Chest
Clinical Investigations: SURGERYThe Management of Chest Tubes in Patients With a Pneumothorax and an Air Leak After Pulmonary Resection
Section snippets
Inclusion Criteria
The study population consisted of 838 patients ≥ 21 years old who underwent elective pulmonary resection at the University of Alabama at Birmingham performed by a general thoracic surgeon (R.J.C.) over a 2-year period. Patients who underwent pneumonectomy, video-assisted thoracoscopic resection, or pulmonary resection performed as a part of a larger procedure (ie, decortication for empyema or Ivor Lewis esophagogastrectomy) were excluded. Data were collected prospectively, and the Institutional
Results
Table 1 compares the demographics, some previously identified risk factors for air leaks,5 and the type of surgery for these 86 patients. It also compares the 72 patients who tolerated water seal to the 14 patients who did not.
Variables associated with water seal failure were the diffusion capacity of the lung for carbon monoxide corrected for alveolar volume (Dlco/Va) [reported as percentage of the predicted value] < 60%, an air leak greater than or equal to expiratory 3, and a pneumothorax ≥
Discussion
The management of drains and tubes after many surgical procedures is highly variable.9 Few trials have been dedicated to these issues, and thus surgical opinion has become dictum. We have studied some of the various issues concerning chest tube management often using prospective randomized trials. We have tried to address one specific question at a time in a select group of consecutive patients who have undergone similar operations by one surgeon with similar preoperative, intraoperative, and
Appendix
The RDC classification system classifies an air leak based on when it occurs during the respiratory cycle (the qualitative aspect of the classification system) and how big the air leak is (the quantitative aspect of the system). Briefly, the RDC system labels air leaks as one of four types: continuous (occurring during inspiration and expiration), inspiratory, expiratory, or forced expiratory. A forced expiratory leak is present when a patient has no air leak detected with deep inspiration and
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Cited by (52)
A chest tube after robotic thymectomy is unnecessary
2023, JTCVS OpenThe Prevention and Management of Air Leaks Following Pulmonary Resection
2015, Thoracic Surgery ClinicsCitation Excerpt :These systems have been shown to significantly reduce the variability in deciding when to remove a chest drain31 and to decrease the duration of chest drain and hospital stay in randomized trials.32–34 Further, when using air leak grading systems, the amount of air leak identified in the early postoperative period can be effective in quantifying the risk of having persistent air leak in the later postoperative period and may predict which patients will not tolerate a no-external-suction algorithm.25,35 Traditional pleural drainage systems deliver a fixed level of suction independent from the level of intrapleural pressure, which can be variable depending on several factors, including the column of fluid in the pleural drainage system tubing.
Performing robotic lobectomy and segmentectomy: Cost, profitability, and outcomes
2014, Annals of Thoracic SurgeryCitation Excerpt :This remains true despite the lack of evidence-based medicine to support many of these steps that are done mainly to maintain physician comfort out of tradition. We have challenged this type of dogmatic thinking over the years by studying the management of chest tubes by surgeons for air leaks [14–18], for high chest tube drainage [19], how best to remove a chest tube [20], and the routine use of postoperative chest roentgenograms [21]. In our opinion, these steps can be eliminated, even during thoracotomy in many patients, and thus, the cost-savings is not attributable only to a robotic or video-assisted operation.
Thoracostomy tube placement and drainage
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