Thoracic Drainage System Research Articles

Conventional and digital pleural drainage systems - advantages and disadvantages.

Pleural cavity drainage is a crucial component of the surgical management of patients with various chest diseases. Digital drainage systems are increasingly used in contemporary thoracic surgical procedure, which is likely a result of their effectiveness in achieving early postoperative ambulation, cutting down on hospital stays and lowering costs. The vast majority of thoracic surgeons worldwide prefer digital drainage systems to traditional ones. The advantages of the former, however, are disputed by some researchers.

Benefits of using digital thoracic drainage systems for post-operative treatment in pediatric populations: personal experience and review of literature.

The digital chest drainage monitoring system (Medela Thopaz+), unlike analogical systems, reliably regulates the pressure applied to the patient's chest and digitally and silently monitors critical therapeutic indicators (volume of fluid and/or drained air). Its use in adulthood has been widely described, but there is still little experience in the pediatric field. The aim of this study is to test this new device in the pediatric population. We conducted a retrospective study of 160 patients undergoing chest surgery at our Hospital. These patients were divided into 82 treated with the Thopaz system in the period from January 2021 to April 2023 and 78 in whom Pleurevac, had been used in the time period from January 2020 to April 2023. The average age of patients was 10.45 years (range: 3.1-17.2) for the Thopaz Group and 10.71 years for Pleurevac Group. The groups were homogeneus also by weight and type of intervention. The device was held in place for 10.64 days (mean) for Thopaz Group, compared to 16.87 days (mean) for Pleurevac Group (p < 0.05). The median number of postoperative x-rays before the closure of the chest tube was 4.29 in the digital drainage group compared to 8.41 in the traditional draining group (p < 0.05). The digital chest monitoring device provides objective measurement, allows for rapid patient mobilization (with good pain control and increased compliance). In addition, the use of Thopaz in the paediatric population seems to be safe (there is no statistically significant difference in terms of complications such as prolonged air leaks and pneumothorax after the chest tube closure) and potentially beneficial.

Digital Thoracic Drainage System: A New Tool For Pediatric Thoracic Surgery.

Digital thoracic drainage systems usage in pediatrics is underreported, making current recommen- dations based on those for adults. We aim to review our experience on the use of this digital system and to evaluate the adequacy of those recommendations. Retrospective analysis of patients in whom digital thoracic drainage system was used. All patients were submitted to thoracoscopic bleb/apical lung resection for primary spontaneous pneumothorax. Initially patients were man- aged using the few existing recommendations for children, but after 2 unsuccessful cases we changed our approach into tube clamping after continuous air leak < 5mL/min for at least 24 hours. Seventeen procedures (median 17.2-years) were performed; there were no intraoperative complications. After changing the air leak target, 11 procedures were consecutively managed without complications; the median number of chest radiographs per procedure was 3.0 and the median number of days with chest tube was 4.0 days. This is the first report on the usage of this system in children in Portugal. This system constitutes an important technological innovation, but it needs more data gathering and prospective trials in order to maximize its use in children. The authors suggest an algorithm for the management of thoracic digital drainage in children: removal of chest tubes when the air leak is <5mL/min for 24 hours and to perform chest tube clamping for a minimum of 6 hours before removal.

Clinical application of a digital thoracic drainage system for objectifying and quantifying air leak versus the traditional vacuum system: a retrospective observational study.

