Chiappetta Marco, Lococo Filippo, Nachira Dania, Ciavarella Leonardo Petracca, Congedo Maria Teresa, Porziella Venanzio, Meacci Elisa, Margaritora Stefano
Unità operativa di Chirurgia Toracica, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli, Roma, Italy.
Unit of Thoracic Surgery, Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, Italy.
Thorac Cardiovasc Surg. 2018 Oct;66(7):595-602. doi: 10.1055/s-0037-1607443. Epub 2017 Oct 27.
Digital devices could help clinical practice measuring the air leak, but their role is still debated. Aim of this study is to test advantages using these devices.
From June 2012 to May 2015, we enrolled 95 patients undergoing lobectomy or wedge resection in a prospective randomized trial. Patients were divided into two groups: group D (digital, 50 patients) evaluated with digital device and group E (empirical, 45 patients) evaluated with water seal. Logistic regression analysis and receiver operating characteristic (ROC) curve analysis were used to select and assess predictors of persistent air leak. In group D, chest drain was removed if the air leak was absent or < 0.5 L/h for 12 consecutive hours and in group E if clinical signs of air leak were absent.
Mean hospitalization and mean chest tube stay was 6.0 ± 3.3 and 4.4 ± 3.2 days, respectively, prolonged air leak occurred in nine (8%). Hospitalization was 5.8 ± 2.5 versus 6.2 ± 4.2 days ( = 0.5), while mean chest tube stay was 4.1 ± 2.0 versus 4.6 ± 3.5 days ( = 0.4) in group D and group E, respectively. Clamping test was needed in one patient in group D and in seven in group E ( = 0.019). At multivariate analysis, heart disease ( < 0.0001), lobectomy ( < 0.0001), fused fissure ( < 0.0001), and air leakage in first postoperative (p.o.) day were predictors of persistent air leak (AUC on the ROC curve of 69.7%, sensibility: 77.8%). In group D, an air leak value > 0.2 L/h with spikes over 0.5 L/h in third p.o. was predictive of persistent air leak, with chest tube duration of 7.73 ± 5.20 versus 4.32 ± 1.33 days (AUC: 83%, sensitivity: 80%, < 0.0001).
In our experience, digital devices reduced observer variability and mistakes in chest tube management, thus identifying patients at risk for prolonged air leak.
数字设备有助于临床实践中测量漏气情况，但其作用仍存在争议。本研究的目的是测试使用这些设备的优势。
2012年6月至2015年5月，我们在一项前瞻性随机试验中纳入了95例行肺叶切除术或楔形切除术的患者。患者分为两组：D组（数字组，50例患者）使用数字设备进行评估，E组（经验组，45例患者）使用水封进行评估。采用逻辑回归分析和受试者工作特征（ROC）曲线分析来选择和评估持续性漏气的预测因素。在D组中，如果连续12小时无漏气或漏气量<0.5L/h，则拔除胸腔引流管；在E组中，如果无漏气的临床体征，则拔除胸腔引流管。
平均住院时间和平均胸腔引流管留置时间分别为6.0±3.3天和4.4±3.2天，9例（8%）出现持续性漏气。D组的住院时间为5.8±2.5天，E组为6.2±4.2天（P = 0.5）；D组和E组的平均胸腔引流管留置时间分别为4.1±2.0天和4.6±3.5天（P = 0.4）。D组有1例患者需要进行夹闭试验，E组有7例（P = 0.019）。多因素分析显示，心脏病（P<0.0001）、肺叶切除术（P<0.0001）、融合裂（P<0.0001）以及术后第一天漏气是持续性漏气的预测因素（ROC曲线下面积为69.７%，敏感度为77.8%）。在D组中，术后第三天漏气值>0.2L/h且峰值超过0.5L/h可预测持续性漏气，胸腔引流管留置时间为7.73±5.20天，而无持续性漏气患者为4.32±1.33天（AUC：83%，敏感度：80%，P<0.0001）。
根据我们的经验，数字设备减少了胸腔引流管管理中的观察者变异性和错误，从而识别出有持续性漏气风险的患者。
