The Influence of Suction on Chest Drain Duration After Lobectomy Using Electronic Chest Drainage

Abstract

Background: Management of chest drains after thoracic surgery remains an area with little consensus. To optimize chest drainage algorithms with electronic chest drainage systems, a randomized controlled trial comparing low variable suction (-5 cm H₂O) versus high variable suction (-20 cm H₂O) was conducted.

Methods: This was a prospective open label randomized trial in patients undergoing lobectomy. Sample size was calculated from a clinical relevant difference in chest drain duration as 1 full day. End points were chest drain duration and length of hospitalization. Data were analyzed by Kaplan-Meier survival analysis and multivariate Cox proportional hazards regression.

Results: The study randomized 106 patients. There was no statistical significant difference in chest drain duration and length of stay between the low-suction and the high-suction groups: Median chest drain duration and hospitalization were 25 hours (interquartile range [IQR] 21 to 55 hours) versus 28 hours (IQR 23 to 77 hours; p = 0.97) and 5 days (IQR 3 to 6 days) versus 5 days (IQR 3 to 7 days; p = 0.75), respectively. Multivariate analysis demonstrated that the diffusing capacity of the lung for carbon monoxide was the only significant predictor of chest drain duration (p = 0.015) and length of hospitalization (p = 0.003). Complications requiring reinsertion of the chest drain were significantly more frequent in the low-suction group (p = 0.03).

Conclusions: There was no clinically relevant difference in chest drain duration or length of hospitalization, but reinsertions of chest drains were significantly more frequent in the low-suction group, a finding suggesting that low suction levels should not be used after lobectomy. Trial registry number is ISRCTN10408356.