The Society for Translational Medicine: Clinical practice guidelines for the postoperative management of chest tube for patients undergoing lobectomy

S. Gao, Z. Zhang, J. Aragón, A. Brunelli, S. Cassivi, Y. Chai, C. Chen, G. Chen, H. Chen, J.-S. Chen, D.T. Cooke, J.B. Downs, P.-E. Falcoz, W. Fang, P.L. Filosso, X. Fu, S.D. Force, M.I. Garutti, D. Gonzalez-Rivas, D. GossotH.J. Hansen, J. He, B.L. Holbek, J. Hu, Y. Huang, M. Ibrahim, A. Imperatori, M. Ismail, G. Jiang, H. Jiang, Z. Jiang, H.K. Kim, D. Li, G. Li, H. Li, Q. Li, X. Li, Y. Li, Z. Li, E. Lim, C.-C. Liu, D. Liu, L. Liu, Y. Liu, K.W. Lobdell, H. Ma, W. Mao, G. Rocco, M. Salati, G. Veronesi

Research output: Contribution to journalArticle

Abstract

The Society for Translational Medicine and The Chinese Society for Thoracic and Cardiovascular Surgery conducted a systematic review of the literature in an attempt to improve our understanding in the postoperative management of chest tubes of patients undergoing pulmonary lobectomy. Recommendations were produced and classified based on an internationally accepted GRADE system. The following recommendations were extracted in the present review: (I) chest tubes can be removed safely with daily pleural fluid of up to 450 mL (non-chylous and non-sanguinous), which may reduce chest tube duration and hospital length of stay (2B); (II) in rare instances, e.g., persistent abundant fluid production, the use of PrRP/B < 0.5 when evaluating fluid output to determine chest tube removal might be beneficial (2B); (III) it is recommended that one chest tube is adequate following pulmonary lobectomy, except for hemorrhage and space problems (2A); (IV) chest tube clearance by milking and stripping is not recommended after lung resection (2B); (V) chest tube suction is not necessary for patients undergoing lobectomy after first postoperative day (2A); (VI) regulated chest tube suction [-11 (-1.08 kPa) to -20 (1.96 kPa) cmH2O depending upon the type of lobectomy] is not superior to regulated seal [-2 (0.196 kPa) cmH2O] when electronic drainage systems are used after lobectomy by thoracotomy (2B); (VII) chest tube removal recommended at the end of expiration and may be slightly superior to removal at the end of inspiration (2A); (VIII) electronic drainage systems are recommended in the management of chest tube in patients undergoing lobectomy (2B). © Journal of Thoracic Disease.
Original languageEnglish
Pages (from-to)3255-3264
Number of pages10
JournalJournal of Thoracic Disease
Volume9
Issue number9
Publication statusPublished - 2017

Fingerprint

Chest Tubes
Translational Medical Research
Practice Guidelines
Suction
Lung
Drainage
Length of Stay
Thoracic Diseases
Thoracotomy
Thoracic Surgery
Hemorrhage

Keywords

  • Chest tube
  • Drainage system
  • GRADE system
  • Lobectomy
  • Recommendation
  • Article
  • breathing pattern
  • chest tube
  • cost control
  • human
  • length of stay
  • lung lobectomy
  • mortality
  • patient care
  • pleura fluid
  • postoperative care
  • postoperative period
  • practice guideline
  • safety
  • suction
  • suction drain
  • systematic review
  • thoracocentesis
  • thoracotomy
  • thorax pressure
  • tube removal

Cite this

The Society for Translational Medicine: Clinical practice guidelines for the postoperative management of chest tube for patients undergoing lobectomy. / Gao, S.; Zhang, Z.; Aragón, J.; Brunelli, A.; Cassivi, S.; Chai, Y.; Chen, C.; Chen, G.; Chen, H.; Chen, J.-S.; Cooke, D.T.; Downs, J.B.; Falcoz, P.-E.; Fang, W.; Filosso, P.L.; Fu, X.; Force, S.D.; Garutti, M.I.; Gonzalez-Rivas, D.; Gossot, D.; Hansen, H.J.; He, J.; Holbek, B.L.; Hu, J.; Huang, Y.; Ibrahim, M.; Imperatori, A.; Ismail, M.; Jiang, G.; Jiang, H.; Jiang, Z.; Kim, H.K.; Li, D.; Li, G.; Li, H.; Li, Q.; Li, X.; Li, Y.; Li, Z.; Lim, E.; Liu, C.-C.; Liu, D.; Liu, L.; Liu, Y.; Lobdell, K.W.; Ma, H.; Mao, W.; Rocco, G.; Salati, M.; Veronesi, G.

