Mesa-Guzman Miguel, Periklis Perikleous, Niwaz Zakiyah, Socci Laura, Raubenheimer Hilgardt, Adams Ben, Gurung Lokesh, Uzzaman Mohsin, Lim Eric
1 Department of Thoracic Surgery, 2 Department Quality and Safety, Royal Brompton Hospital, London, UK.
J Thorac Dis. 2015 Nov;7(11):2053-7. doi: 10.3978/j.issn.2072-1439.2015.11.42.
Chest drain duration is one of the most important influencing aspects of hospital stay but the management is perhaps one of the most variable aspects of thoracic surgical care. The aim of our study is to report outcomes associated with increasing fluid and air leak criteria of protocol based management.
A 6-year retrospective analysis of protocolised chest drain management starting in 2007 with a fluid criteria of 3 mL/kg increasing to 7 mL/kg in 2011 to no fluid criteria in 2012, and an air leak criteria of 24 hours without leak till 2012 when digital air leak monitoring was introduced with a criteria of <20 mL/min of air leak for more than 6 hours. Patient data were obtained from electronic hospital records and digital chest films were reviewed to determine the duration of chest tube drainage and post-drain removal complications.
From 2009 to 2012, 626 consecutive patients underwent thoracic surgery procedures under a single consultant. A total of 160 did not require a chest drain and data was missing in 22, leaving 444 for analysis. The mean age [standard deviation (SD)] was 57±19 years and 272 (61%) were men. There were no differences in the incidence of pneumothoraces (P=0.191), effusion (P=0.344) or re-interventions (P=0.431) for drain re-insertions as progressively permissive criteria were applied. The median drain duration dropped from 1-3 days (P<0.001) and accordingly hospital stay reduced from 4-6 days (P<0.001).
Our results show that chest drains can be safely removed without fluid criteria and air leak of less than 20 mL/min with median drain duration of 1 day, associated with a reduced length of hospital stay.
胸腔引流持续时间是影响住院时间的最重要因素之一，但管理可能是胸外科护理中最具差异的方面之一。我们研究的目的是报告基于方案管理中增加液体和漏气标准相关的结果。
对2007年开始的方案化胸腔引流管理进行6年回顾性分析，液体标准从3 mL/kg增加到2011年的7 mL/kg，2012年无液体标准，漏气标准从无漏气24小时到2012年引入数字漏气监测，标准为漏气<20 mL/分钟持续超过6小时。从电子医院记录中获取患者数据，并复查数字胸片以确定胸管引流持续时间和拔管后并发症。
2009年至2012年，626例连续患者在单一顾问指导下接受胸外科手术。共有160例不需要胸腔引流，22例数据缺失，剩余444例用于分析。平均年龄[标准差（SD）]为57±19岁，272例（61%）为男性。随着逐步放宽标准，气胸发生率（P=0.191）、胸腔积液发生率（P=0.344）或引流管重新插入的再次干预发生率（P=0.431）无差异。中位引流持续时间从1 - 3天下降（P<0.001），相应住院时间从4 - 6天减少（P<0.001）。
我们的结果表明，胸腔引流管可在无液体标准且漏气<20 mL/分钟的情况下安全拔除，中位引流持续时间为1天，住院时间缩短。
