PURPOSE: The recognized advantage of digital drainage systems is precise measurement of postoperative air leak and possibility to check its trend over time. Additionally, continuous recordings of intrapleural pressures are obtained, which are usually considered not relevant. This study tested the hypothesis that these data may be informative and that intrapleural pressure may be related with postoperative air leak after lung resection.
METHODS: The study was designed to prospectively enroll 100 patients undergoing pulmonary resection. Postoperative air leaks were monitored by the use of a digital chest drainage system (DigiVent®, Millicore AB, Sweden). Drains were removed when no air leak was recorded for more than 24 hours. Maximum, minimum intrapleural pressures and air leak flow during the first 72 postoperative hours were compared between patients who had their drains removed within postoperative day 5 (POD5, group A), those in which they were removed between POD6 and POD15 (group B) and those who had drains removed later (group C).
RESULTS: Study inclusion was stopped after 90 cases as the digital device became unavailable. Patients distribution was: group A 51 cases (56.6%), group B 17 cases (18.8%) and group C 22 cases (24.4%). Median air leak was significantly lower in group A after the first 24 hours (lp 0.03), meanwhile no difference was recorded between group B and group C. Maximal intrapleural pressure curves had a different pattern in each subgroup: minimal shifts and continuous negative values in group A, large shifts and almost continuous negative values in group B, large shifts and more positive values in group C (p 0.04). No difference between groups was detected in terms of minimal intrapleural pressures.
CONCLUSIONS: Intrapleural maximal pressures and air leak flows are related and their interaction changes according to the duration of postoperative air leak.
CLINICAL IMPLICATIONS: This information opens interesting perspectives on the potential predictive value of maximal intrapleural pressure in early definition of patients who will need chest drain for a long period of time.
DISCLOSURE: The following authors have nothing to disclose: Francesco Leo, Leonardo Duranti, Simone Furia, Emilia Polimeno, Luca Tavecchio, Paolo Scanagatta, Barbara Conti, Ugo Pastorino
No Product/Research Disclosure Information