Chest Drainage Management after Pulmonary Lobectomy_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZHAO Yongsheng , LIU Lunxu.

Department of Thoracic Surgery，West China Hospital，Sichuan University，Chengdu 610041，P. R. China;

Corresponding author：

Keywords：

Pulmonary lobectomy; 　Chest drainage; 　Management

DOI：

10.7507/1007-4848.20130100

Video：

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Proper management of chest drainage after pulmonary lobectomy is a topic that every thoracic surgeon must face up to. Reasonable chest drainage plays a critical role in postoperative normal physiological recovery. However， there are still controversies and discrepancies in many aspects of chest drainage management after pulmonary lobectomy. In this review，we focus on five aspects of chest drainage management after pulmonary lobectomy，including the choice of chest drainage system，single or double chest tubes，suction or not，treatment of persistent air leak，and removal of chest tube.

Citation： ZHAO Yongsheng,LIU Lunxu.. Chest Drainage Management after Pulmonary Lobectomy. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2013, 20(3): 338-342. doi: 10.7507/1007-4848.20130100 Copy

1.	Okur E， Baysungur V， Tezel C， et al. Comparison of the single or double chest tube applications after pulmonary lobectomies. Eur J Cardiothorac Surg， 2009， 35 （1）：32-35.
2.	Lima VP， Bonfim D， Risso TT， et al. Influence of pleural drainage on postoperative pain， vital capacity and six-minute walk test after pulmonary resection. J Bras Pneumol， 2008， 34 （12）：1003-1007.
3.	Göttgens KW， Siebenga J， Belgers EH， et al. Early removal of the chest tube after complete video-assisted thoracoscopic lobectomies. Eur J Cardiothorac Surg， 2011， 39 （4）：575-578.
4.	时辉，梅龙勇，车国卫．肺癌术后胸腔闭式引流术应用的新观念．中国肺癌杂志， 2010， 13 （11）：999-1003．.
5.	Hyde J， Sykes T， Graham T. Reducing morbidity from chest drains. BMJ， 1997， 314 （7085）：914-915.
6.	Quigley RL. Thoracentesis and chest tube drainage. Crit care Clin， 1995， 11 （1）：111-126.
7.	Rahman NM， Maskell NA， Davies CW， et al. The relationship between chest tube size and clinical outcome in pleural infection. Chest， 2010， 137 （3）：536-543.
8.	Park JK， Kraus FC， Haaga JR. Fluid flow during percutaneous drainage procedures：an in vitro study of the effects of fluid viscosity， catheter size， and adjunctive urokinase. AJR Am J Roentgenol， 1993， 160 （1）：165-169.
9.	Nakamura H， Taniguchi Y， Miwa K， et al. The 19Fr blake drain versus the 28Fr conventional drain after a lobectomy for lung cancer. Thorac Cardiovasc Surg， 2009， 57 （2）：107-109.
10.	Baumann MH. What size chest tube ? What drainage system is ideal ? And other chest tube management questions. Curr Opin Pulm Med， 2003， 9 （4）：276-281.
11.	Light RW. Pleural controversy：optimal chest tube size for drainage. Respirology， 2011， 16 （2）：244-248.
12.	Laws D， Neville E， Duffy J. BTS guidelines for the insertion of a chest drain. Thorax， 2003， 58 （Suppl 2）：ii53-59.
13.	Filosso PL， Giobbe R， Brussino L， et al. Patient’s home care management in persistent air leaks and chronic pneumothorax using a new drainage system. J Cardiovasc Surg （Torino）， 2010， 51 （5）：773-775.
14.	Somolinos SM， Cazas EE， Quetglás FS， et al. Ambulatory treatment of persistent air leaks using a portable chest drainage system：Preliminary results. Cir Esp， 2010， 88 （6）：398-403.
15.	Leeson CE， Weaver RA， Bissell T， et al. PleurAlert：an augmented chest drainage system with electronic sensing， automated alerts and Internet connectivity. Stud Health Technol Inform， 2012， 173：257-259.
16.	Szántó Z， Kovács O. Digital drainage system in the postoperative treatment of thoracic surgical patients. Magy Seb， 2012， 65 （1）：19-23.
