Chest Drain Removal Research Articles

A simple size-tailored algorithm for the removal of chest drain following minimally invasive lobectomy: a prospective randomized study

BackgroundThe pleural space can resorb 0.11–0.36 ml/kg of body weight/hour (h) per hemithorax. There are only a limited number of studies on thresholds for chest drain removal (CDR) and all are based on arbitrary amounts, for example, 300 ml/day. We studied an individualized size-based threshold for CDR–specifically 5 ml/kg, a simple, easily applicable measure.MethodsThis is a single-center prospective randomized trial enrolling 80 patients undergoing VATS lobectomy. There were two groups: an experimental (E) group, in which once the daily output went down to 5 ml/kg the chest drain was removed and a control (C) group, with chest drain removal as per our current practice of less than 250 ml/day.ResultsThe groups did not differ in pre- and peri- and postoperative characteristics, except for chest drain duration (mean, SD 2.02 ± 0.97 vs. 3.25 ± 1.39 days, p < 0.001) and length of hospital stay (median, IQR 4.5; 3 vs. 6; 2.75 days, p = 0.008) in favor of E group. The re-intervention rate was the same in both groups (once in each group).ConclusionThe new threshold for chest drain removal following thoracoscopic lobectomy of 5 ml/kg/d leads to both shorter chest drainage and hospital stay without apparent increase in morbidity. (Clinical registration number: DRKS00014252).

A service evaluation exploring time on physiotherapy caseload following lung lobectomy surgery

Background The number of lobectomy procedures performed in the United Kingdom (UK) continues to increase annually increasing pressure on thoracic surgical bed capacity. Physiotherapy following thoracic surgery can encourage earlier patient independence helping to reduce hospital length of stay and decrease pressure on hospital beds. The purpose of the service evaluation was to explore whether age, gender, type of surgical incision, day first mobilised and chest drain duration affected time on physiotherapy caseload following lobectomy surgery at one teaching hospital. The findings could support the identification of individuals at risk of longer times on physiotherapy caseloads and help direct physiotherapy rehabilitation provision towards these individuals. Methods A retrospective service evaluation was conducted in a UK teaching hospital. Data were retrospectively collected from 1st July 2015–30th June 2016 for all patients reviewed by the cardiothoracic physiotherapy team following lobectomy surgery. Data were collected from patients’ physiotherapy ward sheets, chest radiograph and an electronic patient database and included: date of surgery; day discharged from physiotherapy; age; gender; type of surgical incision; day first mobilised; day chest drains removed. Results 135 individuals were treated by the physiotherapy team following lobectomy surgery within the data collection period. Time on physiotherapy caseload was longer for females and for those who had longer chest drain durations. Time on physiotherapy caseload was reduced by having a VATS incision and was not affected by the patient’s age. Day mobilised postoperatively was an independent predictor of time on physiotherapy caseload however after adjusting for other covariates it was not statistically significantly associated with time on physiotherapy caseload. Conclusion Reviewing chest drain removal practices and providing more intensive physiotherapy input following thoracotomy are worth greater exploration to ascertain whether these interventions could further reduce time on physiotherapy caseload following lobectomy surgery.

Combined minimally invasive resection of thoracic neurogenic dumbbell tumors: A European case series.

BackgroundParaspinal tumors are rare neoplasms arising from neurogenic elements of the posterior mediastinum and surgical resection can be challenging. Here, we demonstrate feasibility and outcomes from the first European case series of combined laminectomy and video‐assisted thoracoscopic surgery (VATS) resection of thoracic neurogenic dumbbell tumors.MethodsA retrospective review of all combined thoracic dumbbell tumor resections performed at our institution between March 2015 to February 2019 was undertaken. Outcomes included operative time, blood loss, length of stay and recurrence rate. Statistical analysis was performed with SPSS statistics (v26). Values are given as mean ± standard deviation and median ± interquartile range.ResultsSeven patients were included in the case series and there were no major complications or mortality. Mean tumor size and operative time were 66 (± 35) mm and 171 (± 63) min, respectively. Median blood loss and length of stay were 40 (± 70) ml and four (± 3) days, respectively. One patient required conversion to thoracotomy to remove a tumor of 135 mm in maximal dimension. Histology in all seven cases confirmed schwannoma. There was no disease recurrence at a maximum follow‐up of 54 months.ConclusionsOur experience demonstrates favorable operative times, minimal blood loss and short length of stay when dealing with relatively large tumors compared to previous reports. Thoracotomy may be required for tumors exceeding 90 mm and chest drain removal on the operative day can facilitate early mobility and discharge. We advocate a combined, minimally invasive laminectomy and VATS resection as the gold‐standard approach for thoracic neurogenic dumbbell tumors.