In: Journal of Thoracic Disease, Vol. 9, No. 9, 2017, p. 3255-3264.

Research output: Contribution to journalArticle

Gao, S, Zhang, Z, Aragón, J, Brunelli, A, Cassivi, S, Chai, Y, Chen, C, Chen, G, Chen, H, Chen, J-S, Cooke, DT, Downs, JB, Falcoz, P-E, Fang, W, Filosso, PL, Fu, X, Force, SD, Garutti, MI, Gonzalez-Rivas, D, Gossot, D, Hansen, HJ, He, J, Holbek, BL, Hu, J, Huang, Y, Ibrahim, M, Imperatori, A, Ismail, M, Jiang, G, Jiang, H, Jiang, Z, Kim, HK, Li, D, Li, G, Li, H, Li, Q, Li, X, Li, Y, Li, Z, Lim, E, Liu, C-C, Liu, D, Liu, L, Liu, Y, Lobdell, KW, Ma, H, Mao, W, Rocco, G, Salati, M & Veronesi, G 2017, 'The Society for Translational Medicine: Clinical practice guidelines for the postoperative management of chest tube for patients undergoing lobectomy', Journal of Thoracic Disease, vol. 9, no. 9, pp. 3255-3264.
Gao, S. ; Zhang, Z. ; Aragón, J. ; Brunelli, A. ; Cassivi, S. ; Chai, Y. ; Chen, C. ; Chen, G. ; Chen, H. ; Chen, J.-S. ; Cooke, D.T. ; Downs, J.B. ; Falcoz, P.-E. ; Fang, W. ; Filosso, P.L. ; Fu, X. ; Force, S.D. ; Garutti, M.I. ; Gonzalez-Rivas, D. ; Gossot, D. ; Hansen, H.J. ; He, J. ; Holbek, B.L. ; Hu, J. ; Huang, Y. ; Ibrahim, M. ; Imperatori, A. ; Ismail, M. ; Jiang, G. ; Jiang, H. ; Jiang, Z. ; Kim, H.K. ; Li, D. ; Li, G. ; Li, H. ; Li, Q. ; Li, X. ; Li, Y. ; Li, Z. ; Lim, E. ; Liu, C.-C. ; Liu, D. ; Liu, L. ; Liu, Y. ; Lobdell, K.W. ; Ma, H. ; Mao, W. ; Rocco, G. ; Salati, M. ; Veronesi, G. / The Society for Translational Medicine: Clinical practice guidelines for the postoperative management of chest tube for patients undergoing lobectomy. In: Journal of Thoracic Disease. 2017 ; Vol. 9, No. 9. pp. 3255-3264.
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title = "The Society for Translational Medicine: Clinical practice guidelines for the postoperative management of chest tube for patients undergoing lobectomy",
abstract = "The Society for Translational Medicine and The Chinese Society for Thoracic and Cardiovascular Surgery conducted a systematic review of the literature in an attempt to improve our understanding in the postoperative management of chest tubes of patients undergoing pulmonary lobectomy. Recommendations were produced and classified based on an internationally accepted GRADE system. The following recommendations were extracted in the present review: (I) chest tubes can be removed safely with daily pleural fluid of up to 450 mL (non-chylous and non-sanguinous), which may reduce chest tube duration and hospital length of stay (2B); (II) in rare instances, e.g., persistent abundant fluid production, the use of PrRP/B < 0.5 when evaluating fluid output to determine chest tube removal might be beneficial (2B); (III) it is recommended that one chest tube is adequate following pulmonary lobectomy, except for hemorrhage and space problems (2A); (IV) chest tube clearance by milking and stripping is not recommended after lung resection (2B); (V) chest tube suction is not necessary for patients undergoing lobectomy after first postoperative day (2A); (VI) regulated chest tube suction [-11 (-1.08 kPa) to -20 (1.96 kPa) cmH2O depending upon the type of lobectomy] is not superior to regulated seal [-2 (0.196 kPa) cmH2O] when electronic drainage systems are used after lobectomy by thoracotomy (2B); (VII) chest tube removal recommended at the end of expiration and may be slightly superior to removal at the end of inspiration (2A); (VIII) electronic drainage systems are recommended in the management of chest tube in patients undergoing lobectomy (2B). {\circledC} Journal of Thoracic Disease.",
keywords = "Chest tube, Drainage system, GRADE system, Lobectomy, Recommendation, Article, breathing pattern, chest tube, cost control, human, length of stay, lung lobectomy, mortality, patient care, pleura fluid, postoperative care, postoperative period, practice guideline, safety, suction, suction drain, systematic review, thoracocentesis, thoracotomy, thorax pressure, tube removal",