17.	Remote-controlled RG. Wireless chest drainage system：an experimental clinical setting. Ann Thorac Surg， 2013， 95 （1）：319-322.
18.	Cerfolio RJ， Varela G， Brunelli A. Digital and smart chest drainage systems to monitor air leaks：the birth of a new era ? Thorac Surg Clin， 2010， 20 （3）：413-420.
19.	Alex J， Ansari J， Bahalkar P， et al. Comparison of the immediate postoperative outcome of using the conventional two drains versus a single drain after lobectomy. Ann Thorac Surg， 2003， 76 （4）：1046-1049.
20.	Gómez-Caro A， Roca MJ， Torres J， et al. Successful use of a single chest drain postlobectomy instead of two classical drains：a randomized study. Eur J Cardiothorac Surg， 2006， 29 （4）：562-566.
21.	Icard P， Chautard J， Zhang X， et al. A single 24F Blake drain after wedge resection or lobectomy：a study on 100 consecutive cases. Eur J Cardiothorac Surg， 2006， 30 （4）：649-651.
22.	Pawelczyk K， Marciniak M， Kacprzak G， et al. One or two drains after lobectomy ? A comparison of both methods in the immediate postoperative period. Thorac Cardiovasc Surg， 2007， 55 （5）：313-316.
23.	Brunelli A， Sabbatini A， Xiume’ F， et al. Alternate suction reduces prolonged air leak after pulmonary lobectomy：a randomized compa-rison versus water seal. Ann Thorac Surg， 2005， 80 （3）：1052-1055.
24.	Marshall MB， Deeb ME， Bleier JI， et al. Suction vs water seal after pulmonary resection：a randomized prospective study. Chest， 2002， 121 （3）：831-835.
25.	Brunelli A， Monteverde M， Borri A， et al. Comparison of water seal and suction after pulmonary lobectomy：a prospective， randomized trial. Ann Thorac Surg， 2004， 77 （6）：1932-1937.
26.	Alphonso N， Tan C， Utley M， et al. A prospective randomized controlled trial of suction versus non-suction to the under-water seal drains following lung resection. Eur J Cardiothorac Surg， 2005， 27 （3）：391-394.
27.	Prokakis C， Koletsis EN， Apostolakis E， et al. Routine suction of intercostal drains is not necessary after lobectomy：a prospective randomized trial. World J Surg， 2008， 32 （11）：2336-2342.
28.	Coughlin SM， Emmerton-Coughlin HM， Malthaner R. Management of chest tubes after pulmonary resection：a systematic review and meta-analysis. Can J Surg， 2012， 55 （4）：264-270.
29.	Adebonojo SA. How prolonged is “prolonged air leak”? Ann Thorac Surg， 1995， 59 （2）：549-550.
30.	余南彬，刘伦旭，蒲江涛．50%葡萄糖溶液在肺手术后持续肺漏气治疗中的应用．中国胸心血管外科临床杂志， 2007， 14 （3）：239．.
31.	Tsukioka T， Inoue K， Oka H， et al. Pleurodesis with a 50% glucose solution in patients with spontaneous pneumothorax in whom an operation is contraindicated. Ann Thorac Cardiovasc Surg. 2012 Dec 26. [Epub ahead of print].
32.	Cobanoglu U， Melek M， Edirne Y. Autologous blood pleurodesis：A good choice in patients with persistent air leak. Ann Thorac Med， 2009， 4 （4）：182-186.
33.	Ahmed A， Page RD. The utility of intrapleural instillation of autologous blood for prolonged air leak after lobectomy. Curr Opin Pulm Med， 2008， 14 （4）：343-347.
34.	Toker A， Dilege S， Tanju S， et al. Perioperative pneumoperitoneum after lobectomy – bilobectomy operations for lung Cancer：a prospective study. Thorac Cardiovasc Surg， 2003， 51 （2）：93-96.
35.	Allibone L. Principles for inserting and managing chest drains. Nurs Times， 2005， 101 （42）：45-49.
36.	Younes RN， Gross JL， Aguiar S， et al. When to remove a chest tube ? A randomized study with subsequent prospective consecutive validation. J Am Coll Surg， 2002， 195 （5）：658-662.
37.	Mckenna RJ Jr， Mahtabifard A， Pickens A， et al. Fast-tracking after video-assisted thoracoscopic surgery lobectomy， segmentectomy， and pneumonectomy， Ann Thorac Surg， 2007， 84 （5）：1663-1667.
38.	Cerfolio RJ， Bryant AS. Results of a prospective algorithm to remove chest tubes after pulmonary resection with high output. J Thorac Cardiovasc Surg， 2008， 135 （2）：269-273.

