicaltrials.gov/ct2/results?cond=&term=NCT03536130&cntry=&state=&city=& dist=

Download Full-text

Toward a Next-Generation Digital Chest Tube

Surgical Innovation ◽

10.1177/15533506211042505 ◽

2021 ◽

pp. 155335062110425

Author(s):

Daniel T. DeArmond ◽

Lucas M. Holt ◽

Andrew P. Wang ◽

Kristen N. Errico ◽

Nitin A. Das

Keyword(s):

Chest Tube ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Air Leak ◽

Chest Tubes ◽

Pump System ◽

Suction Pump ◽

Lung Expansion ◽

Tube Removal ◽

Prolonged Air Leak

Chest tubes in patients who have undergone pulmonary resection with pleural air leak are painful, impair ventilatory mechanics, and increase hospital length of stay and costs. Despite these well-documented concerns, current protocols for chest tube management in this setting are not well supported by evidence. Excessive suction applied to chest tubes has been associated with prolonged air leak due to alveolar over-distension, and most practitioners intuit that suction should be minimized to the lowest level needed to maintain desired pleural apposition. Unfortunately, there is no evidence-based protocol for the establishment of minimal adequate suction. Digital suction devices in current clinical use can identify air leak resolution preventing the delay of chest tube removal but cannot guide suction minimization while an air leak persists. We recently described a monitor of lung expansion in a porcine model of pleural air leak that could detect loss of pleural apposition continuously in real-time based on electrical impedance readings obtained directly from the surface of the lung via chest tube-embedded electrodes. The value of the impedance signal was “in-range” when pleural apposition was present but became abruptly “out-of-range” when pneumothorax due to inadequate suction developed. These findings suggested that a digitally controlled suction pump system could be programmed to recognize the development of pneumothorax and automatically identify and set the minimum level of suction required to maintain pleural apposition. We present here preliminary proof of concept for this system.

Download Full-text

What Keeps Postpulmonary Resection Patients in Hospital?

Canadian Respiratory Journal ◽

10.1155/2003/610570 ◽

2003 ◽

Vol 10 (2) ◽

pp. 86-89 ◽

Cited By ~ 46

Author(s):

T Bardell ◽

D Petsikas

Keyword(s):

Regression Analysis ◽

Linear Regression ◽

Chest Tube ◽

Pulmonary Resection ◽

Linear Regression Analysis ◽

Air Leak ◽

Air Leaks ◽

Tube Removal ◽

Prolonged Air Leak ◽

Chest Tube Removal

BACKGROUND: Prolonged air leak (longer than three days) was hypothesized to be the primary cause of extended hospital stays following pulmonary resection. Its effect on length of stay (LOS) was compared with that of suboptimal pain control, nausea and vomiting, and other causes. Predictors of prolonged LOS and of prolonged air leaks were investigated.DESIGN: Retrospective review of 91 patients. Primary reasons for prolonged hospitalization were determined. Patient characteristics (demographic information, pulmonary function test results, body habitus measurements, smoking history), operative factors (procedure performed, duration of operation, complications) and postoperative factors (time of chest tube removal) were considered. Student'sttest andX2analysis were used to compare continuous and ratio data, respectively, and linear regression analysis was used to define the equation relating two variables.RESULTS: The mean postoperative LOS was 6.4 days. Only prolonged air leak was predictive of increased LOS (9.4 days versus 5.4 days, P<0.001). Forced expiratory volume in 1 s less than 1.5 L/min, carbon monoxide diffusing capacity less than 80% predicted and the detection of a pneumothorax were all predictive of prolonged air leak. A strong correlation between the time of chest tube removal and LOS was found (r=0.937, P<0.001). Linear regression analysis showed postoperative LOS and duration of thoracostomy tube insertion to be related by the equation y = 0.88x + 2.49 days.CONCLUSIONS: These results suggest that increased LOS following pulmonary resection is due primarily to prolonged air leaks. Furthermore, patients who have their chest tubes removed sooner are discharged sooner.

Download Full-text