Effectiveness of the Number of Chest Tubes and how to Remove it after Thoracic Surgery

Mousavian, SA; Naseri, AH; Moslemi, S

Effectiveness of the Number of Chest Tubes and how to Remove it after Thoracic Surgery

Document Type : Original Article

Authors

SA Mousavian ¹

AH Naseri ²

S Moslemi ³

¹ Assistant Professor, Department of Thoracic Surgery, Army University of Medical Sciences, Imam Reza Hospital, Department of General Surgery

² Assistant Professor General Surgery, Aja University of Medical Sciences, Emam Reza Hospital, Tehran, Iran

³ Assistant Professor, Department of General Surgery, Army University of Medical Sciences, Imam Reza Hospital, General Surgery Department

Abstract

Introduction & Objective: At present, based on reference books, at the end of the more thoracic surgeries, two chest tubes are inserted in the anterior and the poster for drainage of air and fluid. Considering the development of thoracic surgery and the advances made, the need to insert two chest tubes and compare it with the embedding of just one tube and also compare the removal of the chest tube in a deep inspiration with deep exhalation will be considered. Materials & Methods: A total of 43 patients referred to the Army Hospitals during the years 95 to 97 who were referred to thoracotomy were randomly assigned a chest tube or two chest tubes. The duration of hospitalization, the amount of pain and re-effusion of fluid after discharge were evaluated. Chest tube removal was done in 22 patients with deep inspiration and 21 patients were in deep expiration. Results: 43 patients aged between 14 and 72 years old, including 27 males and 16 females, were enrolled in the study. Surgery included 21 cases of decortication, 14 cases of hydatid cyst, 3 cases of lobectomy and 5 cases of spontaneous pneumothorax. The amount of pain and duration of hospitalization and patient satisfaction in the group of one chest tube were significantly lower (P < 0.005). The amount of fluid re-accumulation in the group with one chest tube was little more (7 to 4), but not significant (P = 0.05). Taking off chest tube in deep inspiration or expiration if the Valsalva maneuver is done well, there is no difference in the air's lick. Conclusions: The insertion of only one chest tube leads to a reduction in the cost and duration of hospitalization and improves the patient's postoperative activity, but it is necessary for this study to be evaluated in the larger matched group.

Keywords

Chest Tube

Plural Effusion

Pneumothorax

Thoracotomy

1. Miserocchi G, Beretta E, Rivolta I. Respiratory mechanics and fluid dynamics after lung resection surgery. Thorac Surg Clin 2010; 20: 345-57.

2. Albertine KH, Wiener-Kronish JP, Roos PJ, et al. Structure, blood supply, and lymphatic vessels of the sheep’s visceral pleura. Am J Anat 1982; 165;
94-277.

3. Mariassy AT, Wheeldon EB. The pleura: a combined light microscopic, scanning, and transmission electron microscopic study in the sheep. I. Normal pleura. Exp Lung Res 1983; 4: 293-314.

4. Miserocchi G. Physiology and pathophysiology of pleural fluid turnover. Eur Respir J 1997; 10: 219-25.

5. Miserocchi G, Negrini D, Gonano C. Parenchymal stress affects interstitial and pleural pressures in situ lung. J Appl Physiol (1985) 1991; 71: 1967-72.

6. Miserocchi G, Negrini D, Passi A, et al. Development of lung edema: interstitial fluid dynamics and molecular structure. News Physiol Sci 2001; 16:
66-71.

7. Fell SC, DeCamp MM. Technical aspects of lobectomy. In: Shields TW, LoCicero J III, Reed CE, et al, editors. General thoracic surgery. Philadelphia: Lippincott Williams & Wilkins; 2009. p. 421-44.

8. Khan IH, Vaughan R. A national survey of thoracic surgical practice in the UK. Int J Clin Pract 1999;
6-53: 252.

9. Mattioli S, Berrisford RG, Lugaresi ML, et al. Survey on chest drainage systems adopted in Europe. Interact Cardiovasc Thorac Surg 2008; 7: 1155-9.

10. Filosso PL, Sandri A, Felletti G, et al. Preliminary

results of a new small-bore percutaneous pleural catheter used for treatment of malignant pleural effusions in ECOG PS 3-4 patients. Eur J Surg Oncol 2011; 37: 1093-8.

11. 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: 1046-9.

12. Tanaka M, Sagawa M, Usuda K, et al. Postoperative drainage with one chest tube is appropriate for pulmonary lobectomy: a randomized trial. Tohoku J Exp Med 2014; 232: 55-61.

13. Zhou D, Deng XF, Liu QX, et al. Single chest tube drainage is superior to double chest tube drainage after lobectomy: a meta-analysis. J Cardiothorac Surg 2016; 11: 88.

14. Go´mez-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: 562-6.

15. Bell RL, OvadiaP, AbdullahF, etal. Chest tuberemoval: End-inspiration or End-expiration? J Trauma 2001; 50: 674-7.

16. Cerfolio RJ, Bryant AS, Skylizard L, et al. Optimal technique for the removal of chest tubes after pulmonary resection. J Thorac Cardiovasc Surg 2013; 145: 1535-9.

17. French DG, Dilena M, LaPlante S, et al. optimizing postoperative care protocols in thoracic surgery: best evidence and new technology. J Thorac Dis 2016; 8 (Suppl 1): S3-11.