BackgroundDigital thoracic drainage systems have recently been introduced and widely used in clinical practices in developed countries. These systems can monitor intrathoracic pressure changes and air leaks in real time, and also allow for objective and quantitative analyses, which aid in managing patients with a prolonged persistent air leak into the pleural space. We investigated the feasibility and effectiveness of such a new device versus the traditional vacuum system for treating patients with pneumothorax.MethodsClosed thoracostomy drainage was carried out on 100 adult patients with primary or secondary pneumothorax between January 2017 and December 2018. All the patients were aged ≥18 years and treated with a chest tube at a single medical center by the same cardiothoracic surgeons and intensivists. Patients who underwent closed thoracostomy drainage using an indwelling 24-French chest tube were divided into 2 groups immediately before closed thoracostomy: the digital thoracic drainage group (digital group, n=50) and the traditional analogue thoracic drainage group (analogue group, n=50). The detailed information about demographic data, treatment outcome, duration of indwelling catheterization., hospital days, cost-effectiveness and patient satisfaction was evaluated. We also evaluated whether digitally recorded intrapleural pressure changes and air leaks would predict chest tube removal timing and outcome.ResultsThe baseline parameters of the 2 groups were comparable with no significant differences in sex, age, weight or body mass index. The mean hospital day was shorter in the digital group than in the analogue group (17.96±12.23 vs. 18.32±16.64, P=0.902), and there was no statistically significant difference in the hospital length of stay between the 2 groups. Air leaks through the chest tube and duration of chest tube indwelling hours showed no significant statistical differences between the digital and analogue groups (213.47±219.80 vs. 261.94±184.47, P=0.235 and 223.44±218.75 vs 275.29±186.06, P=0.205, respectively). Total drainage amount and ambulation time per day were significantly higher in the digital group than in the analogue group [209.62±139.63 vs. 162.48±80.42 (P=0.042) and 6.42±3.62 vs.3.94±1.74 (P<0.001), respectively]. Hours of full expansion were significantly shorter and sleep disturbance caused by the noise of chest tube drainage was less in the digital group than in the analogue group [25.64±14.55 vs. 46.52±25.53 (P<0.001) and 2.38±1.03 vs. 5.70±2.87 (P<0.001), respectively].ConclusionsTo date, there is no definite consensus and guidelines on the standardized digital suction system in pneumothorax. This study proposed the guidelines for the application of digital thoracic drainage systems in pneumothorax and also suggested that digital thoracic drainage systems might be a valuable tool to determine chest tube removal timing and reducing the length of hospital stay in patients with pneumothorax.

Clinico-radiological profile and outcome of patients undergoing intercostal tube drainage in a tertiary care hospital in West Bengal, India

Introduction: Evacuation of empyema which was first performed centuries ago, marked the beginning of thoracic drainage. The subsequent acquisition of a greater knowledge of the anatomy, physiology, and pathology of the pleural space directed the design of thoracic catheters and drainage systems and the development of the methods by which they are used. Thoracic drainage systems are designed to remove air and liquids from the pleural space or mediastinum, which collect there as a result of injury, disease, or surgical procedures. Method: A total of 100 patients who underwent intercostal tube drainage due to various etiologies are followed up for 3 months in the study Results: In this study it was observed that pneumothorax (67%) as the most common indication for chest drain insertion followed by hydro-pneumothorax. During this period 100 patients of different pathologies related to chest underwent chest intubations. Amongst them 88(88%) were male and 12(12%) were female. Subcutaneous emphysema was found to be the most common complication followed by ICD tube blockage. Among the study population 95% patients were successfully treated & unsuccessful outcome was only 5%. Conclusion: Chest tube insertion is a common procedure usually done for the purpose of draining accumulated air or fluid in the pleural cavity. Small-bore chest tubes (≤14F) are generally recommended as the first-line therapy for spontaneous pneumothorax in non-ventilated patients and pleural effusions in general. Large-bore chest drains may be useful for very large air leaks, as well as post-ineffective trial with small-bore drains.

Complications after Chest Tube Removal and Reinterventions in Patients with Digital Drainage Systems.

