Thorac Cardiovasc Surg 2018; 66(07): 595-602
DOI: 10.1055/s-0037-1607443
Original Thoracic
Georg Thieme Verlag KG Stuttgart · New York

Digital Devices Improve Chest Tube Management: Results from a Prospective Randomized Trial

Marco Chiappetta
1   Unità operativa di Chirurgia Toracica, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli, Roma, Italy
,
Filippo Lococo
2   Unit of Thoracic Surgery, Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, Italy
,
Dania Nachira
1   Unità operativa di Chirurgia Toracica, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli, Roma, Italy
,
Leonardo Petracca Ciavarella
1   Unità operativa di Chirurgia Toracica, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli, Roma, Italy
,
Maria Teresa Congedo
1   Unità operativa di Chirurgia Toracica, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli, Roma, Italy
,
Venanzio Porziella
1   Unità operativa di Chirurgia Toracica, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli, Roma, Italy
,
Elisa Meacci
1   Unità operativa di Chirurgia Toracica, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli, Roma, Italy
,
Stefano Margaritora
1   Unità operativa di Chirurgia Toracica, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli, Roma, Italy
› Author Affiliations
Further Information

Publication History

19 July 2017

25 September 2017

Publication Date:
27 October 2017 (online)

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Abstract

Background Digital devices could help clinical practice measuring the air leak, but their role is still debated. Aim of this study is to test advantages using these devices.

Methods From June 2012 to May 2015, we enrolled 95 patients undergoing lobectomy or wedge resection in a prospective randomized trial. Patients were divided into two groups: group D (digital, 50 patients) evaluated with digital device and group E (empirical, 45 patients) evaluated with water seal. Logistic regression analysis and receiver operating characteristic (ROC) curve analysis were used to select and assess predictors of persistent air leak. In group D, chest drain was removed if the air leak was absent or < 0.5 L/h for 12 consecutive hours and in group E if clinical signs of air leak were absent.

Results Mean hospitalization and mean chest tube stay was 6.0 ± 3.3 and 4.4 ± 3.2 days, respectively, prolonged air leak occurred in nine (8%). Hospitalization was 5.8 ± 2.5 versus 6.2 ± 4.2 days (p = 0.5), while mean chest tube stay was 4.1 ± 2.0 versus 4.6 ± 3.5 days (p = 0.4) in group D and group E, respectively. Clamping test was needed in one patient in group D and in seven in group E (p = 0.019). At multivariate analysis, heart disease (p < 0.0001), lobectomy (p < 0.0001), fused fissure (p < 0.0001), and air leakage in first postoperative (p.o.) day were predictors of persistent air leak (AUC on the ROC curve of 69.7%, sensibility: 77.8%). In group D, an air leak value > 0.2 L/h with spikes over 0.5 L/h in third p.o. was predictive of persistent air leak, with chest tube duration of 7.73 ± 5.20 versus 4.32 ± 1.33 days (AUC: 83%, sensitivity: 80%, p < 0.0001).

Conclusion In our experience, digital devices reduced observer variability and mistakes in chest tube management, thus identifying patients at risk for prolonged air leak.

Disclaimer

The German Society for Thoracic and Cardiovascular Surgery (DGTHG) and The Thoracic and Cardiovascular Surgeon neither endorse nor discourage the use of the new technology described in this article.