Chest tube management following pulmonary lobectomy: change of protocol results in fewer air leaks

• Published in: Interactive cardiovascular and thoracic surgery Vol. 12; no. 1; pp. 28 - 31
• Main Authors: Bertholet, Joost W M, Joosten, Joris J A, Keemers-Gels, Mariël E, van den Wildenberg, Frits J H, Barendregt, Wouter B
• Format: Journal Article
• Language: English
• Published: England 01.01.2011
• Subjects: Aged; Chest Tubes; Drainage - adverse effects; Drainage - instrumentation; Female; Humans; Length of Stay; Lung Neoplasms - pathology; Lung Neoplasms - secondary; Lung Neoplasms - surgery; Male; Middle Aged; Netherlands; Pleural Effusion - etiology; Pleural Effusion - surgery; Pneumonectomy - adverse effects; Pneumothorax - etiology; Pneumothorax - prevention & control; Retrospective Studies; Time Factors; Treatment Outcome; Netherlands
• ISSN: 1569-9293; 1569-9285
• DOI: 10.1510/icvts.2010.248716

Much controversy exists regarding the management of chest tubes following pulmonary lobectomy. The objective of this study was to analyse the effect of a new chest tube management protocol on clinical features, such as postoperative air leak, drain characteristics, 30-day postoperative complications and length of hospital stay. We retrospectively analysed 133 patients who underwent pulmonary lobectomy, from January 2005 to December 2008. A new chest tube protocol was introduced on 1 January 2007 and included placement of a single chest tube and early conversion to water seal. The chest tube was removed when air leak had resolved and (non-chylous) fluid drainage was <400 ml/day. The results of patients in the old (n=68) and the new protocol (n=65) were compared. In the new protocol group the median duration of air leak and duration of chest tube drainage declined significantly. Also the length of hospital stay decreased significantly to a median of eight days. The number of reinterventions and 30-day morbidity and mortality rates did not differ significantly. Our data suggest that placement of a single chest tube and early conversion to water seal decreases the duration of air leak and chest tube drainage and length of hospital stay.