author = "S. Gao and Z. Zhang and J. Arag{\'o}n and A. Brunelli and S. Cassivi and Y. Chai and C. Chen and G. Chen and H. Chen and J.-S. Chen and D.T. Cooke and J.B. Downs and P.-E. Falcoz and W. Fang and P.L. Filosso and X. Fu and S.D. Force and M.I. Garutti and D. Gonzalez-Rivas and D. Gossot and H.J. Hansen and J. He and B.L. Holbek and J. Hu and Y. Huang and M. Ibrahim and A. Imperatori and M. Ismail and G. Jiang and H. Jiang and Z. Jiang and H.K. Kim and D. Li and G. Li and H. Li and Q. Li and X. Li and Y. Li and Z. Li and E. Lim and C.-C. Liu and D. Liu and L. Liu and Y. Liu and K.W. Lobdell and H. Ma and W. Mao and G. Rocco and M. Salati and G. Veronesi",
note = "Export Date: 2 March 2018 Correspondence Address: He, J.; Department of Thoracic Surgical Oncology, Cancer Institute and Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Cancer CenterChina; email: hejie@cicams.ac.cn Tradenames: Thopaz References: Refai, M., Brunelli, A., Salati, M., The impact of chest tube removal on pain and pulmonary function after pulmonary resection (2012) Eur J Cardiothorac Surg, 41, pp. 820-822. , discussion 823; Brunelli, A., Beretta, E., Cassivi, S.D., Consensus definitions to promote an evidence-based approach to management of the pleural space. A collaborative proposal by ESTS, AATS, STS, and GTSC. (2011) Eur J Cardiothorac Surg, 40, pp. 291-297; Guyatt, G., Gutterman, D., Baumann, M.H., Grading strength of recommendations and quality of evidence in clinical guidelines: report from an American college of chest physicians task force (2006) Chest, 129, pp. 174-181; Atkins, D., Best, D., Briss, P.A., Grading quality of evidence and strength of recommendations (2004) BMJ, 328, p. 1490; Cerfolio, R.J., Varela, G., Brunelli, A., Digital and smart chest drainage systems to monitor air leaks: the birth of a new era? (2010) Thorac Surg Clin, 20, pp. 413-420; Bertholet, J.W., Joosten, J.J., Keemers-Gels, M.E., Chest tube management following pulmonary lobectomy: change of protocol results in fewer air leaks (2011) Interact Cardiovasc Thorac Surg, 12, pp. 28-31; Nakanishi, R., Fujino, Y., Yamashita, T., A prospective study of the association between drainage volume within 24 hours after thoracoscopic lobectomy and postoperative morbidity (2009) J Thorac Cardiovasc Surg, 137, pp. 1394-1399; Cerfolio, R.J., Bryant, A.S., Results of a prospective algorithm to remove chest tubes after pulmonary resection with high output (2008) J Thorac Cardiovasc Surg, 135, pp. 269-273; Bjerregaard, L.S., Jensen, K., Petersen, R.H., Early chest tube removal after video-assisted thoracic surgery lobectomy with serous fluid production up to 500 ml/day (2014) Eur J Cardiothorac Surg, 45, pp. 241-246; Mesa-Guzman, M., Periklis, P., Niwaz, Z., Determining optimal fluid and air leak cut offvalues for chest drain management in general thoracic surgery (2015) J Thorac Dis, 7, pp. 2053-2057; Zhang, Y., Li, H., Hu, B., Early removal of the chest tube after lobectomies: a prospective randomized control study (2013) Zhonghua Wai Ke Za Zhi, 51, pp. 533-537; Zhang, Y., Li, H., Hu, B., A prospective randomized single-blind control study of volume threshold for chest tube removal following lobectomy (2014) World J Surg, 38, pp. 60-67; Xie, H.Y., Xu, K., Tang, J.X., A prospective randomized, controlled trial deems a drainage of 300 ml/day safe before removal of the last chest drain after video-assisted thoracoscopic surgery lobectomy (2015) Interact Cardiovasc Thorac Surg, 21, pp. 200-205; Olgac, G., Cosgun, T., Vayvada, M., Low protein content of drainage fluid is a good predictor for earlier chest tube removal after