Condello Ignazio, Nasso Giuseppe, Fiore Flavio, Speziale Giuseppe
GVM Care & Research, Cardiac Surgery, Anthea Hospital, Bari, Italy.
Surg Technol Int. 2023 Sep 15;42:203-208. doi: 10.52198/23.STI.42.CV1663.
Drainage of fluid and evacuation of air from the pericardial and pleural spaces after cardiothoracic surgery is necessary to prevent effusion, tamponade, and pneumothorax, and also to detect hemorrhage. For this purpose, negative-pressure drains are placed in the mediastinum and pleural cavities. We compared the efficacy and safety of two systems wet and dry drainage for the management and monitoring of negative pressure and anti-reflux valve safety systems, to promote healing of the pleural and pericardial cavities.
Two devices for mediastinal chest drainage [Venice PAS (Wet) and Rome PAS (Dry); both Eurosets SRL, Medolla, Italy] were evaluated in terms of safety, efficacy and clinical outcomes in a cohort of 60 patients who underwent elective cardiac surgery procedures. The patients were divided into a minimally invasive cardiac surgery (MICS) group [n=30; mitral valve surgery (MVS) by right anterolateral mini-thoracotomy] and a conventional cardiac surgery (CCS) group [n=30; coronary arterial bypass grafting (CABG) in full sternotomy] at a single institution (Anthea Hospital GVM Care & Research, Bari, Italy).
Negative pressure was managed with a target value of -20 cmH2O measured in the chest tube and was related to the device: deviation of ± 1 cmH2O for the Venice PAS (Wet) and 0 cmH2O for the Rome PAS (Dry) in the MICS group; deviation of 1 ± 0.8 cmH2O for the Venice PAS (Wet) and 0.8±0.2 cmH2O for the Rome PAS (Dry) in the CCS group. A constant volumetric air leak meter (VALM) value and the absence of air-leak bubbling were correlated with the absence of air in the pleural cavity and complete pulmonary re-expansion to restore normal respiratory dynamics in the MICS group for both models of chest drainage. The maximum total pericardial blood drained was 1104 ± 302 ml with Venice PAS (Wet) and 1530 ± 230 with Rome PAS (Dry) in the CCS group. There were no reports of cardiac tamponade in either group.
The two mediastinal chest drainage devices [Venice PAS (Wet) and Rome PAS (Dry)] in this study were effective, accurate for measuring the applied negative pressure, and safe in their application after cardiac surgery procedures via minimally invasive and conventional approaches for blood and liquid drainage, prevention of cardiac tamponade, and restoration of normal respiratory dynamics after surgical pneumothorax. Both systems are equipped with anti-reflux valves to prevent air and blood from entering the drainage, and no adverse events were reported.
心胸外科手术后，从心包和胸腔排出液体和气体对于预防积液、心包填塞和气胸以及检测出血是必要的。为此，在纵隔和胸腔内放置负压引流管。我们比较了两种系统（湿式和干式引流）在负压管理和监测以及抗反流阀安全系统方面的有效性和安全性，以促进胸膜腔和心包腔的愈合。
在一组60例行择期心脏手术的患者中，对两种纵隔胸腔引流装置[威尼斯PAS（湿式）和罗马PAS（干式）；均为意大利梅多拉的Eurosets SRL公司生产]的安全性、有效性和临床结果进行了评估。患者被分为微创心脏手术（MICS）组[n = 30；经右前外侧小切口行二尖瓣手术（MVS）]和传统心脏手术（CCS）组[n = 30；在全胸骨正中切开下行冠状动脉旁路移植术（CABG）]，均来自同一机构（意大利巴里的安泰亚医院GVM护理与研究中心）。
以胸管测量的-20 cmH₂O为目标值进行负压管理，且与装置有关：在MICS组中，威尼斯PAS（湿式）的偏差为±1 cmH₂O，罗马PAS（干式）的偏差为0 cmH₂O；在CCS组中，威尼斯PAS（湿式）的偏差为1±0.8 cmH₂O，罗马PAS（干式）的偏差为0.8±0.2 cmH₂O。对于两种胸腔引流模型，在MICS组中，恒定的体积漏气计（VALM）值和无漏气气泡与胸腔内无空气以及肺完全复张以恢复正常呼吸动力学相关。在CCS组中，使用威尼斯PAS（湿式）时心包引流的最大总血量为1104±302 ml，使用罗马PAS（干式）时为1530±230 ml。两组均未报告心包填塞情况。
本研究中的两种纵隔胸腔引流装置[威尼斯PAS（湿式）和罗马PAS（干式）]是有效的，在测量施加的负压方面准确无误，并且在通过微创和传统方法进行心脏手术后的血液和液体引流、预防心包填塞以及在手术性气胸后恢复正常呼吸动力学方面应用安全。两种系统均配备抗反流阀以防止空气和血液进入引流管，且未报告不良事件。