1. 　Okur E， Baysungur V， Tezel C， et al. Comparison of the single or double chest tube applications after pulmonary lobectomies. Eur J Cardiothorac Surg， 2009， 35 （1）：32-35.
2. 　Lima VP， Bonfim D， Risso TT， et al. Influence of pleural drainage on postoperative pain， vital capacity and six-minute walk test after pulmonary resection. J Bras Pneumol， 2008， 34 （12）：1003-1007.
3. 　Göttgens KW， Siebenga J， Belgers EH， et al. Early removal of the chest tube after complete video-assisted thoracoscopic lobectomies. Eur J Cardiothorac Surg， 2011， 39 （4）：575-578.
4. 　时辉，梅龙勇，车国卫．肺癌术后胸腔闭式引流术应用的新观念．中国肺癌杂志， 2010， 13 （11）：999-1003．.
5. 　Hyde J， Sykes T， Graham T. Reducing morbidity from chest drains. BMJ， 1997， 314 （7085）：914-915.
6. 　Quigley RL. Thoracentesis and chest tube drainage. Crit care Clin， 1995， 11 （1）：111-126.
7. 　Rahman NM， Maskell NA， Davies CW， et al. The relationship between chest tube size and clinical outcome in pleural infection. Chest， 2010， 137 （3）：536-543.
8. 　Park JK， Kraus FC， Haaga JR. Fluid flow during percutaneous drainage procedures：an in vitro study of the effects of fluid viscosity， catheter size， and adjunctive urokinase. AJR Am J Roentgenol， 1993， 160 （1）：165-169.
9. 　Nakamura H， Taniguchi Y， Miwa K， et al. The 19Fr blake drain versus the 28Fr conventional drain after a lobectomy for lung cancer. Thorac Cardiovasc Surg， 2009， 57 （2）：107-109.
10. 　Baumann MH. What size chest tube ? What drainage system is ideal ? And other chest tube management questions. Curr Opin Pulm Med， 2003， 9 （4）：276-281.
11. 　Light RW. Pleural controversy：optimal chest tube size for drainage. Respirology， 2011， 16 （2）：244-248.
12. 　Laws D， Neville E， Duffy J. BTS guidelines for the insertion of a chest drain. Thorax， 2003， 58 （Suppl 2）：ii53-59.
13. 　Filosso PL， Giobbe R， Brussino L， et al. Patient’s home care management in persistent air leaks and chronic pneumothorax using a new drainage system. J Cardiovasc Surg （Torino）， 2010， 51 （5）：773-775.
14. 　Somolinos SM， Cazas EE， Quetglás FS， et al. Ambulatory treatment of persistent air leaks using a portable chest drainage system：Preliminary results. Cir Esp， 2010， 88 （6）：398-403.
15. 　Leeson CE， Weaver RA， Bissell T， et al. PleurAlert：an augmented chest drainage system with electronic sensing， automated alerts and Internet connectivity. Stud Health Technol Inform， 2012， 173：257-259.
16. 　Szántó Z， Kovács O. Digital drainage system in the postoperative treatment of thoracic surgical patients. Magy Seb， 2012， 65 （1）：19-23.
17. 　Remote-controlled RG. Wireless chest drainage system：an experimental clinical setting. Ann Thorac Surg， 2013， 95 （1）：319-322.
18. 　Cerfolio RJ， Varela G， Brunelli A. Digital and smart chest drainage systems to monitor air leaks：the birth of a new era ? Thorac Surg Clin， 2010， 20 （3）：413-420.
19. 　Alex J， Ansari J， Bahalkar P， et al. Comparison of the immediate postoperative outcome of using the conventional two drains versus a single drain after lobectomy. Ann Thorac Surg， 2003， 76 （4）：1046-1049.
20. 　Gómez-Caro A， Roca MJ， Torres J， et al. Successful use of a single chest drain postlobectomy instead of two classical drains：a randomized study. Eur J Cardiothorac Surg， 2006， 29 （4）：562-566.
