The Influence of Suction on Chest Drain Duration After Lobectomy Using Electronic Chest Drainage

Abstract

Management of chest drains after thoracic surgery remains an area with little consensus. To optimize chest drainage algorithms with electronic chest drainage systems, a randomized controlled trial comparing low variable suction (-5 cm H2O) versus high variable suction (-20 cm H2O) was conducted. This was a prospective open label randomized trial in patients undergoing lobectomy. Sample size was calculated from a clinical relevant difference in chest drain duration as 1 full day. End points were chest drain duration and length of hospitalization. Data were analyzed by Kaplan-Meier survival analysis and multivariate Cox proportional hazards regression. The study randomized 106 patients. There was no statistical significant difference in chest drain duration and length of stay between the low-suction and the high-suction groups: Median chest drain duration and hospitalization were 25 hours (interquartile range [IQR] 21 to 55 hours) versus 28 hours (IQR 23 to 77 hours; p= 0.97) and 5 days (IQR 3 to 6 days) versus 5 days (IQR 3 to 7 days; p= 0.75), respectively. Multivariate analysis demonstrated that the diffusing capacity of the lung for carbon monoxide was the only significant predictor of chest drain duration (p= 0.015) and length of hospitalization (p= 0.003). Complications requiring reinsertion of the chest drain were significantly more frequent in the low-suction group (p= 0.03). There was no clinically relevant difference in chest drain duration or length of hospitalization, but reinsertions of chest drains were significantly more frequent in the low-suction group, a finding suggesting that low suction levels should not be used after lobectomy. Trial registry number is ISRCTN10408356.