Introduction: Digital thoracic drainage systems are a new technology in minimally invasive thoracic surgery. However, the criteria for chest tube removal in digital thoracic drainage systems have never been evaluated. We aim to investigate the incidence and predictive factors of complications and reinterventions after drainage tube removal in patients with a digital drainage system. Method: Patients who received lung resection surgery and had their chest drainage tubes connected with a digital drainage system were retrospectively reviewed. Results: A total of 497 patients were monitored with digital drainage systems after lung resection surgery. A total of 175 (35.2%) patients had air leak-related complications after drainage tube removals, whereas 25 patients (5.0%) required reintervention. We identified that chest drainage duration of five days was an optimal cut-off value in predicting air leak-related complications and reinterventions. In multiple logistic regression analysis, previous chest surgery history; small size (16 Fr.) drainage tubes; the presence of initial air leaks, defined as air leaks recorded by the digital drainage system immediately after operation; and duration of chest drainage ≥5 days were independent factors of air leak-related complications, whereas the presence of initial air leaks and duration of chest drainage ≥5 days were independent predictive factors of reintervention after drainage tube removal. Conclusion: Air leak-related complications and reinterventions after drainage tube removals happened in 35.2% and 5.0% of patients with digital thoracic drainage systems. The management of chest drainage tubes in patients with predictive factors, i.e., the presence of initial air leaks and duration of chest drainage of more than five days, should be treated with caution.

EP1.17-33 Predictors of Air-Related Complication and Re-Intervention After Pleural Drainage Tube Removal in Digital Thoracic Drainage System Use

EP1.17-33 Predictors of Air-Related Complication and Re-Intervention After Pleural Drainage Tube Removal in Digital Thoracic Drainage System Use

P1.16-23 Comparison of Electronic and Traditional Thoracic Drainage Systems for Postoperative Chest Tube Management After Pulmonary Resection

P1.16-23 Comparison of Electronic and Traditional Thoracic Drainage Systems for Postoperative Chest Tube Management After Pulmonary Resection

New Concept for a Thoracic Drainage System Using Magnetic Actuation.

Objectives. Thoracic drainage is a common procedure to drain fluid, blood, or air from the pleural cavity. Some attempts to develop approaches to new thoracic drainage systems have been made; however, a simple tube is often currently used. The existing drain presupposes that it is placed correctly and that the tip does not require moving after insertion into the thoracic cavity. However, in some cases, the drain is not correctly placed and reinsertion of an additional drain is required, resulting in significant invasiveness to the patient. Therefore, a more effective drainage system is needed. This study aimed to develop and assess a new thoracic drain via a collaboration between medical and engineering personnel. Methods. We developed the concept of a controllable drain system using magnetic actuation. A dry laboratory trial and accompanying questionnaire assessment were performed by a group of thoracic and general surgeons. Objective mechanical measurements were obtained. Porcine experiments were also carried out. Results. In a dry laboratory trial, use of the controllable drain required significantly less time than that required by replacing the drain. The average satisfaction score of the new drainage system was 4.07 out of 5, indicating that most of the research participants were satisfied with the quality of the drain with a magnetic actuation. During the porcine experiment, the transfer of the tip of the drain was possible inside the thoracic cavity and abdominal cavity. Conclusion. This controllable thoracic drain could reduce the invasiveness for patients requiring thoracic or abdominal cavity drainage.

On the Reduction of the Biological Danger of Environmental Contamination by Using a “Complete and Reusable Thoracic Drainage System”

A clean environment is essential for human health and well-being. A significant share of total waste is represented by hospital waste that is produced in increasing quantities by sanitary units, with the appearance of the disposable tools. Taking into account the unfavourable environmental impact, the biological danger that this waste represents, and the restrictive legislation imposed by the European Union, urgent measures are needed to reduce their quantities. In this regard, the paper refers to the design of a completely reusable thoracic drainage system and to the positive implications that this system has on the amount of hospital waste. The research starts with the presentation of the medical system from Romania, continues with the classification of the hospital waste, then highlights the dangers and the risks caused by this and analyzes the impact on the sensitive groups. Furthermore, the paper presents the disposable bicameral and tricameral thoracic drainage device systems used in hospitals and then the advantages of using a completely reusable thoracic drainage system. The paper introduces also a research method based on the “opinion questioning”. The method uses a questionnaire with 23 items, addressed to physicians, because, despite restrictive legislation related to hospital waste management, this is not always respected. Each participant of the study works in a different hospital so that the questioned sample is representative.