Virtual reality vs. Kalinox\xae for management of pain in intensive care unit after cardiac surgery: a randomized study

IntroductionThe management of pain and anxiety remains a challenge in the intensive care unit. By distracting patients, virtual reality (VR) may have a role in painful procedures. We compared VR vs. an inhaled equimolar mixture of N2O and O2 (Kalinox®) for pain and anxiety management during the removal of chest drains after cardiac surgery.MethodsProspective, non-inferiority, open-label study. Patients were randomized, for Kalinox® or VR session during drain removal. The analgesia/nociception index (ANI) was monitored during the procedure for objective assessment of pain and anxiety. The primary endpoint was the ΔANI (ANImin − ANI0) during the procedure, based on ANIm (average on 4 min). We prespecified VR as non-inferior to Kalinox® with a margin of 3 points. Self-reported pain and anxiety were also analysed using numeric rate scale (NRS).Results200 patients were included, 99 in the VR group and 101 in the Kalinox® group; 90 patients were analysed in both groups in per-protocol analysis. The median age was 68.0 years [60.0–74.8]. The ΔANI was − 15.1 ± 12.9 in the Kalinox® group and − 15.7 ± 11.6 in the VR group (NS). The mean difference was, therefore, − 0.6 [− 3.6 to 2.4], including the non-inferiority margin of 3. Patients in the VR group had a significantly higher pain NRS scale immediately after the drain removal, 5.0 [3.0–7.0] vs. 3.0 [2.0–6.0], p = 0.009, but no difference 10 min after. NRS of anxiety did not differ between the two groups.ConclusionBased on the ANI, the current study showed that VR did not reach the statistical requirements for a proven non-inferiority vs. Kalinox® in managing pain and anxiety during chest drain removal. Moreover, VR was less effective based on NRS. More studies are needed to determine if VR might have a place in the overall approach to pain and anxiety in intensive care units.Trial registration NCT, NCT03956264. Registered 20 May 2019, https://clinicaltrials.gov/ct2/show/NCT03956264

Does erector spinae plane block result in improved postoperative analgesia and enhanced recovery in adult patients after cardiac surgery?

A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether erector spinae plane block (ESPB) resulted in improved postoperative analgesia and enhanced recovery in adult cardiac surgical patients. A total of 333 papers were found using the reported search of which, 7 papers represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient groups studied, study type, relevant outcomes and results of these papers are tabulated. The cardiac surgical procedures included off-pump coronary artery bypass surgery (1 study), mitral/tricuspid valve repair (1 study), robotic minimally invasive coronary artery bypass surgery (1 study) and other cardiac surgeries (4 studies). ESPB was compared to intravenous analgesia (5 studies), thoracic epidural analgesia (1 study) and serratus anterior plane block and paravertebral block (1 study). With ESPB, there was significant improvement in postoperative pain scores (4 studies), decreased opioid requirement/rescue analgesia (3 studies), increased duration of analgesia (1 study), decreased time to extubation (3 studies), less increase in postoperative Troponin T (1 study), earlier ambulation (2 studies), earlier oral intake (1 study), earlier chest drain removal (1 study), better patient satisfaction (1 study), reduced adverse events (1 study) and decreased intensive care unit stay (3 studies). We conclude that ESPB may be associated with improved postoperative analgesia and enhanced recovery after adult cardiac surgery based on the available evidence. However, there is a need for better quality randomized controlled trials to consolidate these findings.

Intercostal Catheters for Postoperative Pain Management in VATS Reduce Opioid Consumption.