lobectomy (2014) Interact Cardiovasc Thorac Surg, 19, pp. 650-655; Okur, E., Baysungur, V., Tezel, C., Comparison of the single or double chest tube applications after pulmonary lobectomies (2009) Eur J Cardiothorac Surg, 35, pp. 32-35. , discussion 35-6; Alex, J., Ansari, J., Bahalkar, P., Comparison of the immediate postoperative outcome of using the conventional two drains versus a single drain after lobectomy (2003) Ann Thorac Surg, 76, pp. 1046-1049; G{\'o}mez-Caro, A., Roca, M.J., Torres, J., Successful use of a single chest drain postlobectomy instead of two classical drains: a randomized study (2006) Eur J Cardiothorac Surg, 29, pp. 562-566; Pawelczyk, K., Marciniak, M., Kacprzak, G., One or two drains after lobectomy?. A comparison of both methods in the immediate postoperative period. (2007) Thorac Cardiovasc Surg, 55, pp. 313-316; Tanaka, M., Sagawa, M., Usuda, K., Postoperative drainage with one chest tube is appropriate for pulmonary lobectomy: a randomized trial (2014) Tohoku J Exp Med, 232, pp. 55-61; Gross, S.B., Current challenges, concepts, and controversies in chest tube management (1993) AACN Clin Issues Crit Care Nurs, 4, pp. 260-275; Oakes, L.L., Hinds, P., Rao, B., Chest tube stripping in pediatric oncology patients: an experimental study (1993) Am J Crit Care, 2, pp. 293-301; Lim-Levy, F., Babler, S.A., De Groot-Kosolcharoen, J., Is milking and stripping chest tubes really necessary? (1986) Ann Thorac Surg, 42, pp. 77-80; Pierce, J.D., Piazza, D., Naftel, D.C., Effects of two chest tube clearance protocols on drainage in patients after myocardial revascularization surgery (1991) Heart Lung, 20, pp. 125-130; Isaacson, J.J., George, L.T., Brewer, M.J., The effect of chest tube manipulation on mediastinal drainage (1986) Heart Lung, 15, pp. 601-605; Charnock, Y., Evans, D., Nursing management of chest drains: a systematic review (2001) Aust Crit Care, 14, pp. 156-160; Dango, S., Sienel, W., Passlick, B., Impact of chest tube clearance on postoperative morbidity after thoracotomy: results of a prospective, randomised trial (2010) Eur J Cardiothorac Surg, 37, pp. 51-55; Management of Subcutaneous Emphysema After Pulmonary Resection (2008) Ann Thorac Surg, 85, pp. 1759-1763; Cerfolio, R.J., Bass, C., Katholi, C.R., Prospective randomized trial compares suction versus water seal for air leaks (2001) Ann Thorac Surg, 71, pp. 1613-1617; Coughlin, S.M., Emmerton-Coughlin, H.M.A., Malthaner, R., Management of chest tubes after pulmonary resection: a systematic review and meta-analysis (2012) Can J Surg, 55, pp. 264-270; Marshall, M.B., Deeb, M.E., Bleier, J.I., Suction vs water seal after pulmonary resection: a randomized prospective study (2002) Chest, 121, pp. 831-835; Alphonso, N., Tan, C., Utley, M., A prospective randomized controlled trial of suction versus non-suction to the under-water seal drains following lung resection (2005) Eur J Cardiothorac Surg, 27, pp. 391-394; Ayed, A.K., Suction versus water seal after thoracoscopy for primary spontaneous pneumothorax: prospective randomized study (2003) Ann Thorac Surg, 75, pp. 1593-1596; Brunelli, A., Monteverde, M., Borri, A., Comparison of water seal and suction after pulmonary lobectomy: a prospective, randomized trial (2004) Ann Thorac Surg, 77, pp. 1932-1937. , discussion 1937; Brunelli, A., Sabbatini, A., Xium{\'e}, F., Alternate suction reduces prolonged air leak after pulmonary lobectomy: a randomized comparison versus water seal (2005) Ann Thorac Surg, 80, pp. 1052-1055; Lang, P., Manickavasagar, M., Burdett, C., Suction on chest drains following lung resection: evidence and practice are not aligned (2016) Eur J Cardiothorac Surg, 49, pp. 611-616; Kakhki, A.D., Pooya, M., Pejhan, S., Effect of chest tube suction on air-leak following lung resection (2006) Tanaffos, 