Treatment of Chylothorax with Pleurodesis, a Lesser Known Complication of Behçet's Disease: A Case Report

Behçet's Disease (BD) is a multisystemic vasculitis which usually affects optical, genital, and oral mucosae and often reoccurs intermittently. Chylothorax is a very rare complication of BD which usually causes thrombosis in the major venous system. A 27-year-old man with a 10-year history of BD referred to our cardiovascular surgery department with symptoms of serious aches in the left arm, edema, and apparent veins on the left anterior chest wall. A total thrombosis of the left internal and external jugular veins and the left subclavian vein was observed. One month after a successful treatment and discharge, the patient returned to our clinic with symptoms of dyspnea and coughs. A chest radiograph showed a consolidated region. A milky liquid was aspirated through thoracocentesis from the left thorax, and its biochemical analysis helped us arrive at a diagnosis of chylothorax. The patient was hospitalized and administered corticosteroids and immunosuppressive therapy with a high-carbohydrate and low-fat dietary regimen for BD. Thereafter, a left thoracic drainage system was established. On the seventh day of hospitalization, due to a progressing cheilosis flow, a pleurodesis process was applied with talcum powder. However, the chylous drainage was continued and 60 mL of venous autologous blood was injected into the left thorax through a drainage tube. The treatment was successful, and the patient was discharged from the hospital uneventfully. At 1 month's follow-up, the chest radiograph was normal.

Digital thoracic drainage: a new system to monitor air leaks in pediatric population

IntroductionNew digital thoracic drainage systems allow an objective measurement of air leakage. They have proven their usefulness in the postoperative thoracic surgery in adults, but there is little experience with its use in the pediatric population. The objective of our study is to analyze their safety and effectiveness in the postoperative period of the pediatric patients. MethodA prospective consecutive observational study was done. All patients submitted to pulmonary resection between 2011 and 2017 and in whom digital thoracic drainage system was used (Thopaz Chest Drain System, Medela, Switzerland) were prospectively enrolled in this study. We analyzed variables: duration of chest tube (CT), days of hospitalization and radiographs in the immediate postoperative period related to the presence of CT. This group was compared with a historical cohort of patients (from 2011 to 2015) with a pulmonary resection in whom the traditional thoracic drainage was used. For the statistical analysis, the Mann–Whitney U-Test was used for independent samples. ResultTwenty-six patients were included, Digital drainage system was used in13 patients and traditional drainage was used in 13 patients. The median age was 18 months (12 days-14 years). The mean number of days with the chest tube was 1.69 ± 0.6 in digital drainage group versus 5.38 ± 4 days in traditional drainage group (p < 0.05) The mean number of postoperative radiographs was 2.8 ± 1.1 in digital drainage group versus 6.23 ± 5.2 radiographs in traditional drainage group (p < 0.05). The average hospital stay in digital drainage group was 5.69 ± 2.7 days versus 7 ± 4.7 days in the traditional drainage group (p > 0.05). No complications related to the use of digital drainage group were registered. ConclusionThe digital thoracic drainage systems provide an objective measurement of air leakage, allowing early chest tube removal and decreasing the number of radiographs performed postoperatively. Its use in the pediatric population appears to be safe and potentially beneficial. Level of evidenceII.