Background: Postoperative pain after video-assisted thoracoscopic surgery (VATS) affects patients’ recovery, postoperative complications, and length of stay (LOS). Despite its relevance, there are no guidelines on optimal perioperative pain management. This study aims to analyse the effects of an additional intercostal catheter (ICC) in comparison to a single shot intraoperative intercostal nerve block (SSINB). Methods: All patients receiving an anatomic VATS resection between June 2019 and May 2020 were analysed retrospectively. The ICC cohort included 51 patients, the SSINB cohort included 44 patients. Results: There was no difference in age, gender, comorbidities, or duration of surgery between cohorts. Pain scores on the first postoperative day, after chest drain removal, and highest pain score measured did not differ between groups. The overall amount of opioids (morphine equivalent: 3.034 mg vs. 7.727 mg; p = 0.002) as well as the duration of opioid usage (0.59 days vs. 1.25 days; p = 0.005) was significantly less in the ICC cohort. There was no difference in chest drain duration, postoperative complications, and postoperative LOS. Conclusions: Pain management with ICC reduces the amount of opioids and number of days with opioids patients require to achieve sufficient analgesia. In conclusion, ICC is an effective regional anaesthesia tool in postoperative pain management in minimally invasive thoracic surgery.

Risk factors and events in the adult intensive care unit associated with pain as self-reported at the end of the intensive care unit stay

BackgroundThe short-term and long-term consequences of the most frequent painful procedures performed in the ICU are unclear. This study aimed to identify the risk factors associated with pain-related discomfort perceived by critically ill patients during the whole ICU stay as self-reported by patients at the end of their ICU stay.MethodsThe study involved 34 ICUs. Adult patients who survived an ICU stay of 3 calendar days or more were eligible for inclusion. Discomforts, including the pain-related discomfort, were assessed using the French 18-item questionnaire on discomfort in ICU patients, the “Inconforts des Patients de REAnimation” (IPREA). Patients scored each item from 0 (minimal discomfort) to 10 (maximal discomfort). Associations between patient characteristics at ICU admission, life support therapies and main potentially painful procedures performed during the ICU stay and pain-related discomfort scores assessed at the end of the ICU stay were analyzed.ResultsPatients with complete IPREA questionnaires (n = 2130) were included. The median pain-related discomfort score was 3 (IQR 0–5). From the univariate analysis, pain-related discomfort scores were negatively correlated with age and positively correlated with ICU stay duration; surgical patients reported significant higher pain-related discomfort scores than medical patients; chest drain insertion, chest drain removal, use of bladder catheter, central venous catheter (CVC) insertion, complex dressing change, and intra-hospital transport were associated with pain-related discomfort scores. From the multivariate analyses using generalized estimating equations models, only age, chest drain removal, use of a bladder catheter, CVC insertion, and intra-hospital transport were the main risk factors associated with pain-related discomfort scores.ConclusionPatients who underwent chest drain removal, bladder catheter, CVC insertion, and intra-hospital transport during their ICU stay reported higher pain-related discomfort scores (with respect to the whole ICU stay and assessed at the end of their ICU stay) than patients who did not experience these events. This study may pave the way for further targeted studies aiming at investigating a causal link between these common procedures in the ICU and adult critically ill patients’ perceptions of their ICU stay regarding recalled pain.Trial Registration: Clinicaltrials.gov Identifier NCT02442934, retrospectively registered on May 13, 2015

The impact of same-day chest drain removal on pulmonary function after thoracoscopic lobectomy.

This study aims to assess the feasibility and impact on long-term pulmonary function of chest drain removal on the operation day following thoracoscopic right upper lobectomy for clinical stage I non-small cell lung cancer. We retrospectively evaluated the data of 116 patients between May 2013 and March 2019. We evaluated the correlations of clinical parameters of chest drain removal and medium- and long-term pulmonary function by comparing removal on operation day (R group) and retainment (D group). The R group comprised 64 patients, and the D group had 52 patients. Fifty patients (96.2%) in the D group had chest drain removed within 3 postoperative days. Since February 2016, chest drain removal on operation day was performed in 64 of 74 patients (86.5%) according to our chest drain removal protocol. Removal of chest drains on operation day was associated with shorter postoperative hospitalization (p < 0.01) and lower postoperative complications ≧ grade II of the Clavien-Dindo classification (p = 0.026). Only one patient in the R group needed reinsertion. The R group had greater spirometry results at 3- and 12-postoperative months (POM). R group patients had statistically improved pulmonary functions from 3 to 12POM, while those in the D Group were stagnated at 6POM. Removal of chest drains on operation day using our protocol is safe and feasible for thoracoscopic right upper lobectomy. This protocol was statistically associated with slightly better long-term pulmonary function, which could not bring clinically meaningful medium- and long-term benefit.

