Digital Drainage Devices Research Articles

Evaluation of the Efficacy of a Digital Chest Drainage System in Traumatic Pneumothorax.

Pneumothorax is the major complication in patients with chest trauma. Thoracic injury is a major cause oftrauma-related deaths, with up to half of these patients developing pneumothorax. The initial primary management of pneumothorax is intercostal chest drainage (ICD). Chest drainage systems are used to resolve pleural air leakage (PAL), lymphatic or exudative effusion, blood accumulation after chest surgery or trauma, and other disease conditions such as pneumothorax. This study evaluates the efficacy of a digital chest drainage system (Thopaz+, Medela AG, Baar, Switzerland) in patients with pneumothorax following chest trauma and analyzes the satisfaction score by patients. A hospital-based cross-sectional study was conducted in a tertiary care centre at the Department of Cardiovascular and Thoracic Surgery (CTVS). All patients with a diagnosis of traumatic pneumothorax/hemopneumothorax from January 2021 to June 2022, aged more than 15 years, were enrolled for the study. A total of 102 patientsrequired chest drainage systems and were selected for the study. We analysed demographic data, clinical profiles, and routine investigations with chest X-rays and computed tomography (CT) scans. All patients were connected with digital drainage devices and monitored for air leaks and other complications. Patient satisfaction was evaluated by a purposefully developed survey questionnaire. Most of our study subjects were male (84.3%) and the mean age was 42.38±15.75 years. The total duration of chest tube, post-operative air leak and duration of hospital stay were noted. The mean chest tube duration was 4.39±1.18 days. Twelve patients were found to have air leaks with digital drainage devices. The mean duration of hospital stay was 5.75±1.49 days. All subjects were provided with a survey questionnaire to assess their response to digital drainage devices. We found that patients were comfortable and had positive responses for the Thopaz+ device. We found that Thopaz+ digital drainage system is useful in reducing chest tube duration and hospital stay. It also helps in the early resolution of air leaks and minimises complications. Most of our patients showed a positive attitude. With regard to Thopaz+ digital device, our study concludes that Thopaz+ should be considered for patients who need chest tube drain for pneumothorax.

Low suction on digital drainage devices promptly improves post-operative air leaks following lung resection operations: a retrospective study

BackgroundWe investigated the most effective suction pressure for preventing or promptly improving postoperative air leaks on digital drainage devices after lung resection.MethodsWe retrospectively analyzed the postoperative data of 242 patients who were monitored with a digital drainage system after pulmonary resection in our institution between December 2017 and June 2020. We divided the patients into three groups according to the suction pressure used: A (low-pressure suction group: − 5 cm H2O), B (intermediate-pressure group: − 10 cm H2O), and C (high-pressure suction group: − 20 cm H2O). We evaluated the duration of air leaks, timing of chest tube replacement, the amount of postoperative air leak, volume of fluid drained before chest tube removal, and the total number of air leaks during drainage.ResultsIn total, 217 patients were included in this study. The duration of air leaks gradually decreased with significant difference between the groups, the highest decrease in A, the lowest decrease in C (P = 0.019). Timing of chest tube replacement, on the other hand, did not significantly differ between the three groups (P = 0.126). The number of postoperative air leaks just after surgery did not significantly differ between the three groups (P = 0.175), but the number of air leaks on postoperative day 1 were fewest in group A, then B, and greatest in group C (P = 0.033). The maximum amount of air leaks during drainage was lowest in A, then B, and highest in C (P = 0.036). Volume of fluid drained before chest tube removal did not significantly differ between the three groups (P = 0.986).ConclusionLow-pressure suction after pulmonary resection seems to avoid or promptly improve postoperative air leaks in digital drainage devices after lung resection.Trial registrationThis is a single-institution, retrospective analysis-based study of data from an electronic database. Study protocol was approved by the Akashi Medical Center Institutional Research Ethics Board (approval number: 2020–9).

What is the optimal level of suction on digital chest drainage devices following pulmonary lobectomy?

A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was: what is the optimal level of suction on digital chest drainage devices following pulmonary lobectomy? Altogether 367 papers were found using the reported search, of which 4 randomized controlled trials using digital chest drainage devices represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. The new digital drainage systems enhance early mobilization as recommended in the enhanced recovery after surgery programme. There is, however, no consensus on the optimal level of suction to apply after pulmonary lobectomy. This is especially the case for digital drainage devices. Surgeon preference will likely continue to guide practice, until the evidence gives clear-cut recommendations. According to the current data, a low suction reduces total fluid drainage and perhaps air leak duration compared to higher suction levels in both video-assisted thoracoscopic surgery and open pulmonary lobectomies using digital drainage devices, although the evidence is not overwhelming.

Early postoperative day 0 chest tube removal using a digital drainage device protocol after thoracoscopic major pulmonary resection.

The aim of this study was to assess the safety of early chest tube removal on postoperative day 0 (POD 0) on the basis of a digital drainage device protocol in patients undergoing thoracoscopic major lung resection and its contribution as a component of an enhanced recovery after surgery programme. One hundred consecutive patients who underwent thoracoscopic lobectomy or segmentectomy were submitted to the following criteria for chest tube removal: Air flow ≤20 ml/min for at least 4 h without fluid threshold, except if haemorrhagic or chylous. Two groups were defined according to chest tube removal on POD 0 (G0) or POD ≥1 (G1). Primary outcome was pleural complication and secondary outcomes were cardiopulmonary complication, length of drainage, length of stay (LOS), compliance with opioid-free analgesic protocol and readmission. The follow-up was 90 days from discharge. The chest tube was removed on POD 0 in 45% of patients (G0). None of them required tube reinsertion for pneumothorax and 1 patient was readmitted for a delayed pleural effusion. Among the 55% remaining patients (G1), the median length of drainage was 2 days, including 3 prolonged air leaks (>5 days). G0 and G1 were not different in terms of cardiopulmonary complication and readmission (6.6% vs 9% and 4.4% vs 7.2%, respectively). The median LOS was 1 day in G0 and 2 days in G1. The compliance with opioid-free analgesic protocol was significantly higher (75% vs 45%, P = 0.004) in G0 compared to G1. Early POD 0 chest tube removal after thoracoscopic major pulmonary resection is safe in selected patients on the basis of a digital drainage device protocol. Also, it may contribute, by reducing early postoperative pain, to enhance postoperative recovery as part of an advanced enhanced recovery after surgery programme.

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.

Management of chest drainage tubes after lung surgery.

Since chest tubes have been routinely used to drain the pleural space, particularly after lung surgery, the management of chest tubes is considered to be essential for the thoracic surgeon. The pleural drainage system requires effective drainage, suction, and water-sealing. Another key point of chest tube management is that a water seal is considered to be superior to suction for most air leaks. Nowadays, the most common pleural drainage device attached to the chest tube is the three-bottle system. An electronic chest drainage system has been developed that is effective in standardizing the postoperative management of chest tubes. More liberal use of digital drainage devices in the postoperative management of the pleural space is warranted. The removal of chest tubes is a common procedure occurring almost daily in hospitals throughout the world. Extraction of the tube is usually done at the end of full inspiration or at the end of full expiration. The tube removal technique is not as important as how it is done and the preparation for the procedure. The management of chest tubes must be based on careful observation, the patient's characteristics, and the operative procedures that had been performed.