Skip to main content
SpringerLink
Log in

Prospective Study to Evaluate the Role of Protocol-Based Management of Chest Tubes in Patients Undergoing Elective Thoracic Surgery

  • Original Article
  • Published:
Indian Journal of Surgery Aims and scope Submit manuscript

Abstract

Intercostal chest tube (ICD) management has been mostly determined by personal experience of surgeons and prevailing local practices rather than a scientifically validated protocol. This study was done to evaluate the impact of protocol-based management of chest tubes in patients undergoing elective thoracic surgeries. This was a prospective observational study conducted from June 2016 to March 2018 at a tertiary care hospital to study the impact of algorithmic management of chest tubes in patients undergoing non-pneumonectomy elective thoracic surgery. A preformed algorithm was followed in all the patients. Chest tube was removed if all the criteria for chest tube removal were met, i.e., stable patient, no air leak, drainage < 250 ml, and no (or small non-expanding) pneumothorax. Out of 122 patients recruited in study, 45.08% patients underwent operations for inflammatory lung and pleural conditions. ICD protocol could be followed in 101 patients, and 84 patients were discharged according to the protocol. Chest tube dwelling time and post-operative hospital stay were significantly less in patient in whom protocol was followed vis-a-vis those in whom it could not be followed. Reinsertions were significantly higher in patients in whom protocol could not be followed. No difference in readmissions and mortality was noted. Comparison with data before starting of the study revealed an early ICD removal, and discharge was possible in prospective patients. Protocol-based management in patients undergoing elective thoracic surgeries decreases the chest tube dwelling time and post-operative hospital stay without increasing morbidity and mortality.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Farrington B, Chadwick J, Mann WN (1952) The medical works of Hippocrates. J Hell Stud 72:132

    Google Scholar 

  2. Zhang Y, Li H, Hu B et al (2014) A prospective randomized single-blind control study of volume threshold for chest tube removal following lobectomy. World J Surg 38:60–67. https://doi.org/10.1007/s00268-013-2271-7

    Article  PubMed  Google Scholar 

  3. Xie H-Y, Xu K, Tang J-X et al (2015) 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. Interact Cardiovasc Thorac Surg 21:200–205. https://doi.org/10.1093/icvts/ivv115

    Article  PubMed  Google Scholar 

  4. Bertholet JWM, Joosten JJA, Keemers-Gels ME et al (2011) Chest tube management following pulmonary lobectomy: change of protocol results in fewer air leaks. Interact Cardiovasc Thorac Surg 12:28–31. https://doi.org/10.1510/icvts.2010.248716

    Article  PubMed  Google Scholar 

  5. Cerfolio RJ, Bryant AS (2008) Results of a prospective algorithm to remove chest tubes after pulmonary resection with high output. J Thorac Cardiovasc Surg 135:269–273. https://doi.org/10.1016/j.jtcvs.2007.08.066

    Article  PubMed  Google Scholar 

  6. Cerfolio RJ, Tummala RP, Holman WL et al (1998) A prospective algorithm for the management of air leaks after pulmonary resection. Ann Thorac Surg 66:1726–1730. https://doi.org/10.1016/S0003-4975(98)00958-8

    Article  CAS  PubMed  Google Scholar 

  7. Gómez-Caro A, Roca MJ, Torres J et al (2006) Successful use of a single chest drain postlobectomy instead of two classical drains: a randomized study. Eur J Cardiothorac Surg 29:562–566. https://doi.org/10.1016/j.ejcts.2006.01.019

    Article  PubMed  Google Scholar 

  8. Miserocchi G (1997) Physiology and pathophysiology of pleural fluid turnover. Eur Respir J 10:219–225

    Article  CAS  Google Scholar 

  9. French DG, Dilena M, LaPlante S et al (2016) Optimizing postoperative care protocols in thoracic surgery: best evidence and new technology. J Thorac Dis 8:S3–S11. https://doi.org/10.3978/j.issn.2072-1439.2015.10.67

    Article  PubMed  PubMed Central  Google Scholar 

  10. Cerfolio RJ, Minnich DJ, Bryant AS (2009) The removal of chest tubes despite an air leak or a pneumothorax. Ann Thorac Surg 87:1690–1696. https://doi.org/10.1016/j.athoracsur.2009.01.077

    Article  PubMed  Google Scholar 

  11. Zhou J, Lyu M, Chen N et al (2018) Digital chest drainage is better than traditional chest drainage following pulmonary surgery: a meta-analysis. Eur J Cardiothorac Surg. https://doi.org/10.1093/ejcts/ezy141

  12. Göttgens KWA, Siebenga J, Belgers EHJ et al (2011) Early removal of the chest tube after complete video-assisted thoracoscopic lobectomies. Eur J Cardiothorac Surg 39:575–578. https://doi.org/10.1016/j.ejcts.2010.08.002