5, pp. 37-43; Prokakis, C., Koletsis, E.N., Apostolakis, E., Routine Suction of Intercostal Drains Is Not Necessary After Lobectomy: A Prospective Randomized Trial (2008) World J Surg, 32, pp. 2336-2342; Qiu, T., Shen, Y., Wang, M.Z., External Suction versus Water Seal after Selective Pulmonary Resection for Lung Neoplasm: A Systematic Review. Biondi-Zoccai G, editor. (2013) PLoS One, 8; Deng, B., Tan, Q.Y., Zhao, Y.P., Suction or non-suction to the underwater seal drains following pulmonary operation: meta-analysis of randomised controlled trials (2010) Eur J Cardiothorac Surg, 38, pp. 210-215; Refai, M., Brunelli, A., Varela, G., The values of intrapleural pressure before the removal of chest tube in non-complicated pulmonary lobectomies (2012) Eur J Cardiothorac Surg, 41, pp. 831-833; Brunelli, A., Salati, M., Pompili, C., Regulated tailored suction vs regulated seal: a prospective randomized trial on air leak duration (2013) Eur J Cardiothorac Surg, 43, pp. 899-904; Bell, R.L., Ovadia, P., Abdullah, F., Chest tube removal: end-inspiration or end-expiration? (2001) J Trauma, 50, pp. 674-677; Cerfolio, R.J., Bryant, A.S., Skylizard, L., Optimal technique for the removal of chest tubes after pulmonary resection (2013) J Thorac Cardiovasc Surg, 145, pp. 1535-1539; Varela, G., Jimenez, M.F., Novoa, N., Portable chest drainage systems and outpatient chest tube management (2010) Thorac Surg Clin, 20, pp. 421-426; Bertolaccini, L., Rizzardi, G., Filice, M.J., {"}Six sigma approach{"}-an objective strategy in digital assessment of postoperative air leaks: a prospective randomised study (2011) Eur J Cardiothorac Surg, 39, pp. e128-e132; Pompili, C., Detterbeck, F., Papagiannopoulos, K., Multicenter international randomized comparison of objective and subjective outcomes between electronic and traditional chest drainage systems (2014) Ann Thorac Surg, 98, pp. 490-496. , discussion 496-7; Filosso, P.L., Ruffini, E., Solidoro, P., Digital air leak monitoring after lobectomy for primary lung cancer in patients with moderate COPD: can a fast-tracking algorithm reduce postoperative costs and complications? (2010) J Cardiovasc Surg (Torino), 51, pp. 429-433; Brunelli, A., Salati, M., Refai, M., Evaluation of a new chest tube removal protocol using digital air leak monitoring after lobectomy: a prospective randomised trial (2010) Eur J Cardiothorac Surg, 37, pp. 56-60; Varela, G., Jimenez, M.F., Novoa, N.M., Postoperative chest tube management: measuring air leak using an electronic device decreases variability in the clinical practice (2009) Eur J Cardiothorac Surg, 35, pp. 28-31; Cerfolio, R.J., Bryant, A.S., The benefits of continuous and digital air leak assessment after elective pulmonary resection: a prospective study (2008) Ann Thorac Surg, 86, pp. 396-401; Lijkendijk, M., Licht, P.B., Neckelmann, K., Electronic versus traditional chest tube drainage following lobectomy: a randomized trial (2015) Eur J Cardiothorac Surg, 48, pp. 893-898. , discussion 898; Mier, J.M., Molins, L., Fibla, J.J., The benefits of digital air leak assessment after pulmonary resection: prospective and comparative study (2010) Cir Esp, 87, pp. 385-389; Anegg, U., Lindenmann, J., Matzi, V., AIRFIX: the first digital postoperative chest tube airflowmetry-a novel method to quantify air leakage after lung resection (2006) Eur J Cardiothorac Surg, 29, pp. 867-872; Gilbert, S., McGuire, A.L., Maghera, S., Randomized trial of digital versus analog pleural drainage in patients with or without a pulmonary air leak after lung resection (2015) J Thorac Cardiovasc Surg, 150, pp. 1243-1249",
year = "2017",
language = "English",
volume = "9",
pages = "3255--3264",
journal = "Journal of Thoracic Disease",
issn = "2072-1439",
publisher = "AME Publishing Company",
number = "9",

