REMOVAL OF CHEST DRAINS IN POST CORONARY ARTERY BYPASS GRAFT PATIENTS: DO VARIOUS PHASES OF RESPIRATION MAKE A DIFFERENCE?

Abstract

Background: Pleural drainage via intercostal tube is widely used in every trauma center, oncology center and tertiary health care providing centers all over the world, hence there are great efforts directed to find out the best way to manage the intercostal tube during and after its insertion. In this study we try to find out the best respiratory phase, If there is any, to remove the intercostal tube.Aim of the Work: To find out the ideal respiratory phase during which tube thoracostomy can be safely removed.Patients and Methods: (291) patients who underwent coronary artery bypass grafting surgery have been randomized into four groups according to the phase of respiration they were asked to adapt during pleural drain removal. Intervention: patients were asked to adapt one of the following respiratory phases during the removal process; group end-inspiratory, group (P) end-expiratory, Valsalva maneuver after full inspiration (Q) or Valsalva maneuver after full expiration (R) group. Pre-removal chest X-ray and post removal chest X-rays were obtained and compared. This study was conducted between December 2019 and November 2020 in cardiac surgery post-operative intensive care unit at Nasser Institute Hospital.Results: By comparing pre and post removal chest X-ray films to detect small insignificant recurrent pneumothorax, which is newly developed pneumothorax or increased existing small pneumothorax, in 6 patients in group (P), 8 patients in group (Q) ,7 patients in group (R) and 5 patients in group (S) . Significant pneumothorax occurred in additional 2 cases in group (R) which required re-insertion of intercostal tube.Conclusion: It is safe to remove chest tube in any phase of respiration if performed by a well-trained physician.