    Article  PubMed  Google Scholar 

  13. McKenna RJ, Mahtabifard A, Pickens A et al (2007) Fast-tracking after video-assisted thoracoscopic surgery lobectomy, segmentectomy, and pneumonectomy. Ann Thorac Surg 84:1663–1667; discussion 1667-1668. https://doi.org/10.1016/j.athoracsur.2007.05.058

    Article  PubMed  Google Scholar 

  14. Pratap H, Dewan RK, Singh L et al (2007) Surgical treatment of pulmonary aspergilloma: a series of 72 cases. Indian J Chest Dis Allied Sci 49:23–27

    PubMed  Google Scholar 

  15. Mohapatra B, Sivakumar P, Bhattacharya S, Dutta S (2016) Surgical treatment of pulmonary aspergillosis: a single center experience. Lung India 33:9. https://doi.org/10.4103/0970-2113.173077

    Article  PubMed  PubMed Central  Google Scholar 

  16. Cerfolio RJ, Pickens A, Bass C, Katholi C (2001) Fast-tracking pulmonary resections. J Thorac Cardiovasc Surg 122:318–324. https://doi.org/10.1067/mtc.2001.114352

    Article  CAS  PubMed  Google Scholar 

  17. Liang S, Ivanovic J, Gilbert S et al (2013) Quantifying the incidence and impact of postoperative prolonged alveolar air leak after pulmonary resection. J Thorac Cardiovasc Surg 145:948–954. https://doi.org/10.1016/j.jtcvs.2012.08.044

    Article  PubMed  Google Scholar 

  18. Wood DE, Lauer LM, Layton A, Tong KB (2016) Prolonged length of stay associated with air leak following pulmonary resection has a negative impact on hospital margin. Clinicoecon Outcomes Res 8:187–195. https://doi.org/10.2147/CEOR.S95603

    Article  PubMed  PubMed Central  Google Scholar 

  19. Bjerregaard LS, Jensen K, Petersen RH, Hansen HJ (2014) Early chest tube removal after video-assisted thoracic surgery lobectomy with serous fluid production up to 500 ml/day. Eur J Cardiothorac Surg 45:241–246. https://doi.org/10.1093/ejcts/ezt376

    Article  PubMed  Google Scholar 

  20. Brunelli A, Sabbatini A, Xiume’ F et al (2005) Alternate suction reduces prolonged air leak after pulmonary lobectomy: a randomized comparison versus water seal. Ann Thorac Surg 80:1052–1055. https://doi.org/10.1016/j.athoracsur.2005.03.073

    Article  PubMed  Google Scholar 

Download references

Place of Study

All India Institute of Medical Sciences, New Delhi.

Previous Presentation

This study was presented as podium poster presentation (Dr. C Palanivelu Best PG Paper) ASICON, Chennai-2018.

Author information

Authors and Affiliations

  1. Department of Surgical Oncology, BRAIRCH, AIIMS, New Delhi, India

    Ajit Singh Oberoi

  2. Department of Surgical Disciplines, All India Institute of Medical Sciences (AIIMS), Room Number 5035, Fifth Floor, Teaching Block, New Delhi, India

    Rajinder Parshad,  Suhani, Vathulru Seenu & Mohit Kumar Joshi

  3. Department of Anaesthesia, Critical Care and Pain Medicine, AIIMS, New Delhi, India

    Lokesh Kashyap

  4. Indian Council of Medical Research (ICMR), National Institute of Medical Statistics (NIMS), New Delhi, India

    Khangembam Jitenkumar Singh

Authors
  1. Ajit Singh Oberoi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Rajinder Parshad
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Suhani
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Vathulru Seenu
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Mohit Kumar Joshi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Lokesh Kashyap
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Khangembam Jitenkumar Singh
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Dr. Ajit: project writing and management, defining the study, extensive literature search, actually performing the study, data acquisition, data analysis, statistical inferences, manuscript writing, repeated editing and reviewing.

Dr. Rajinder: conceptualization, study design, project writing and management, defining the study, extensive literature search, actually performing the study, operative work, manuscript writing, repeated editing and reviewing.

Dr. Suhani: study design, project writing and management, extensive literature search, actually performing the study, operative work, manuscript writing, repeated editing and reviewing.

Dr. Seenu: conceptualization, study design, manuscript editing and reviewing.

Dr. Mohit: project writing and management, actually performing the study, operative work, manuscript editing and reviewing.

Dr. Lokesh: performing the study, anesthesia team, manuscript editing and reviewing.

Mr. Jitenkumar: data analysis, statistical inferences, manuscript editing and reviewing.

Corresponding author

Correspondence to Rajinder Parshad.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee (Institute Ethics Committee for Post-graduate Research, IECPG-337/29.06.2016) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Disclaimer

View expressed in the submitted article is the view of the contributing authors and not the official position of the institution.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Oberoi, A.S., Parshad, R., Suhani et al. Prospective Study to Evaluate the Role of Protocol-Based Management of Chest Tubes in Patients Undergoing Elective Thoracic Surgery. Indian J Surg 82, 1050–1057 (2020). https://doi.org/10.1007/s12262-020-02182-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12262-020-02182-2

Keywords

Search

Navigation