Intercostal chest drain fixation strength: comparison of techniques and sutures

ObjectiveThe accidental removal of an intercostal chest drain (ICD) is common and may result in serious complications. A number of fixation techniques and suture material are in use, and the...

Are routine post drain removal chest x-rays necessary after oesophagectomy?

Background: Routine chest X-rays (CXR) are often performed following the removal of chest drains placed during oesophagectomy. CXRs are costly and inconvenient for the patient, often being performed out of working hours. The aim of this study was to evaluate whether routine CXR is necessary following drain removal or if CXRs should only be performed when indicated by the clinical status of the patient.Methods: This was a retrospective study of oesophagectomies performed at a single high volume centre. Routine post chest drain removal CXRs were analyzed and compared to baseline post-operative CXRs. The clinical status of the patient before and after chest drain removal was recorded.Results: 188 patients were identified. 111/188 (59%) had a pleural effusion or pneumothorax on their baseline post-operative CXR. Abnormal findings on post drain removal CXR were common with 72/188 (38.3%) patients having a new or worse pleural effusion or pneumothorax. Only, 5.6% (11/188) of these patients actually developed clinical signs after chest drain removal. Of these, only 2.1% (4/188) required chest drain re-insertion. No patients underwent intervention without showing clinical deterioration. No re-intervention was prompted by CXR finding alone.Conclusions: Routine CXR following chest drain removal is unnecessary. It is safe to only perform CXRs on patients who develop clinical signs.

Balanced Chest Drainage Prevents Post-Pneumonectomy Pulmonary Oedema

Pneumonectomy in the adult patient is associated with a mortality of 1-9%. Death is often due to post pneumonectomy pulmonary oedema (PPPO). The use of balanced chest drainage system (BCD) in the setting of post pneumonectomy has been reported to be of benefit in the prevention of PPPO. This study seeks to compare the incidence of PPPO in patients who underwent pneumonectomy and whose empty pleural space was managed either with CRD or BCD. This retrospective observational cohort study involved 98 patients who were operated on by one surgeon at Liverpool Hospital, Sydney, Australia from 1997 to 2019. The patients were divided into two groups according to the era in which they had their pneumonectomy. Group 1 consisted of 18 patients managed with clamp-release drainage between 1997 and 2002. Group 2 consisted of 80 patients managed with balanced chest drainage between 2003 and 2019. The primary outcomes of interest were the development of PPPO and death. Demographic and clinico-pathological variables between the groups were compared including whether the phrenic nerve was sacrificed, volume of infused intraoperative fluid, duration of single lung ventilation, intraoperative tidal volumes, agents of anaesthetic induction and maintenance, mean urine output in the first 4 postoperative hours, institution of a postoperative 1.5 L fluid restriction, total chest drainage, day of chest drain removal, presence of radiological postoperative mediastinal shift, post-pneumonectomy pulmonary oedema and death. Group characteristics were compared using t-test and chi-squared for continuous and categorical variables respectively. Univariate and multivariate analysis was also undertaken using the Firth method of logistic regression for rare occurrences in a stepwise fashion. Through univariate analysis, balanced chest drainage, postoperative fluid restriction and intraoperative fluid infusion showed significant effect on PPPO. Through multivariate analysis, balanced chest drainage was found to have independent protective value for PPPO and mortality. Compared with clamp-release drainage, balanced chest drainage results in a lower incidence of post-pneumonectomy pulmonary oedema and death.

Chest drains: purse string suture 4.0.

There are many discussions about the technique of removal of chest drains. In our hospital, we have used an intracutaneous suture technique with non-absorbable suture material for the purse-string suture for a few years now. Thus the cosmetic results improved considerably. Nevertheless, the thread has to be removed after 10-14days. To further improve patient comfort we developed a purse-string suture technique using an absorbable barbed suture. We noticed better cosmetic results and less painfull drain removal. Furthermore, there is no more need for a stitch removal which reduces material costs and also pain.

