Skip to main content
SpringerLink
Log in

Advantages of applying digital chest drainage system for postoperative management of patients following pulmonary resection: a systematic review and meta-analysis of 12 randomized controlled trials

  • Review Article
  • Published:
General Thoracic and Cardiovascular Surgery Aims and scope Submit manuscript

Abstract

Objectives

This meta-analysis aimed to evaluate the value of the chest digital drainage system for the postoperative management of patients who have undergone pulmonary resection.

Methods

We searched the PubMed, EMBASE, the Cochrane Library, and Web of Science databases for included randomized controlled trials (RCTs) on the application of digital drainage systems versus the analog drainage system for patients with lung disease after pulmonary resection. Dichotomous variables were evaluated using risk ratios (RRs) and 95% confidence intervals (CIs), and mean and standardized mean differences (MDs and SMDs, respectively) with 95% CIs were used to calculate continuous variables. Statistical analyses were performed using Stata and RevMan software.

Results

In total, 12 RCTs involving 2000 patients were analyzed. Significant differences in duration of chest tube placement (SMD =  −0.49; 95% CI =  −0.78 to −0.20), length of hospital stay (MD =−0.79 days; 95% CI = −1.24 to −0.34), and number of chest tube clamping tests (RR = 0.74; 95% CI = 0.36–1.49) were observed between the two groups, which did not significant differ in the occurrence of prolonged air leak or cardiopulmonary complication rate.

Conclusions

The digital chest drainage system is mainly advantageous in the duration of chest tube placement, length of hospital stay, and number of chest tube clamping tests. Future research should evaluate the requirements and economic impact of using digital system in routine clinical practice.

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
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8

Similar content being viewed by others

References

  1. Yotsukura M, Okubo Y, Yoshida Y, Nakagawa K, Watanabe S. Predictive factors and economic impact of prolonged air leak after pulmonary resection. Gen Thorac Cardiovasc Surg. 2022;70(1):44–51.

    Article  Google Scholar 

  2. Mueller MR, Marzluf BA. The anticipation and management of air leaks and residual spaces post lung resection. J Thorac Dis. 2014;6(3):271–84.

    Google Scholar 

  3. Bardell T, Petsikas D. What keeps postpulmonary resection patients in hospital? Can Respir J. 2003;10(2):86–9.

    Article  CAS  Google Scholar 

  4. Brunelli A, Al Refai M, Monteverde M, et al. Pleural tent after upper lobectomy: a randomized study of efficacy and duration of effect. Ann Thorac Surg. 2002;74(6):1958–62.

    Article  Google Scholar 

  5. Okereke I, Murthy SC, Alster JM, Blackstone EH, Rice TW. Characterization and importance of air leak after lobectomy. Ann Thorac Surg. 2005;79(4):1167–73.

    Article  Google Scholar 

  6. Brunelli A, Cassivi SD, Halgren L. Risk factors for prolonged air leak after pulmonary resection. Thorac Surg Clin. 2010;20(3):359–64.

    Article  Google Scholar 

  7. Steéphan F, Boucheseiche S, Hollande J, et al. Pulmonary complications following lung resection: a comprehensive analysis of incidence and possible risk factors. Chest. 2000;118(5):1263–70.

    Article  Google Scholar 

  8. DeCamp MM, Blackstone EH, Naunheim KS, et al. Patient and surgical factors influencing air leak after lung volume reduction surgery: lessons learned from the national emphysema treatment trial. Ann Thorac Surg. 2006;82(1):197–207.

    Article  Google Scholar 

  9. Ranger WR, Halpin D, Sawhney AS, Lyman M, Locicero J. Pneumostasis of experimental air leaks with a new photopolymerized synthetic tissue sealant. Am Surg. 1997;63(9):788–95.

    CAS  Google Scholar 

  10. Sánchez PG, Vendrame GS, Madke GR, et al. Lobectomia por carcinoma brônquico: análise das co-morbidades e seu impacto na morbimortalidade pós-operatória. J Bras Pneumol. 2006;32(6):495–504.

