Delphi-Konsens der Deutschen Gesellschaft für Thoraxchirurgie über das Management von Thoraxdrainagen

Zusammenfassung

Einleitung Thoraxdrainagen sind ein wichtiges Arbeitsinstrument, nicht nur in der Thoraxchirurgie, wo sie täglich eingelegt, modifiziert und entfernt werden, sondern in vielen Fachrichtungen bei Auftreten von thorakalen Problemen wie Pneumothorax oder Pleuraergüssen. Ziel dieser Arbeitsgruppe der Deutschen Gesellschaft für Thoraxchirurgie war die Erarbeitung eines Konsensus anhand des Delphi-Verfahrens bez. der Handhabung von Thoraxdrainagen.

Methodik Die Arbeitsgruppe erarbeitete 2 elektronische Delphi-Fragerunden. Als Konsens wurde eine Übereinstimmung in ≥ 75% definiert. Nach der statistischen Auswertung der Ergebnisse der elektronischen Fragerunde erfolgte eine Expertenkonferenz, die in einer finalen Delphi-Abstimmung versucht hat, weiteren Konsens über noch strittige Themen zu erreichen.

Ergebnisse Dreizehn Fragen bez. der Handhabung von Thoraxdrainagen konnten formuliert und abgestimmt werden. Konsens konnte für folgende Themen erreicht werden: Bedingungen der Anlage, Größe der Thoraxdrainage, Anlagetechnik, Diagnostik nach Anlage und vor Entfernung, postinterventionelle Handhabung der Thoraxdrainage, Dokumentation, Zahl der Drainagen nach anatomischer Lungenresektion, Verwendung von Fibrinolytika, Art der Unterdruckerzeugung. Kein Konsens konnte für folgende Themen erreicht werden: Eigenblutpleurodese, Reduktion des angewendeten Sogs bei persistierender Fistelung.

Fazit Die vorliegende Arbeit fasst die Ergebnisse eines Delphi-Prozesses zusammen, der 2017 – 2018 mit Experten aus zertifizierten Kliniken oder hochvolumigen thoraxchirurgischen Einheiten geführt wurde. Insgesamt zeigte sich eine sehr hohe Konsensrate bez. Drainagenanlage, perinterventionellem Management und Entfernungsalgorithmus. Die Handhabung bei hohem Fistelvolumen war der Hauptpunkt, bei dem ein Konsens nicht erreicht werden konnte. Die o. g. Empfehlungen sollen als Ausgangspunkt für die Entwicklung von klinikinternen Standards dienen, da sie auf konsentierten Expertenmeinungen basieren.

Abstract

Background Chest tubes are a valuable instrument and are used on a daily basis – not only by thoracic surgeons but also by a variety of medical specialists who treat pneumothorax or pleural effusions. The goal of the working group of the German Thoracic Society (DGT) was to achieve a consensus on the management of chest tube/drainage using the Delphi process.

Methods The assigned group of the DGT designed and conducted two electronic rounds of questions in all major thoracic and lung cancer centres. Consensus was considered as rate of ≥ 75%. After statistical analysis of the results, an expert meeting took place and a final Delphi process poll was used in order to reach consensus for controversial topics.

Results Thirteen questions on the management of chest tubes were proposed and voted on. A consensus was reached for the following topics: conditions for chest tube insertion, size of drainage/tube, technique of insertion, diagnostic measures after insertion and prior to removal, post-interventional management, documentation, number of chest tubes after anatomical lung resection, use of fibrinolytic agents, type of negative pressure. No consensus was reached for the following topics: autologous blood pleurodesis, reduction of suction in cases of persistent air leakage.

Conclusion Our manuscript depicts the results of a Delphi process in 2017 – 1018 involving experts of the German Thoracic Society from high volume departments certified for thoracic surgery. A very high rate of consensus was documented for topics such as chest tube insertion, peri-interventional management and removal algorithm. The most important topic for which there was no consensus was the case of persistent air leakage. The resulting expert recommendations of the Delphi process could be used as a starting point for internal clinical procedures.

Schlüsselwörter

Thoraxdrainage - Delphi-Konsens - Handhabung

Key words

chest tube - Delphi consensus - management

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