}

TY - JOUR

T1 - The Society for Translational Medicine: Clinical practice guidelines for the postoperative management of chest tube for patients undergoing lobectomy

AU - Gao, S.

AU - Zhang, Z.

AU - Aragón, J.

AU - Brunelli, A.

AU - Cassivi, S.

AU - Chai, Y.

AU - Chen, C.

AU - Chen, G.

AU - Chen, H.

AU - Chen, J.-S.

AU - Cooke, D.T.

AU - Downs, J.B.

AU - Falcoz, P.-E.

AU - Fang, W.

AU - Filosso, P.L.

AU - Fu, X.

AU - Force, S.D.

AU - Garutti, M.I.

AU - Gonzalez-Rivas, D.

AU - Gossot, D.

AU - Hansen, H.J.

AU - He, J.

AU - Holbek, B.L.

AU - Hu, J.

AU - Huang, Y.

AU - Ibrahim, M.

AU - Imperatori, A.

AU - Ismail, M.

AU - Jiang, G.

AU - Jiang, H.

AU - Jiang, Z.

AU - Kim, H.K.

AU - Li, D.

AU - Li, G.

AU - Li, H.

AU - Li, Q.

AU - Li, X.

AU - Li, Y.

AU - Li, Z.

AU - Lim, E.

AU - Liu, C.-C.

AU - Liu, D.

AU - Liu, L.

AU - Liu, Y.

AU - Lobdell, K.W.

AU - Ma, H.

AU - Mao, W.

AU - Rocco, G.

AU - Salati, M.

AU - Veronesi, G.

