TY - JOUR
T1 - The effects of low suction on digital drainage devices after lobectomy using video-assisted thoracoscopic surgery
T2 - A randomized controlled trial
AU - Holbek, Bo Laksáfoss
AU - Christensen, Merete
AU - Hansen, Henrik Jessen
AU - Kehlet, Henrik
AU - Petersen, René Horsleben
PY - 2019/4/1
Y1 - 2019/4/1
N2 - OBJECTIVES 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 cmH 2 O compared to-10 cmH 2 O, using a digital drainage device. METHODS 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. RESULTS For the-2 cmH 2 O and-10 cmH 2 O 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). CONCLUSIONS A low suction level significantly shortened drainage duration, time to air leak cessation and total fluid production, without increasing morbidity. Clinical trial registration number NCT02911259.
AB - OBJECTIVES 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 cmH 2 O compared to-10 cmH 2 O, using a digital drainage device. METHODS 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. RESULTS For the-2 cmH 2 O and-10 cmH 2 O 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). CONCLUSIONS A low suction level significantly shortened drainage duration, time to air leak cessation and total fluid production, without increasing morbidity. Clinical trial registration number NCT02911259.
KW - Chest drains
KW - Enhanced recovery after surgery
KW - Length of stay
KW - Lung cancer
KW - Prolonged air leak
KW - Video-assisted thoracoscopic surgery lobectomy
UR - http://www.scopus.com/inward/record.url?scp=85063272251&partnerID=8YFLogxK
U2 - 10.1093/ejcts/ezy361
DO - 10.1093/ejcts/ezy361
M3 - Journal article
C2 - 30445572
AN - SCOPUS:85063272251
SN - 1010-7940
VL - 55
SP - 673
EP - 681
JO - European Journal of Cardio-Thoracic Surgery
JF - European Journal of Cardio-Thoracic Surgery
IS - 4
ER -
