Determining Optimal Air Leak Resolution Criteria When Using Digital Pleural Drainage Device After Lung Resection

PS054 

Abstract Submission 

Mohsen Alayche (1), William Klement (2), Justen Choueiry (1), Jamie Strain (2), Urmila Bhattacharyya (2), Adnan Mekdachi (1), Daniel Jones (3), Donna Maziak (3), Andrew Seely (3), Sudhir Sundaresan (3), Patrick Villeneuve (3), Sebastien Gilbert (3)

(1) Faculty of Medicine, University of Ottawa, Ottawa, Ontario, (2) Ottawa Hospital Research Institute, Ottawa, Ontario, (3) Division of Thoracic Surgery, University of Ottawa, The Ottawa Hospital, Ottawa, Ontario

Mohsen Alayche    -  Contact Me
Faculty of Medicine, University of Ottawa

William Klement    -  Contact Me
Ottawa Hospital Research Institute

Justen Choueiry    -  Contact Me
Faculty of Medicine, University of Ottawa

Jamie Strain    -  Contact Me
Ottawa Hospital Research Institute

Urmila Bhattacharyya    -  Contact Me
Ottawa Hospital Research Institute

Adnan Mekdachi    -  Contact Me
Faculty of Medicine, University of Ottawa

Daniel Jones    -  Contact Me
Division of Thoracic Surgery, University of Ottawa, The Ottawa Hospital

Donna Maziak    -  Contact Me
Division of Thoracic Surgery, University of Ottawa, The Ottawa Hospital

Andrew Seely    -  Contact Me
Division of Thoracic Surgery, University of Ottawa, The Ottawa Hospital

Sudhir Sundaresan    -  Contact Me
Division of Thoracic Surgery, University of Ottawa, The Ottawa Hospital

Patrick Villeneuve    -  Contact Me
Division of Thoracic Surgery, University of Ottawa, The Ottawa Hospital

*Sebastien Gilbert    -  Contact Me
Division of Thoracic Surgery, University of Ottawa, The Ottawa Hospital

Mohsen Alayche    -  Contact Me
N/A

Objective: No evidence currently supports specific air leak resolution criteria when using digital pleural drainage devices after lung resection. The aim of this study was to determine an optimal air leak resolution criteria where duration of chest tube drainage is minimized while avoiding potential complications from premature chest tube removal.

Methods: Airflow data was collected prospectively in 400 patients from September 2015 to April 2019 at 10-minute intervals using a digital pleural drainage device (Thopaz-TM Medela, Bar, Switzerland). All air leak resolution criteria permutations were created by combining airflow thresholds ranging from 10-100 mL/min at 5 mL/min increments, and time periods ranging from 4-12 hours at 1-hour increments. To determine the duration of the postoperative air leak, alongside the frequency and volume of any air leak recurrence, all air leak resolution criteria were retrospectively applied to the digital pleural drainage data of each patient. An air leak recurred if transpleural airflow exceeded threshold after the air leak was deemed resolved according to the criteria being tested. Descriptive statistics were used to identify an optimal air leak resolution criteria in terms of safety (lowest frequency and volume of recurrent air leaks), and efficiency (minimizing hospital stay).

Results: The majority of the 400 patients underwent lobectomies (57% [226/400]), wedge resections (29% [116/400]), or segmentectomies (8% [32/400]) for lung cancer (86% [342/400]). A total of 171 air leak resolution criteria were used to analyze 1808 patient-days of digital pleural drainage data. Most patients (67% [266/400]) experienced an air leak recurrence for at least one of the air leak resolution criteria evaluated. The air leak resolution criteria with the most recurrences (48% [192/400]) was 10 mL/min for 4 hours of fluid drainage and the criteria with the least recurrences (24% [94/400]) was 80 mL/min for 12 hours of fluid drainage. An air leak resolution criteria of 60 mL/min for 8 hours of fluid drainage was associated with the shortest initial drainage, combined with the lowest air leak recurrence frequency and volume.

Conclusion: A postoperative air leak that remains less than 60 mL/min for 8 consecutive hours can be deemed resolved and carries minimal risk of recurrence after chest tube removal. This criteria should be prospectively evaluated in future studies.

Chest Wall, Pleural and Mediastinal Disease