OBJECTIVES Prolonged air leak (PAL >5 days) is an important factor affecting the fast-track discharge protocol. Our goal is to identify which patients are at high risk for PAL after VATS lobectomy and whether the use of a digital chest drain could mitigate predictors. METHODS From January 2017 to November 2020, 465 patients were operated of VATS lobectomy. The patients were randomized (1:1) in two groups depending on the type of drainage connected with their single (28Ch) chest tube: traditional “bubble-in-chamber” chest drainage or digital chest drainage (Drentech™ Palm EVO). To identify potential predictors of PAL and to assess if the digital drainage could reduce the impact of the predictors, we considered separately the two groups of patients. RESULTS We performed 268 right lobectomies and 197 left lobectomies (M/F: 274/191) and we observed 29 pts. with PAL (> 20 ml/min or FE >1; 11 pts. in digital and 18 pts. in traditional group). Mean age was 67.39 years (±9.58) and the histology was, with the exception of 1 case, malignant (primitive or secondary). In the multivariate analysis, in the digital group, pre-operative FEV1 (OR, 0.16, 95%CI: 0.03;0.76, p=0.021) can be considered as a predictor of prolonged air leak. Referring, instead, to traditional chest drainage group, pre-operative FEV1 (OR, 0.95, 95%CI: 0.92;0.99, p=0.006) as well as pre-operative TLC (OR, 2.11, 95%CI: 1.11;4.40, p=0.047) have a role in the development of an air leakage. Comparing pleural pressure values (differential, Δ) of PAL cases Δ pleural pressure is significantly lower (5 cmH2O, IQR:2-7 versus 7 cmH2O, IQR:6-12, p<0.001) than no PAL patients. CONCLUSIONS Video thoracoscopic surgical procedure have different pros such as decreased of duration of chest tube and fast discharge. The analysis identified predictors of PAL in both groups considered and reported that digital chest drainage could lead to further improvement.
MAY THE DIGITAL CHEST DRAINAGE ATTENUATE PREDICTORS OF PROLONGED AIR LEAK AFTER VATS PULMONARY LOBECTOMY? RESULTS OF A PROSPECTIVE MULTICENTER RANDOMIZED STUDY BETWEEN ELECTRONIC AND TRADITIONAL CHEST DRAINAGE SYSTEMS / Andriolo, LUIGI GAETANO; Spagnoli, Alessandra; Marulli, Giuseppe; Comacchio, Giovanni; Brascia, Debora; Lomangino, Ivan; Parini, Sara; Lucia Urgese, Anna; Mendogni, Paolo; Greco, Gaetano; Rena, Ottavio; Nosotti, Mario; Di Rienzo, Gaetano; Rea, Federico. - (2021). (Intervento presentato al convegno 29th Meeting of the European Society of Thoracic Surgeons 20 - 22 June 2021 tenutosi a On line).
MAY THE DIGITAL CHEST DRAINAGE ATTENUATE PREDICTORS OF PROLONGED AIR LEAK AFTER VATS PULMONARY LOBECTOMY? RESULTS OF A PROSPECTIVE MULTICENTER RANDOMIZED STUDY BETWEEN ELECTRONIC AND TRADITIONAL CHEST DRAINAGE SYSTEMS.
Luigi Gaetano Andriolo
;Alessandra Spagnoli;
2021
Abstract
OBJECTIVES Prolonged air leak (PAL >5 days) is an important factor affecting the fast-track discharge protocol. Our goal is to identify which patients are at high risk for PAL after VATS lobectomy and whether the use of a digital chest drain could mitigate predictors. METHODS From January 2017 to November 2020, 465 patients were operated of VATS lobectomy. The patients were randomized (1:1) in two groups depending on the type of drainage connected with their single (28Ch) chest tube: traditional “bubble-in-chamber” chest drainage or digital chest drainage (Drentech™ Palm EVO). To identify potential predictors of PAL and to assess if the digital drainage could reduce the impact of the predictors, we considered separately the two groups of patients. RESULTS We performed 268 right lobectomies and 197 left lobectomies (M/F: 274/191) and we observed 29 pts. with PAL (> 20 ml/min or FE >1; 11 pts. in digital and 18 pts. in traditional group). Mean age was 67.39 years (±9.58) and the histology was, with the exception of 1 case, malignant (primitive or secondary). In the multivariate analysis, in the digital group, pre-operative FEV1 (OR, 0.16, 95%CI: 0.03;0.76, p=0.021) can be considered as a predictor of prolonged air leak. Referring, instead, to traditional chest drainage group, pre-operative FEV1 (OR, 0.95, 95%CI: 0.92;0.99, p=0.006) as well as pre-operative TLC (OR, 2.11, 95%CI: 1.11;4.40, p=0.047) have a role in the development of an air leakage. Comparing pleural pressure values (differential, Δ) of PAL cases Δ pleural pressure is significantly lower (5 cmH2O, IQR:2-7 versus 7 cmH2O, IQR:6-12, p<0.001) than no PAL patients. CONCLUSIONS Video thoracoscopic surgical procedure have different pros such as decreased of duration of chest tube and fast discharge. The analysis identified predictors of PAL in both groups considered and reported that digital chest drainage could lead to further improvement.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
