Aim: We aimed to distinguish a pleural space effect from an active air leak, using a digital chest drain system that provided continuous air flow and pleural pressure checks.
Methods: between March 2010 and October 2011, we employed 144 digital drains for 138 thoracic surgical procedures.
Results: We observed 18 (12.5%) active air leaks, among which 4 (2.8%) were prolonged air leaks characterized by high differential pleural pressure due to increased mean expiratory pressure (>1 cm H2O; p < 0.0001), and 3 (2.1%) late air leaks, all long-lasting (p < 0.0001), predicted by pressure curve divergence before the air flow appearance. We also reported 25 (17.4%) pleural space effects characterized by a high differential pleural pressure, but mainly due to a lower mean inspiratory pressure (<20 cm H2O; p < 0.0001), and especially related to surgical pleurodesis procedures (p < 0.0003) and wide lung resections (p < 0.0002); there was no increasing pneumothorax after provocative clamping.
Conclusions: A digital chest drain system, ensuring continuous air flow and pleural pressure measurement, could clearly identify a pleural space effect, avoiding the frequent misinterpretation of an active air leak, and allowing safe removal of the chest tube at the right time.
VarelaGJiménezMFNovoaNArandaJL. Estimating hospital costs attributable to prolonged air leak in pulmonary lobectomy. Eur J Cardiothorac Surg2005; 27: 329–333.
2.
OkerekeIAlsterJMBlackstoneEHRiceTW. Characterization and importance of air leak after lobectomy. Ann Thorac Surg2005; 79: 1167–1173.
3.
SinghalSFerrarisVABridgesCRCloughERMitchellJDFernandoHC. Management of alveolar air leaks after pulmonary resection. Ann Thorac Surg2010; 89: 1327–1335.
4.
AneggULindenmannJMatziVMujkicDMaierAFritzL. AIRFIX: the first digital postoperative chest tube airflowmetry—a novel method to quantify air leakage after lung resection. Eur J Cardiothorac Surg2006; 29: 867–872.
5.
DernevikLBelboulARådbergG. Initial experience with the world’s first digital drainage system. The benefits of recording air leaks with graphic representation. Eur J Cardiothorac Surg2007; 31: 209–213.
6.
VarelaGJimènezMFNovoaNMArandaJL. Postoperative chest tube management measuring air leak using an electronic device decreases variability in the clinical practice. Eur J Cardiothorac Surg2009; 35: 28–31.
7.
CerfolioRJBryantAS. The benefits of continuous and digital air leak assessment after elective pulmonary resection: a prospective study. Ann Thorac Surg2008; 86: 396–401.
8.
VarelaGBrunelliAJimenézMFDi NunzioLNovoaNArandaJL. Chest drainage suction decreases differential pleural pressure after upper lobectomy and has no effect after lower lobectomy. Eur J Cardiothorac Surg2010; 37: 531–534.
9.
BrunelliASalatiMDi NunzioLXiuméFSabbatiniA. Evaluation of a new chest tube removal protocol using digital air leak monitoring after lobectomy: a prospective randomised trial. Eur J Cardiothorac Surg2010; 37: 56–60.
10.
CerfolioRJMinnichDJBryantAS. The removal of chest tubes despite an air leak or a pneumothorax. Ann Thorac Surg2009; 87: 1690–1694.
11.
Feller-KopmanDParkerMJSchwartzsteinRM. assessment of pleural pressure in the evaluation of pleural effusions. Chest2009; 135: 201–209.
12.
CerfolioRJBassCSPaskAHKatholiCR. Predictors and treatment of persistent air leaks. Ann Thorac Surg2002; 73: 1727–1730.
13.
BrunelliAMonteverdeMBorriASalatiMMarascoRD. Predictors of prolonged air leak after pulmonary lobectomy. Ann Thorac Surg2004; 77: 1205–1210.
14.
BrunelliAXiumeFAl RefaiMSalatiMMarascoRSabbatiniA. Air leaks after lobectomy increase the risk of empyema but not of cardiopulmonary complications: a case-matched analysis. Chest2006; 130: 1150–1156.