21. 　Icard P， Chautard J， Zhang X， et al. A single 24F Blake drain after wedge resection or lobectomy：a study on 100 consecutive cases. Eur J Cardiothorac Surg， 2006， 30 （4）：649-651.
22. 　Pawelczyk K， Marciniak M， Kacprzak G， et al. One or two drains after lobectomy ? A comparison of both methods in the immediate postoperative period. Thorac Cardiovasc Surg， 2007， 55 （5）：313-316.
23. 　Brunelli A， Sabbatini A， Xiume’ F， et al. Alternate suction reduces prolonged air leak after pulmonary lobectomy：a randomized compa-rison versus water seal. Ann Thorac Surg， 2005， 80 （3）：1052-1055.
24. 　Marshall MB， Deeb ME， Bleier JI， et al. Suction vs water seal after pulmonary resection：a randomized prospective study. Chest， 2002， 121 （3）：831-835.
25. 　Brunelli A， Monteverde M， Borri A， et al. Comparison of water seal and suction after pulmonary lobectomy：a prospective， randomized trial. Ann Thorac Surg， 2004， 77 （6）：1932-1937.
26. 　Alphonso N， Tan C， Utley M， et al. A prospective randomized controlled trial of suction versus non-suction to the under-water seal drains following lung resection. Eur J Cardiothorac Surg， 2005， 27 （3）：391-394.
27. 　Prokakis C， Koletsis EN， Apostolakis E， et al. Routine suction of intercostal drains is not necessary after lobectomy：a prospective randomized trial. World J Surg， 2008， 32 （11）：2336-2342.
28. 　Coughlin SM， Emmerton-Coughlin HM， Malthaner R. Management of chest tubes after pulmonary resection：a systematic review and meta-analysis. Can J Surg， 2012， 55 （4）：264-270.
29. 　Adebonojo SA. How prolonged is “prolonged air leak”? Ann Thorac Surg， 1995， 59 （2）：549-550.
30. 　余南彬，刘伦旭，蒲江涛．50%葡萄糖溶液在肺手术后持续肺漏气治疗中的应用．中国胸心血管外科临床杂志， 2007， 14 （3）：239．.
31. 　Tsukioka T， Inoue K， Oka H， et al. Pleurodesis with a 50% glucose solution in patients with spontaneous pneumothorax in whom an operation is contraindicated. Ann Thorac Cardiovasc Surg. 2012 Dec 26. [Epub ahead of print].
32. 　Cobanoglu U， Melek M， Edirne Y. Autologous blood pleurodesis：A good choice in patients with persistent air leak. Ann Thorac Med， 2009， 4 （4）：182-186.
33. 　Ahmed A， Page RD. The utility of intrapleural instillation of autologous blood for prolonged air leak after lobectomy. Curr Opin Pulm Med， 2008， 14 （4）：343-347.
34. 　Toker A， Dilege S， Tanju S， et al. Perioperative pneumoperitoneum after lobectomy – bilobectomy operations for lung Cancer：a prospective study. Thorac Cardiovasc Surg， 2003， 51 （2）：93-96.
35. 　Allibone L. Principles for inserting and managing chest drains. Nurs Times， 2005， 101 （42）：45-49.
36. 　Younes RN， Gross JL， Aguiar S， et al. When to remove a chest tube ? A randomized study with subsequent prospective consecutive validation. J Am Coll Surg， 2002， 195 （5）：658-662.
37. 　Mckenna RJ Jr， Mahtabifard A， Pickens A， et al. Fast-tracking after video-assisted thoracoscopic surgery lobectomy， segmentectomy， and pneumonectomy， Ann Thorac Surg， 2007， 84 （5）：1663-1667.
38. 　Cerfolio RJ， Bryant AS. Results of a prospective algorithm to remove chest tubes after pulmonary resection with high output. J Thorac Cardiovasc Surg， 2008， 135 （2）：269-273.

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