When to remove a chest tube?: A randomized study with subsequent prospective consecutive validation
Operative procedures on the pleural space are usually managed by chest tube drainage. Timing for removing the tube is empirically established, with wide variation among surgeons. Our objective was to evaluate the effectiveness and safety of establishing a volume of 200 mL/d of uninfected drainage as...
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Published in | Journal of the American College of Surgeons Vol. 195; no. 5; pp. 658 - 662 |
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Main Authors | , , , , |
Format | Journal Article |
Language | English |
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New York, NY
Elsevier Inc
01.11.2002
Elsevier Science |
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Abstract | Operative procedures on the pleural space are usually managed by chest tube drainage. Timing for removing the tube is empirically established, with wide variation among surgeons. Our objective was to evaluate the effectiveness and safety of establishing a volume of 200 mL/d of uninfected drainage as a threshold for removal of chest tube, as compared with more frequently used volumes of 100 and 150 mL/d.
A prospective randomized study was performed in a single institution. Patients (n = 139) submitting to pleural drainage after surgical procedures were randomized to one of three groups, defined by the planned timing of chest tube removal (depending on the threshold volume per day of pleural fluid drained): G-100 (≤100 mL/d, n = 44); G-150 (≤150 mL/d, n = 58); and G-200 (≤200 mL/d, n = 37). Subsequently, another 91 consecutive patients had chest tubes removed when drainage was less than 200 mL/d (G-val, prospective validation group). All patients had similar discharge and 60-day followup. Drainage time, hospital stay, and reaccumulation rate were registered.
Drainage time (median days: 3.5 for G-100, 3 for G-150, 3 for G-200, 3 for G-val) and hospital stay (median days: 4 for G-100, 3 for G-150, 3 for G-200, 3 for G-val) were not statistically different among groups. Radiologic reaccumulation rates were 9.1% for G-100, 13.1% for G-150, 5.4% for G-200, and 10.9% for G-val, and the thoracenteses rates were 2.3%, 0.8%, 2.7%, and 3.3%, respectively, with no major differences among groups (G-100 versus G-150 versus G-200; G-200 versus G-val).
Increasing the threshold of daily drainage to 200 mL before removing the chest tube did not markedly affect drainage, hospitalization time, or overall costs, nor did it increase the likelihood of major pleural fluid reaccumulation. This volume (200 mL/d) could be recommended for chest tube withdrawal decision for uninfected pleural fluid with no evidence of air leaks. |
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AbstractList | BACKGROUNDOperative procedures on the pleural space are usually managed by chest tube drainage. Timing for removing the tube is empirically established, with wide variation among surgeons. Our objective was to evaluate the effectiveness and safety of establishing a volume of 200 mL/d of uninfected drainage as a threshold for removal of chest tube, as compared with more frequently used volumes of 100 and 150 mL/d.STUDY DESIGNA prospective randomized study was performed in a single institution. Patients (n = 139) submitting to pleural drainage after surgical procedures were randomized to one of three groups, defined by the planned timing of chest tube removal (depending on the threshold volume per day of pleural fluid drained): G-100 (< or = 100 mL/d, n = 44); G-150 (< or =150 mL/d, n = 58); and G-200 (< or = 200 mL/d, n = 37). Subsequently, another 91 consecutive patients had chest tubes removed when drainage was less than 200 mL/d (G-val, prospective validation group). All patients had similar discharge and 60-day followup. Drainage time, hospital stay, and reaccumulation rate were registered.RESULTSDrainage time (median days: 3.5 for G-100, 3 for G-150, 3 for G-200, 3 for G-val) and hospital stay (median days: 4 for G-100, 3 for G-150, 3 for G-200, 3 for G-val) were not statistically different among groups. Radiologic reaccumulation rates were 9.1% for G-100, 13.1% for G-150, 5.4% for G-200, and 10.9% for G-val, and the thoracenteses rates were 2.3%, 0.8%, 2.7%, and 3.3%, respectively, with no major differences among groups (G-100 versus G-150 versus G-200; G-200 versus G-val).CONCLUSIONSIncreasing the threshold of daily drainage to 200 mL before removing the chest tube did not markedly affect drainage, hospitalization time, or overall costs, nor did it increase the likelihood of major pleural fluid reaccumulation. This volume (200 mL/d) could be recommended for chest tube withdrawal decision for uninfected pleural fluid with no evidence of air leaks. Operative procedures on the pleural space are usually managed by chest tube drainage. Timing for removing the tube is empirically established, with wide variation among surgeons. Our objective was to evaluate the effectiveness and safety of establishing a volume of 200 mL/d of uninfected drainage as a threshold for removal of chest tube, as compared with more frequently used volumes of 100 and 150 mL/d. A prospective randomized study was performed in a single institution. Patients (n = 139) submitting to pleural drainage after surgical procedures were randomized to one of three groups, defined by the planned timing of chest tube removal (depending on the threshold volume per day of pleural fluid drained): G-100 (< or = 100 mL/d, n = 44); G-150 (< or =150 mL/d, n = 58); and G-200 (< or = 200 mL/d, n = 37). Subsequently, another 91 consecutive patients had