N1 - Export Date: 2 March 2018 Correspondence Address: He, J.; Department of Thoracic Surgical Oncology, Cancer Institute and Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Cancer CenterChina; email: hejie@cicams.ac.cn Tradenames: Thopaz References: Refai, M., Brunelli, A., Salati, M., The impact of chest tube removal on pain and pulmonary function after pulmonary resection (2012) Eur J Cardiothorac Surg, 41, pp. 820-822. , discussion 823; Brunelli, A., Beretta, E., Cassivi, S.D., Consensus definitions to promote an evidence-based approach to management of the pleural space. A collaborative proposal by ESTS, AATS, STS, and GTSC. (2011) Eur J Cardiothorac Surg, 40, pp. 291-297; Guyatt, G., Gutterman, D., Baumann, M.H., Grading strength of recommendations and quality of evidence in clinical guidelines: report from an American college of chest physicians task force (2006) Chest, 129, pp. 174-181; Atkins, D., Best, D., Briss, P.A., Grading quality of evidence and strength of recommendations (2004) BMJ, 328, p. 1490; Cerfolio, R.J., Varela, G., Brunelli, A., Digital and smart chest drainage systems to monitor air leaks: the birth of a new era? (2010) Thorac Surg Clin, 20, pp. 413-420; Bertholet, J.W., Joosten, J.J., Keemers-Gels, M.E., Chest tube management following pulmonary lobectomy: change of protocol results in fewer air leaks (2011) Interact Cardiovasc Thorac Surg, 12, pp. 28-31; Nakanishi, R., Fujino, Y., Yamashita, T., A prospective study of the association between drainage volume within 24 hours after thoracoscopic lobectomy and postoperative morbidity (2009) J Thorac Cardiovasc Surg, 137, pp. 1394-1399; Cerfolio, R.J., Bryant, A.S., Results of a prospective algorithm to remove chest tubes after pulmonary resection with high output (2008) J Thorac Cardiovasc Surg, 135, pp. 269-273; Bjerregaard, L.S., Jensen, K., Petersen, R.H., Early chest tube removal after video-assisted thoracic surgery lobectomy with serous fluid production up to 500 ml/day (2014) Eur J Cardiothorac Surg, 45, pp. 241-246; Mesa-Guzman, M., Periklis, P., Niwaz, Z., Determining optimal fluid and air leak cut offvalues for chest drain management in general thoracic surgery (2015) J Thorac Dis, 7, pp. 2053-2057; Zhang, Y., Li, H., Hu, B., Early removal of the chest tube after lobectomies: a prospective randomized control study (2013) Zhonghua Wai Ke Za Zhi, 51, pp. 533-537; Zhang, Y., Li, H., Hu, B., A prospective randomized single-blind control study of volume threshold for chest tube removal following lobectomy (2014) World J Surg, 38, pp. 60-67; Xie, H.Y., Xu, K., Tang, J.X., A prospective randomized, controlled trial deems a drainage of 300 ml/day safe before removal of the last chest drain after video-assisted thoracoscopic surgery lobectomy (2015) Interact Cardiovasc Thorac Surg, 21, pp. 200-205; Olgac, G., Cosgun, T., Vayvada, M., Low protein content of drainage fluid is a good predictor for earlier chest tube removal after lobectomy (2014) Interact Cardiovasc Thorac Surg, 19, pp. 650-655; Okur, E., Baysungur, V., Tezel, C., Comparison of the single or double chest tube applications after pulmonary lobectomies (2009) Eur J Cardiothorac Surg, 35, pp. 32-35. , discussion 35-6; Alex, J., Ansari, J., Bahalkar, P., Comparison of the immediate postoperative outcome of using the conventional two drains versus a single drain after lobectomy (2003) Ann Thorac Surg, 76, pp. 1046-1049; Gómez-Caro, A., Roca, M.J., Torres, J., Successful use of a single chest drain postlobectomy instead of two classical drains: a randomized study (2006) Eur J Cardiothorac Surg, 29, pp. 562-566; Pawelczyk, K., Marciniak, M., Kacprzak, G., One or two drains after lobectomy?. A comparison of both methods in the immediate postoperative period. (2007) Thorac Cardiovasc Surg, 55, pp. 313-316; Tanaka, M., Sagawa, M., Usuda, K., Postoperative drainage with one chest tube is appropriate for pulmonary lobectomy: a randomized trial (2014) Tohoku J Exp Med, 232, pp. 55-61; Gross, S.B., Current challenges, concepts, and controversies in chest tube management (1993) AACN Clin Issues Crit Care Nurs, 4, pp. 260-275; Oakes, L.L., Hinds, P., Rao, B., Chest tube stripping in pediatric oncology patients: an experimental study (1993) Am J Crit Care, 2, pp. 293-301; Lim-Levy, F., Babler, S.A., De Groot-Kosolcharoen, J., Is milking and stripping chest tubes really necessary? 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Biondi-Zoccai G, editor. (2013) PLoS One, 8; Deng, B., Tan, Q.Y., Zhao, Y.P., Suction or non-suction to the underwater seal drains following pulmonary operation: meta-analysis of randomised controlled trials (2010) Eur J Cardiothorac Surg, 38, pp. 210-215; Refai, M., Brunelli, A., Varela, G., The values of intrapleural pressure before the removal of chest tube in non-complicated pulmonary lobectomies (2012) Eur J Cardiothorac Surg, 41, pp. 831-833; Brunelli, A., Salati, M., Pompili, C., Regulated tailored suction vs regulated seal: a prospective randomized trial on air leak duration (2013) Eur J Cardiothorac Surg, 43, pp. 899-904; Bell, R.L., Ovadia, P., Abdullah, F., Chest tube removal: end-inspiration or end-expiration? (2001) J Trauma, 50, pp. 674-677; Cerfolio, R.J., Bryant, A.S., Skylizard, L., Optimal technique for the removal of chest tubes after pulmonary resection (2013) J Thorac Cardiovasc Surg, 145, pp. 1535-1539; Varela, G., Jimenez, M.F., Novoa, N., Portable chest drainage systems and outpatient chest tube management (2010) Thorac Surg Clin, 20, pp. 421-426; Bertolaccini, L., Rizzardi, G., Filice, M.J., "Six sigma approach"-an objective strategy in digital assessment of postoperative air leaks: a prospective randomised study (2011) Eur J Cardiothorac Surg, 39, pp. e128-e132; Pompili, C., Detterbeck, F., Papagiannopoulos, K., Multicenter international randomized comparison of objective and subjective outcomes between electronic and traditional chest drainage systems (2014) Ann Thorac Surg, 98, pp. 490-496. , discussion 496-7; Filosso, P.L., Ruffini, E., Solidoro, P., Digital air leak monitoring after lobectomy for primary lung cancer in patients with moderate COPD: can a fast-tracking algorithm reduce postoperative costs and complications? 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PY - 2017

