P1.16-61 Intermittent Chest Tube Clamping Shortens Chest Tube Duration After Lung Cancer Surgery: An Interim Analysis of Randomized Clinical Trial

Abstract

Postoperative pleural drainage markedly influences the length of hospital stay and the financial costs of medical care. Our previous retrospective study proved the safety and effectiveness of chest tube clamping in the term of shortening chest tube duration. This study aims to determine if intermittent chest tube clamping could decrease chest tube duration and total drainage volume after lung cancer surgery in randomized clinical trial. This trial is registered with ClinicalTrials.gov (NCT03379350). All the patients were managed with gravity drainage (water seal only, without suction) during the first 12–24 h (depending on the time of surgery completion) after surgery. Once a radiograph confirmed re-expansion of the lung on the morning of the POD1 and no air leak was detected, patients were randomly assigned to intermittent chest tube clamping as study arm or traditional chest tube management as control arm. Patients in control arm were unchangeably managed with gravity drainage. In clamping arm, the chest tube would be clamped, and the nurses would check the patient every 6 h. If the patient had no problems with compliance, the clamp was removed for 30 minutes in the morning to record the drainage volume every 24 h. The criterion for chest tube removal was drainage volume <250 mL in 24 h. Seven-two consecutive patients with operable lung cancer treated using lobectomy were randomized, all of them were eligible and evaluable. Thirty-seven and 35 patients were randomly assigned to clamping arm and control arm, respectively. There were no significant differences between two groups in terms of demographics, such of age, gender and the percentage of neoadjuvant treatment. Analyses were performed to compare drainage duration between two groups. Chest tube drainage duration was significantly shorter in clamping group than in control group (2.3±0.5 days vs. 2.7±0.9 days, p = 0.011). Total drainage volume was significantly less in clamping group than in control group (411.0±183.1 ml vs. 553.7±333.6 ml, p = 0.030). Only one patient in clamping group underwent thoracocentesis after chest tube removal due to chylothorax, which was probably caused by excess high-fat diet. No pyrexia relevant to chest tube clamping occurred. There was some degree of improvement on plasma albumin declination at discharge in clamping group over control group (7.5±2.5 g/L vs. 8.6±3.6 g/L, p = 0.119), but without a significant statistical difference. Intermittent postoperative chest tube clamping decreases chest tube duration and total drainage volume while maintaining patient safety. Further investigation is warranted.