Comparison of digital and traditional thoracic drainage systems for postoperative chest tube management after pulmonary resection: A prospective randomized trial

ObjectiveThe objective of this study was to evaluate whether a digital thoracic drainage system (group D) is clinically useful compared with a traditional thoracic drainage system (group T) in chest tube management following anatomic lung resection. MethodsPatients scheduled to undergo segmentectomy or lobectomy were prospectively randomized before surgery to group D or T. A stratification randomization was performed according to the following air leak risk factors: age, sex, smoking status, and presence of emphysema and/or chronic obstructive pulmonary disease. The primary end point was the duration of chest tube placement. ResultsNo statistically significant differences were found between groups D (n = 135) and T (n = 164) with regard to the duration of chest tube placement (median, 2.0 vs 3.0 days; P = .149), duration of hospitalization (median, 6.0 vs 7.0 days; P = .548), or frequency of postoperative adverse events (25.1% vs 20.7%; P = .361). In subgroup analyses of the 64 patients with postoperative air leak (20 in group D and 44 in group T), the duration of chest tube placement (median, 4.5 vs 4.0 days; P = .225) and duration of postoperative air leak (median, 3.0 vs 3.0 days; P = .226) were not significantly different between subgroups. ConclusionsThe use of a digital thoracic drainage system did not shorten the duration of chest tube placement in comparison to a traditional thoracic drainage system after anatomic lung resection.

Utility of Objective Chest Tube Management After Pulmonary Resection Using a Digital Drainage System

We sought to evaluate the clinical utility of chest tube management after pulmonary resection based on objective digital monitoring of pleural pressure and digital surveillance for air leaks. We prospectively recorded the perioperative data of 308 patients who underwent pulmonary resection between December 2013 and January 2016. We used information from a digital monitoring thoracic drainage system to measure peak air leakage during the first 24 hours after the operation, patterns of air leakage over the first 72 hours, and patterns of pleural pressure changes until the chest tubes were removed. There were 240 patients with lung cancer and 68 patients with other diseases. The operations included 49 wedge resections, 58 segmentectomies, and 201 lobectomies. A postoperative air leak was observed in 61 patients (20%). A prolonged air leak exceeding 20 mL/min lasting 5 days or more was observed in 18 patients (5.8%). Multivariate analysis of various perioperative factors showed forced expiratory volume in 1 second below 70%, patterns of air leakage, defined as exacerbating and remitting or without a trend toward improvement, and peak air leakage of 100 mL/min or more were significant positive predictors of prolonged air leak. Fluctuations in pleural pressure occurred justafter the air leakage rate decreased to less than 20mL/min. Digital monitoring of peak air leakage and patterns of air leakage were useful for predicting prolonged air leak after pulmonary resection. Information on the disappearance of air leak could be derived from the change in the rate of air leakage and from the increase in fluctuation of pleural pressure.

ポータブル型胸腔ドレナージ装置（トパーズ）使用下に起こった肺全摘後進行性皮下気腫の1例

症例は62歳男性．右肺扁平上皮癌にて術前放射線化学療法後に胸腔鏡補助下右肺全摘術（ND2a-2）を施行した．ポータブル型胸腔ドレナージ装置であるThopazⓇ（トパーズ）にblakeドレーンⓇをつなげて術後胸腔内ドレナージした．術後，咳嗽が多く認められ，皮下気腫が増加した．トパーズのエアリーク表示量はほぼ0 ml/分であった．気管支鏡で気管支断端瘻がないことを確認した．トパーズのドレナージトラブルと判断し，ドレーン抜去すると皮下気腫は軽快した．トパーズには胸腔内圧調節機能があり，胸腔内が過陰圧になるとバルブが開き空気を吸い込ませる機能がある．本症例では咳嗽による急激な胸腔内圧上昇時に胸腔内の空気が皮下に漏れ，その結果起こった胸腔内圧の低下を感知したトパーズ経由で胸腔内へ空気が流入するという機序を繰り返したと考えられた．

The effect of intrathoracic pressure changes recorded by digital thoracic drainage system on cardiac functions

Aim: Intrathoracic pressure changes can be determined numerically with digital thoracic drainage systems which can be attached to the chest tubes. Echocardiography can be used in the evaluation of cardiac function and it is more practical, inexpensive and non-invasive method than cardiac catheterization and radionuclide ventriculography. In our study, we investigated intrathoracic pressure changes while documenting the effects of these changes on cardiac functions.

