Determining optimal air leak resolution criteria when using digital pleural drainage device after lung resection

• Published in: JTCVS open Vol. 18; pp. 360 - 368
• Main Authors: Alayche, Mohsen, Choueiry, Justen, Mekdachi, Adnan, Maziak, Donna E., Seely, Andrew J.E., Sundaresan, Sudhir R., Villeneuve, Patrick J., Jones, Daniel, Klement, William, Gilbert, Sebastien
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Inc 01-04-2024; Elsevier
• Subjects: air leak duration; air leak recurrence; air leak resolution criteria; chest tube; Thoracic: Lung; chest tube; air leak duration; air leak resolution criteria; air leak recurrence
• ISSN: 2666-2736; 2666-2736
• DOI: 10.1016/j.xjon.2024.01.016

There is limited clinical evidence to support any specific parenchymal air leak resolution criteria when using digital pleural drainage devices following lung resection. The aim of this study is to determine an optimal air leak resolution criteria, where duration of chest tube drainage is minimized while avoiding complications from premature chest tube removal.
Airflow data averaged at 10-minute intervals was collected prospectively using a digital pleural drainage device (Thopaz; Medela) in 400 patients from 2015 to 2019. All permutations of air leak resolution criteria from <10 to 100 mL/minute for 4 to 12 hours were applied retrospectively to the pleural drainage data to determine air leak duration, and air leak recurrence frequency and volume. Air leak recurrence indicates potential for rather than occurrence of adverse events. Descriptive statistics were used to identify the optimal criteria based on patient safety (low frequency and volume of air leak recurrences), and efficiency (shortest initial air leak duration).
The majority of the 400 patients underwent lobectomy (57% [227 out of 400]), wedge resections (29% [115 out of 400]), or segmentectomies (8% [32 out of 400]) for lung cancer (90% [360 out of 400]). An airflow threshold <50 mL/minute resulted in longer air leak duration before meeting the criteria for air leak resolution (P < .0001). Air leak recurrence frequency and volume were greater in patients with a monitoring period <8 consecutive hours (P < .0001).
When using a digital pleural drainage device, a postoperative air leak resolution criteria <50 mL/minute for 8 consecutive hours was associated with the best safety and efficiency profile.
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