Y1 - 2017

N2 - The Society for Translational Medicine and The Chinese Society for Thoracic and Cardiovascular Surgery conducted a systematic review of the literature in an attempt to improve our understanding in the postoperative management of chest tubes of patients undergoing pulmonary lobectomy. Recommendations were produced and classified based on an internationally accepted GRADE system. The following recommendations were extracted in the present review: (I) chest tubes can be removed safely with daily pleural fluid of up to 450 mL (non-chylous and non-sanguinous), which may reduce chest tube duration and hospital length of stay (2B); (II) in rare instances, e.g., persistent abundant fluid production, the use of PrRP/B < 0.5 when evaluating fluid output to determine chest tube removal might be beneficial (2B); (III) it is recommended that one chest tube is adequate following pulmonary lobectomy, except for hemorrhage and space problems (2A); (IV) chest tube clearance by milking and stripping is not recommended after lung resection (2B); (V) chest tube suction is not necessary for patients undergoing lobectomy after first postoperative day (2A); (VI) regulated chest tube suction [-11 (-1.08 kPa) to -20 (1.96 kPa) cmH2O depending upon the type of lobectomy] is not superior to regulated seal [-2 (0.196 kPa) cmH2O] when electronic drainage systems are used after lobectomy by thoracotomy (2B); (VII) chest tube removal recommended at the end of expiration and may be slightly superior to removal at the end of inspiration (2A); (VIII) electronic drainage systems are recommended in the management of chest tube in patients undergoing lobectomy (2B). © Journal of Thoracic Disease.

AB - The Society for Translational Medicine and The Chinese Society for Thoracic and Cardiovascular Surgery conducted a systematic review of the literature in an attempt to improve our understanding in the postoperative management of chest tubes of patients undergoing pulmonary lobectomy. Recommendations were produced and classified based on an internationally accepted GRADE system. The following recommendations were extracted in the present review: (I) chest tubes can be removed safely with daily pleural fluid of up to 450 mL (non-chylous and non-sanguinous), which may reduce chest tube duration and hospital length of stay (2B); (II) in rare instances, e.g., persistent abundant fluid production, the use of PrRP/B < 0.5 when evaluating fluid output to determine chest tube removal might be beneficial (2B); (III) it is recommended that one chest tube is adequate following pulmonary lobectomy, except for hemorrhage and space problems (2A); (IV) chest tube clearance by milking and stripping is not recommended after lung resection (2B); (V) chest tube suction is not necessary for patients undergoing lobectomy after first postoperative day (2A); (VI) regulated chest tube suction [-11 (-1.08 kPa) to -20 (1.96 kPa) cmH2O depending upon the type of lobectomy] is not superior to regulated seal [-2 (0.196 kPa) cmH2O] when electronic drainage systems are used after lobectomy by thoracotomy (2B); (VII) chest tube removal recommended at the end of expiration and may be slightly superior to removal at the end of inspiration (2A); (VIII) electronic drainage systems are recommended in the management of chest tube in patients undergoing lobectomy (2B). © Journal of Thoracic Disease.

KW - Chest tube

KW - Drainage system

KW - GRADE system

KW - Lobectomy

KW - Recommendation

KW - Article

KW - breathing pattern

KW - chest tube

KW - cost control

KW - human

KW - length of stay

KW - lung lobectomy

KW - mortality

KW - patient care

KW - pleura fluid

KW - postoperative care

KW - postoperative period

KW - practice guideline

KW - safety

KW - suction

KW - suction drain

KW - systematic review

KW - thoracocentesis

KW - thoracotomy

KW - thorax pressure

KW - tube removal

M3 - Article

VL - 9

SP - 3255

EP - 3264

JO - Journal of Thoracic Disease

JF - Journal of Thoracic Disease

SN - 2072-1439

IS - 9

ER -