Fig. 16.1
Mean differential pressure trending in the first hours after pulmonary lobectomy. Left: patients experiencing prolonged air leak (more than 5 days) through chest tube. Right: patients without the complication. Using these data, a mathematical model can be constructed to predict the occurrence of prolonged air leak with the records from the first postoperative hours
According to the data in the literature, storing data on the flow of air through chest tubes or on the postoperative pleural pressures still awaits identification of clinical applications and may be interesting only from a theoretical point of view.
Conclusions
After the analysis of the related literature, I have found evidence supporting the use of digital systems to facilitate the standardization of postoperative care after lung resection by decreasing variations in clinical practice (Table 16.1). For those surgeons recommending postoperative pleural suction, it is obvious that any smart portable suction device allows early mobilization of the patients, but to date it is not clear if pleural suction is advisable or not as a routine in pulmonary resection.
Table 16.1
Evidence and recommendations on the use of digital drainage systems after lung resection
Supposed advantage of the use of digital devices | Grade of evidence | Recommendation | Strength of recommendation |
|---|---|---|---|
Standardized postoperative care facilitated | High | Use digital devices if large variations in clinical practice regarding pleural tubes management are detected | Strong |
Early ambulation facilitated | Very low | Not applicable to the general population of thoracic patients. Only in centers routinely using active suction | Weak |
Length of hospital stay and costs decreased | Moderate | The effect seems to be a consequence of better standardization. Very small savings (less than 1 day) in hospitalization time | Weak |
Improving knowledge on the pleural space after lung resection through the analysis of stored data on pressures and air flow | Very low | Still not applicable to clinical practice. No published benefits for patients | Weak |
A Personal View of the Data
In my personal practice, active suction after lobectomy or lesser lung resection is not indicated. All patients undergoing major thoracic procedures are included in an intensive chest physiotherapy program including early mobilization, which is easily achieved because patients are not required to stay on suction. The physiotherapy program is directly related to a substantially reduced risk of pulmonary complications. Thus, significant improvements can be gained in perioperative care after lung resection unrelated to the type of pleural drainage or suction modality.
Recommendations
Use of digital pleural drainage devices is recommended if large variations in clinical management of pleural tubes are detected, in order to standardize care and reduce costs (Evidence quality high; strong recommendation).
Use of digital pleural drainage devices is not recommended for the general population of thoracic surgery patients who are managed without active suction (Evidence quality low; weak recommendation).
Use of digital pleural drainage devices is not recommended as a means to reduce hospital length of stay or costs (Evidence quality low; weak recommendation).
References
1.
2.
Graham AN, Cosgrove AP, Gibbons JR, McGuigan JA. Randomised clinical trial of chest drainage systems. Thorax. 1992;47:461–2.PubMedCentralPubMedCrossRef
3.
4.
Dernevik L, Belboul A, Rådberg G. Initial experience with the world’s first digital drainage system. The benefits of recording air leaks with graphic representation. Eur J Cardiothorac Surg. 2007;31:209–13.PubMedCrossRef
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
