Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada.
Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Division of Thoracic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada.
Semin Thorac Cardiovasc Surg. 2019;31(4):861-867. doi: 10.1053/j.semtcvs.2019.02.023. Epub 2019 Feb 21.
Improving evidence-based chest tube removal may reduce the length of stay following surgery. Presently, most chest tube removal protocols include a fluid output threshold based on a 24-hour observation period. The purpose of this study was to evaluate if, within a 24-hour time period, fluid output measurements at 6, 8, and 12 hours could predict if the total 24-hour fluid output would comply with a predetermined volume threshold considered acceptable for safe chest tube removal. Following lung resection, pleural fluid output data were prospectively recorded by a digital drainage system and analyzed retrospectively. Twenty-four-hour fluid output was calculated from every available 6-, 8-, and 12-hour measurement and compared to set 24-hour output criteria for chest tube removal (ie, 400 mL, 250 mL, and 20% of whole-body lymphatic flow). Performance of interim fluid outputs in predicting whether 24-hour fluid output criteria were satisfied was measured. From 2015 to 2018, 150 patients had digital pleural fluid drainage data suitable for analysis. Performance of interim fluid output data in identifying which patients would satisfy 24-hour output criteria ranged from 85% (95% confidence interval [CI] = 83-86) to 94% (95% CI = 93-94) for specificity, 75% (95% CI = 73-76) to 92% (95% CI = 90-93) for positive predictive value, and 6% (95% CI = 6-7) to 15% (95% CI = 14-17) for false-positive rate. Potential time saved in duration of drainage using interim fluid output data ranged from 10 to 16 hours. Pleural fluid output measured for 6-, 8-, and 12-hour durations can accurately identify patients who will meet 24-hour fluid output threshold for safe chest tube removal.
提高基于证据的胸腔引流管移除率可能会减少手术后的住院时间。目前，大多数胸腔引流管移除方案都包括基于 24 小时观察期的液体输出阈值。本研究旨在评估在 24 小时时间段内，6、8 和 12 小时的液体输出测量值是否可以预测总 24 小时液体输出是否符合被认为安全移除胸腔引流管的预定体积阈值。在肺切除术后，通过数字引流系统前瞻性地记录胸腔积液数据，并进行回顾性分析。从每一个可用的 6、8 和 12 小时测量值计算 24 小时液体输出量，并与设定的胸腔引流管移除 24 小时输出标准（即 400ml、250ml 和全身淋巴流量的 20%）进行比较。测量了中期液体输出量预测 24 小时液体输出标准是否满足的性能。2015 年至 2018 年，有 150 名患者的数字胸腔积液引流数据适合分析。中期液体输出数据在确定哪些患者将满足 24 小时输出标准方面的性能从特异性的 85%（95%置信区间[CI] = 83-86）到 94%（95% CI = 93-94），阳性预测值从 75%（95% CI = 73-76）到 92%（95% CI = 90-93），假阳性率从 6%（95% CI = 6-7）到 15%（95% CI = 14-17）。使用中期液体输出数据可节省的引流时间从 10 小时到 16 小时不等。测量 6、8 和 12 小时的胸腔积液输出量可以准确识别出符合安全胸腔引流管移除的 24 小时液体输出阈值的患者。