Bronchial valve treatment for pulmonary air leak after anatomical lung resection for cancer

A persistent post-operative pulmonary expiratory air leak after an anatomical pulmonary resection is usually managed conservatively, but can be associated with significant morbidity and increased costs. The use of bronchial valves is a minimally invasive method that may be an effective and safe treatment in this setting. In a prospective study, the clinical efficacy of intrabronchial valve treatment in patients with a prolonged persistent pulmonary air leak after anatomical surgical resection for cancer was investigated. 10 out of 277 patients with anatomical pulmonary resection for cancer were included, and 90% were scheduled for valve treatment. We demonstrated an air leak cessation at a median of 2 days after valve placement, which resulted in chest tube removal at a median of 4 days after valve placement. Elective removal of the intrabronchial valves could be safely planned 3 weeks after valve implantation. Lung function alteration associated with airway occlusion by valves was limited. Intrabronchial valve treatment with the aid of a digital thoracic drainage system is an effective and safe therapy for patients with a prolonged pulmonary air leak after anatomical lung resection for cancer.

Effectiveness assessment when treating with a closed thoracic drainage system

Background: The role of nursing in the management of chest drains is diverse and important. There is a paucity of data regarding the management of chest drains by nurses. Objective: To establish an evaluation system for nurses to help guide the care of patients being treated with closed thoracic drainage tubes. Methods: An ADC (availability, dependability, and capacity) model was used as the framework to evaluate treatment guidelines. A questionnaire was developed and tested for reliability and validity based on experimental models of thoracic drainage. Patients were subsequently randomly selected and screened using the effectiveness assessment form. Results: Overall dimension scores and subgroups were correlated (r > 0.7). Test-retest reliability met required standards (r = 0.769-0.889, p Conclusions: The proposed assessment form provides an evidence-based tool for nurses to effectively manage patients with closed thoracic drainage systems. Experimental and clinical measures confirm the tool's reliability and validity. Keywords: Closed thoracic chest drain, evidence-based, nurses

Cuidados com o sistema de drenagem torácica em adultos internados no Hospital Universitário Regional de Maringá, Estado do Paraná, Brasil

The handling of adults’ closed thoracic drainage systems at the University Hospital of Maringa, Maringa, Parana State, Brazil during a 10-month period was prospectively evaluated. Ninety thoracic drainages in 75 patients were analyzed. Traumatic causes in young patients determined pleural drainage (61/90, 68%). The absence of an omental tag of tape as a complementary tube fixation was the most common, albeit isolated case, occurrence in the procedure. In fact, it has been routinely found in 20% (18/90) of cases. Whereas tube obstruction (due to kinking, siphoning, clotting or fibrin) was detected in 12% (11/90) of drainage cases, drainage complications (subcutaneous emphysema, infection, accidental dislodgement, pneumothorax following chest tube removal) occurred in 21% (20/90) of cases. Adequate handling of tube thoracostomy reduces morbidity related to this procedure. Current research enhances the importance of continuous training and of textbooks that would standardize procedures for health teams whose role involves interventions in the thoracic drainage system.

Research in effectiveness evaluation indicator for thoracic close drainage system

Objective To establish a scientific, objective and practical evaluation scale for thoracic close drainage system. Methods Based on the evidence-based practice and related documents, the indicators of efficiency for thoracic close drainage system were identified tentatively. Then Delphi method was used and 23 experts were investigated and consulted by two rounds. Results The index of experts activity was 92% and 100% in the first and second round of Delphi consultation, respectively. The scale comprised 50 indicators in 3 dimensions, the experts' authority coefficient was 0.987. Conclusions The reliability and authority of the scale are acceptable and it can be used to evaluate the efficiency of thoracic close drainage system. Key words: Thoracic close drainage; Effectiveness evaluation; Delphi method