    Article  Google Scholar 

  11. Antanavicius G, Lamb J, Papasavas P, Caushaj P. Initial chest tube management after pulmonary resection. Am Surg. 2005;71(5):416–9.

    Article  CAS  Google Scholar 

  12. Baumann MH. Treatment of spontaneous pneumothorax. Curr Opin Pulm Med. 2000;6(4):275–80.

    Article  CAS  Google Scholar 

  13. Gareeboo S, Singh S. Tube thoracostomy: how to insert a chest drain. Br J Hosp Med. 2006;67(Sup1):M16–8.

    Article  Google Scholar 

  14. Iberti TJ, Stern PM. Chest tube thoracostomy. Crit Care Clin. 1992;8(4):879–95.

    Article  CAS  Google Scholar 

  15. Dernevik L, Belboul A, Rådberg G. Initial experience with the world’s first digital drainage system. The benefits of recording air leaks with graphic representation. Eur J Cardiothorac Surg. 2007;31(2):209–13.

    Article  Google Scholar 

  16. Cerfolio RJ, Bryant AS, Singh S, Bass CS, Bartolucci AA. The management of chest tubes in patients with a pneumothorax and an air leak after pulmonary resection. Chest. 2005;128(2):816–20.

    Article  Google Scholar 

  17. Cerfolio RJ. Recent advances in the treatment of air leaks. Curr Opin Pulm Med. 2005;11(4):319–23.

    Article  Google Scholar 

  18. Wang H, Hu W, Ma L, Zhang Y. Digital chest drainage system versus traditional chest drainage system after pulmonary resection: a systematic review and meta-analysis. J Cardiothorac Surg. 2019;14(1):13.

    Article  Google Scholar 

  19. Brunelli A, Salati M, Refai M, Di Nunzio L, Xiumé F, Sabbatini A. Evaluation of a new chest tube removal protocol using digital air leak monitoring after lobectomy: a prospective randomised trial. Eur J Cardiothorac Surg. 2010;37(1):56–60.

    Article  Google Scholar 

  20. Cerfolio RJ. Advances in thoracostomy tube management. Surg Clin. 2002;82(4):833–48.

    Google Scholar 

  21. Zhou J, Lyu M, Chen N, et al. Digital chest drainage is better than traditional chest drainage following pulmonary surgery: a meta-analysis. Eur J Cardiothorac Surg. 2018;54(4):635–43.

    Article  Google Scholar 

  22. Egger M, Smith GD, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ. 1997;315(7109):629–34.

    Article  CAS  Google Scholar 

  23. Langer G, Meerpohl JJ, Perleth M, Gartlehner G, Kaminski-Hartenthaler A, Schünemann H. GRADE Guidelines: 1. Introduction – GRADE evidence profiles and summary of findings tables. Z Für Evidenz Fortbild Qual Im Gesundheitswesen. 2012;106(5):357–68.

    Article  Google Scholar 

  24. De Waele M, Agzarian J, Hanna WC, et al. Does the usage of digital chest drainage systems reduce pleural inflammation and volume of pleural effusion following oncologic pulmonary resection?—a prospective randomized trial. J Thorac Dis. 2017;9(6):1598–606.

    Article  Google Scholar 

  25. Lijkendijk M, Licht PB, Neckelmann K. Electronic versus traditional chest tube drainage following lobectomy: a randomized trial. Eur J Cardiothorac Surg. 2015;48(6):893–8.

    Article  Google Scholar 

  26. Pompili C, Detterbeck F, Papagiannopoulos K, et al. Multicenter international randomized comparison of objective and subjective outcomes between electronic and traditional chest drainage systems. Ann Thorac Surg. 2014;98(2):490–7.

    Article  Google Scholar 

  27. Bertolaccini L, Rizzardi G, Filice MJ, Terzi A. ‘Six Sigma approach’—an objective strategy in digital assessment of postoperative air leaks: a prospective randomised study. Eur J Cardiothorac Surg. 2011;39(5):e128–32.

    Article  Google Scholar 

  28. Cerfolio RJ, Bryant AS. The benefits of continuous and digital air leak assessment after elective pulmonary resection: a prospective study. Ann Thorac Surg. 2008;86(2):396–401.