chest tubes removed when drainage was less than 200 mL/d (G-val, prospective validation group). All patients had similar discharge and 60-day followup. Drainage time, hospital stay, and reaccumulation rate were registered. Drainage time (median days: 3.5 for G-100, 3 for G-150, 3 for G-200, 3 for G-val) and hospital stay (median days: 4 for G-100, 3 for G-150, 3 for G-200, 3 for G-val) were not statistically different among groups. Radiologic reaccumulation rates were 9.1% for G-100, 13.1% for G-150, 5.4% for G-200, and 10.9% for G-val, and the thoracenteses rates were 2.3%, 0.8%, 2.7%, and 3.3%, respectively, with no major differences among groups (G-100 versus G-150 versus G-200; G-200 versus G-val). Increasing the threshold of daily drainage to 200 mL before removing the chest tube did not markedly affect drainage, hospitalization time, or overall costs, nor did it increase the likelihood of major pleural fluid reaccumulation. This volume (200 mL/d) could be recommended for chest tube withdrawal decision for uninfected pleural fluid with no evidence of air leaks. Operative procedures on the pleural space are usually managed by chest tube drainage. Timing for removing the tube is empirically established, with wide variation among surgeons. Our objective was to evaluate the effectiveness and safety of establishing a volume of 200 mL/d of uninfected drainage as a threshold for removal of chest tube, as compared with more frequently used volumes of 100 and 150 mL/d. A prospective randomized study was performed in a single institution. Patients (n = 139) submitting to pleural drainage after surgical procedures were randomized to one of three groups, defined by the planned timing of chest tube removal (depending on the threshold volume per day of pleural fluid drained): G-100 (≤100 mL/d, n = 44); G-150 (≤150 mL/d, n = 58); and G-200 (≤200 mL/d, n = 37). Subsequently, another 91 consecutive patients had chest tubes removed when drainage was less than 200 mL/d (G-val, prospective validation group). All patients had similar discharge and 60-day followup. Drainage time, hospital stay, and reaccumulation rate were registered. Drainage time (median days: 3.5 for G-100, 3 for G-150, 3 for G-200, 3 for G-val) and hospital stay (median days: 4 for G-100, 3 for G-150, 3 for G-200, 3 for G-val) were not statistically different among groups. Radiologic reaccumulation rates were 9.1% for G-100, 13.1% for G-150, 5.4% for G-200, and 10.9% for G-val, and the thoracenteses rates were 2.3%, 0.8%, 2.7%, and 3.3%, respectively, with no major differences among groups (G-100 versus G-150 versus G-200; G-200 versus G-val). Increasing the threshold of daily drainage to 200 mL before removing the chest tube did not markedly affect drainage, hospitalization time, or overall costs, nor did it increase the likelihood of major pleural fluid reaccumulation. This volume (200 mL/d) could be recommended for chest tube withdrawal decision for uninfected pleural fluid with no evidence of air leaks. |
Author | Gross, Jefferson L Haddad, Fabio J Younes, Riad N Deheinzelin, Daniel Aguiar, Samuel |
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References_xml | – volume: 75 start-page: 471 year: 1999 end-page: 474 ident: BIB7 article-title: A regional survey of chest drains publication-title: Postgrad Med contributor: fullname: Hasan – volume: 58 start-page: 248 year: 1997 end-page: 252 ident: BIB3 article-title: Insertion of a chest drain publication-title: Br J Hosp Med contributor: fullname: Treasure – volume: 66 start-page: 1751 year: 1998 end-page: 1754 ident: BIB6 article-title: Early chest tube removal after video-assisted thoracoscopic wedge resection of the lung publication-title: Ann Thorac Surg contributor: fullname: Magovern – volume: 179 start-page: 553 year: 1994 end-page: 557 ident: BIB4 article-title: Randomized study of algorithms for discontinuing tube thoracostomy drainage publication-title: J Am Coll Surg contributor: fullname: Hoyt – volume: 179 start-page: 13 year: 2000 end-page: 16 ident: BIB8 article-title: The efficacy of Xrays after chest tube removal publication-title: Am J Surg contributor: fullname: Dudrick – volume: 46 start-page: 369 year: 1999 end-page: 371 ident: BIB5 article-title: Prospective randomized trial of thoracostomy removal algorithms publication-title: J Trauma contributor: fullname: Boyakye – volume: 112 start-page: 709 year: 1997 end-page: 713 ident: BIB9 article-title: Analysis of chest tube thoracostomy performed by pulmonologists at a teaching hospital publication-title: Chest contributor: fullname: Sahn – volume: 37 start-page: 572 year: 1996 end-page: 576 ident: BIB10 article-title: A questionnaire survey on practice of chest tube management publication-title: Singapore Med J contributor: fullname: Ng |
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Snippet | Operative procedures on the pleural space are usually managed by chest tube drainage. Timing for removing the tube is empirically established, with wide... BACKGROUNDOperative procedures on the pleural space are usually managed by chest tube drainage. Timing for removing the tube is empirically established, with... |
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SubjectTerms | Biological and medical sciences Chest Tubes Female Humans Male Medical sciences Middle Aged Pleural Effusion - surgery Prospective Studies Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Surgery of the respiratory system Thoracic Surgical Procedures - methods Treatment Outcome |
Title | When to remove a chest tube?: A randomized study with subsequent prospective consecutive validation |
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