Effectiveness of Ice Compress Application upon the Level of Pain among Patients with Chest Drainage

Effectiveness of Ice Compress Application upon the Level of Pain among Patients with Chest Drainage

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

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...

Clinical guidelines on perioperative management strategies for enhanced recovery after lung surgery.

The concept of enhanced recovery after surgery (ERAS) was first developed in Denmark in 1997 by Dr. Kehlet (1). ERAS is designed to optimize perioperative management, improve patient prognosis, reduce complications, shorten hospital stay, and lower cost (2-5). In recent years, this multi-disciplinary and multi-modal perioperative rehabilitation concept has been widely applied in open and endoscopic procedures including colorectal surgery (6,7), gynecological surgery (8,9), liver surgery (10,11), breast surgery (12,13), urologic surgery (14,15), and spinal surgery (16-18). Advances in thoracic surgery, especially the popularization of minimally invasive techniques, have dramatically expanded or changed the concept of surgical treatment (19-21). Early recovery from thoracic surgery is now routine (22-24). In Jan 2019, the European Society of Thoracic Surgeons published guidelines for enhanced recovery after lung surgery (25) on: preoperative counselling, nutritional screening, smoking cessation, rehabilitation for high-risk patients, avoidance of fasting, carbohydrate loading, avoidance of preoperative sedatives, venous thromboembolism prophylaxis, prevention of hypothermia, short-acting anesthetics to facilitate early emergence, regional anesthesia, nausea and vomiting control, opioid-sparing analgesia, euvolemic fluid management, minimally invasive surgery, early chest drain removal, avoidance of urinary catheters, and early mobilization after surgery. The lung is a unique organ in that it receives the total cardiac output and acts as a giant filter for systemic venous blood (26). It is, in addition, an open organ; through the airway, the alveoli interact with the surrounding environment. Due to its unique anatomy and physiology, the lung is susceptible to injuries caused by a variety of harmful endogenous and exogenous factors (27). Perioperative risk factors and treatment measures can result in damage to the lungs, which in turn can lead to postoperative pulmonary complications (PPCs) (e.g., atelectasis and pneumonia) and pleural complications, affecting early and long-term recovery (28-30), and accounting for up to 84% of all deaths (31). Perioperative airway and protective ventilatory management in lung surgery are an important part of ERAS (32,33). Given the circumstances, we have established clinical guidelines based primarily on an extensive literature review, with discussion and consensus focused on the issue of perioperative airway management for enhanced recovery following lung surgery. In addition, we will briefly review other perioperative measures designed toward the goal of ERAS for thoracic surgery.

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

BackgroundIn 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.MethodsThis 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.DiscussionTo 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 registrationClinicalTrials.gov, NCT03536130. Retrospectively registered on 24 May 2018.

Early-term postoperative thoracic outcomes of videothoracoscopic vertebral body tethering surgery.

This study aims to discuss the early-term postoperative thoracic complications in videothoracoscopic anterior vertebral body tethering surgery. The study included 56 patients (3 males, 53 females; mean age 12.6 years; range, 10 to 16 years) operated with a total of 65 videothoracoscopic anterior vertebral body tethering surgeries between April 2014 and November 2018. Surgical indications were adolescents with different growth potentials, who had thoracic, thoracolumbar or double curves less than 70°. Surgical details and postoperative thoracic complications were recorded. Forty-two patients were administered thoracic tether, whereas five and nine patients were administered thoracolumbar tether and both approaches concomitantly, respectively. Two patients developed ipsilateral total atelectasis, one patient contralateral lobar atelectasis, one patient chylothorax, one patient pleural effusion, and one patient pneumothorax after chest drain removal. Overall thoracic complication rate was 9.2% and 30-day readmission rate was 1.8%. All patients achieved their rehabilitation goals. Videothoracoscopy-assisted anterior vertebral body tethering is a safe and efficient technique that yields low complication rates. Early postoperative functional results are promising with high patient satisfaction. Pre- and postoperative respiratory rehabilitation may decrease thoracic complication rates.

A surgical perspective of ERAS guidelines in thoracic surgery.