    Article  Google Scholar 

  29. Takamochi K, Nojiri S, Oh S, et al. Comparison of digital and traditional thoracic drainage systems for postoperative chest tube management after pulmonary resection: a prospective randomized trial. J Thorac Cardiovasc Surg. 2018;155(4):1834–40.

    Article  Google Scholar 

  30. Plourde M, Jad A, Dorn P, et al. Digital air leak monitoring for lung resection patients: a randomized controlled clinical trial. Ann Thorac Surg. 2018;106(6):1628–32.

    Article  Google Scholar 

  31. Chiappetta M, Lococo F, Nachira D, et al. Digital devices improve chest tube management: results from a prospective randomized trial. Thorac Cardiovasc Surg. 2018;66(7):595–602.

    Article  Google Scholar 

  32. Mendogni P, Tosi D, Marulli G, et al. Multicenter randomized controlled trial comparing digital and traditional chest drain in a VATS pulmonary lobectomy cohort: interim analysis. J Cardiothorac Surg. 2021;16(1):188.

    Article  Google Scholar 

  33. Gilbert S, McGuire AL, Maghera S, et al. Randomized trial of digital versus analog pleural drainage in patients with or without a pulmonary air leak after lung resection. J Thorac Cardiovasc Surg. 2015;150(5):1243–51.

    Article  Google Scholar 

  34. Marjański T, Sternau A, Rzyman W. THORACIC SURGERY The implementation of a digital chest drainage system significantly reduces complication rates after lobectomy – a randomized clinical trial. Pol J Cardio-Thorac Surg. 2013;2:133–8.

    Article  Google Scholar 

Download references

Acknowledgements

Thanks to Shuya Ni, a PhD student from Jinan University, for her help at various stages of this review. This work was supported by the National Natural Science Foundation of China (72074103); the Fundamental Research Funds for the Central Universities (lzujbky-2021-ct06, lzujbky-2021-kb22); and the Gansu Special Project of Soft Science (20CX9ZA109).

Author information

Author notes

  1. Liying Zhou and Kangle Guo are co-first authors.

Authors and Affiliations

  1. Health Technology Assessment Center/Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, 199 Donggang West Road, Lanzhou, 730000, China

    Liying Zhou, Kangle Guo, Xue Shang, Fenfen E, Meng Xu, Yanan Wu, Kehu Yang & Xiuxia Li

  2. Evidence Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, 199 Donggang West Road, Lanzhou, 730000, China

    Liying Zhou, Kangle Guo, Xue Shang, Fenfen E, Meng Xu, Yanan Wu, Kehu Yang & Xiuxia Li

  3. Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, 730000, China

    Liying Zhou, Kangle Guo, Xue Shang, Fenfen E, Meng Xu, Yanan Wu, Kehu Yang & Xiuxia Li

Authors
  1. Liying Zhou
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kangle Guo
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Xue Shang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Fenfen E
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Meng Xu
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Yanan Wu
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Kehu Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Xiuxia Li
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

L.Z. provided research topics and ideas, and completed the drafting; K.G. provided technical support and some methodological guidance; X.S., E.F., M.X., and Y.W. provided part of the data analysis. All authors discussed the results and commented on the manuscript. All authors involved in manuscript writing and final approval of manuscript.

Corresponding authors

Correspondence to Kehu Yang or Xiuxia Li.

Ethics declarations

Conflict of interest

All authors have completed the ICMJE uniform disclosure form. The authors have no conflicts of interest to declare.

Ethical statement

The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Reporting checklist

We present the following article in accordance with the PRISMA reporting checklist.

Additional information

Publisher's Note

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

Rights and permissions

Springer Nature or its licensor holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Zhou, L., Guo, K., Shang, X. et al. Advantages of applying digital chest drainage system for postoperative management of patients following pulmonary resection: a systematic review and meta-analysis of 12 randomized controlled trials. Gen Thorac Cardiovasc Surg 71, 1–11 (2023). https://doi.org/10.1007/s11748-022-01875-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11748-022-01875-7

Keywords

Search

Navigation