Guidelines for enhanced recovery after surgery (ERAS) have recently been published for lung surgery. Although some of the recommendations are generic or focused on anesthetic and nursing care, other recommendations are more specific to a thoracic surgeon's practice. The present review concentrates on the surgical approach, optimal chest drain management, and the importance of early mobilization. Most lung cancer resections are still performed via an open thoracotomy approach. If a thoracotomy is to be used, a muscle-sparing approach may result in reduced pain and better postoperative function. Sparing of the intercostal bundle also reduces pain. There is now evidence that minimally invasive surgery for early lung cancer results in superior patient outcomes. Postoperatively, single chest tubes should be used without the routine application of external suction. Digital drainage systems are more reliable and may produce superior outcomes. Conservative chest drain removal policies are unnecessary and impair patient recovery. Early mobilization protocols should be instigated to reduce postoperative complications. The use of ERAS after lung surgery has the potential to improve patient outcomes. Although specific surgical elements are in the minority, thoracic surgeons should be involved in all aspects of perioperative care as part of the wider multidisciplinary team.

The Impact of Using Ice on Quality of Pain Associated with Chest Drain Removal in Postcardiac Surgery Patients: An Evidence-Based Care

Background:Patients undergoing cardiothoracic surgery require the placement of at least one chest drain. Chest Drain Removal (CDR) has been considered to be a painful event in patient’s postoperative recuperation.Objective:This study aimed to evaluate the impact of using ice on quality of pain associated with CDR in adult patients undergoing cardiac surgeryMaterials and Methods:This randomized, observer-blind, crossover trial was done on 51 post-cardiac surgery patients who had two chest drains in the Mashhad Heart Center in Iran. The patients were assigned to ice, placebo, and control groups. Ice and placebo bags were used over the region around the chest drains for 20 minutes prior to CDR. The quality of pain was assessedviaShort-Form McGill Pain Questionnaire (SF-MPQ) before and after CRT. The data were analyzed through the SPSS software using ANOVA, Kruskal-Wallis, and Chi-square tests.Results:The study findings revealed that the three groups were not significantly different regarding pain quality before CDR (p=0.24). However, the ice bag group (4.6±4.4) was significantly different from the placebo (8.1±6.9) and control groups (7.1±5.3) concerning the pain quality score immediately after CDR (p&lt;0.05). The results of chi-square test also showed that the three groups were significantly different regarding “hot-burning” (p=0.009). However, no significant differences were observed with regard to other items of SF-MPQ.Conclusion:The results indicated that ice bag application could be used as an effective, safe, and inexpensive non-pharmacological intervention to reduce patients’ pain and increase their comfort during CDR.

The effects of low suction on digital drainage devices after lobectomy using video-assisted thoracoscopic surgery: a randomized controlled trial†.

The optimal level of suction on digital chest drainage devices after lobectomy using video-assisted thoracoscopic surgery (VATS) is unknown and varies between thoracic centres. In this randomized controlled trial, we assessed the potential benefits of low suction of -2 cmH2O compared to -10 cmH2O, using a digital drainage device. Two hundred and twenty-eight patients were randomized into 2 groups after VATS lobectomy for suspected or confirmed lung cancer. Primary outcome was time to chest drain removal. Drain data were obtained from the digital drainage devices, and patient data were obtained from medical records during admission, with a follow-up until postoperative day 30. For the -2 cmH2O and -10 cmH2O groups, median (interquartile range) drainage duration was 27.4 h (23.3-71.2) and 47.5 h (24.5-117.8) (P = 0.047), and the incidence of prolonged air leak >5 days was 14.4% and 24.3% (P = 0.089), respectively. Median total fluid production was 566 h (329-1155) ml and 795 h (454-1605) ml (P = 0.007). Median time to consistent air leak cessation (<20 ml/min) was 5.2 h (0.3-34.2) and 23.7 h (0.8-90.8) (P < 0.001). There were no differences in the proportion or the size of the pneumothorax or subcutaneous emphysema after drain removal, and no differences were observed in postoperative morbidity. Median length of in-hospital stay was 2.0 days (2.0-5.8) and 3.0 days (2.0-9.0) (P = 0.18). A low suction level significantly shortened drainage duration, time to air leak cessation and total fluid production, without increasing morbidity. NCT02911259.