Digital Drains Reduce Complications and Promote Early Chest Tube Removal

The study "Reduction of drainage-associated complications in cardiac surgery with a digital drainage system: a randomized controlled trial", performed by Arnaud Van Linden et al. provides evidence for the safety of digital chest drainage and monitoring systems within cardiac surgery. It even suggests that patients benefit by a reduction of chest-drainage associated complications. The trial was designed to investigate potential differences between an analog wet-seal system and a digital chest drainage and monitoring system in elective cardiac surgery patients in a German hospital.

Good to know

  • Pleural and/or mediastinal chest drains are a standard postoperative practice after cardiothoracic surgery.
  • Digital systems are recommended as part of the ERAS (Enhanced Recovery after Surgery) pathway for the perioperative management after lung surgery in order to improve patients’ outcome1.
  • Digital chest drains provide continuous, precisely controlled, uninterrupted drainage from the operating room onwards2 and allow fast objective clinical decisions3.
  • Digital chest drainage and monitoring systems give patients mobility and independence in the postoperative phase4.
  • Early mobilization after cardiac surgery seems to be an element to prevent postoperative complications, enhance functional capacity, and shorten the length of hospital stay5.
  • Traditionally used analog systems ("wet seal" drainage systems) result in patient’s immobility as well as subjective assessment of air leaks, leading to high interobserver variability in quantifying air leak severity6 and deciding when to pull the drain.7
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About the clinic:

The study was performed in the Kerckhoff Clinic in Bad Nauheim (Germany) under the lead of Dr. Arnaud Van Linden and Prof. Dr. Thomas Walther. Prof. Dr. Walther was the head of the heart surgery department and has performed more than 7.800 surgeries8. The Institute is one of the largest cardiac centers in Germany and handles more than 2.000 cardiac surgeries each year9.

Sources:

1 Batchelor TJP, Rasburn NJ, Abdelnour-Berchtold E, et al. Guidelines for enhanced recovery after lung surgery: recommendations of the Enhanced Recovery After Surgery (ERAS®) Society and the European Society of Thoracic Surgeons (ESTS). Eur J Cardiothorac Surg 2019;55:91-115.

2 Barozzi et al., 64th European Society for Cardiovascular and Endovascular Surgery (ESCVS); Volume 56 Supplement 1 No 2, April 2015

3 The benefits of digital air leak assessment after pulmonary resection: Prospective and comparative study. Mier JM, Molins L, Fibla JJ, Cir Esp 2010, 87(6):385-9.

4 Danitsch D. Benefits of digital thoracic drainage systems. Nurs Times 2012;108:16-7

5 Ramos Dos Santos PM, Ricci NA, Suster ÉAB, et al. Effects of early mobilisation in patients after cardiac surgery: a systematic review. Physiotherapy 2017;103:1-12.

6 McGuire AL, Petrcich W, Maziak DE, et al. Digital versus analogue pleural drainage phase 1: prospective evaluation of interobserver reliability in the assessment of pulmonary air leaks. Interact Cardiovasc Thorac Surg 2015;21:403-7.

7 Varela G, Jiménez MF, Novoa NM, et al. Postoperative chest tube management: measuring air leak using an electronic device decreases variability in the clinical practice. Eur J Cardiothorac Surg 2009;35:28-31.

8 https://aktuelles.uni-frankfurt.de/menschen/herzchirurgie-unter-neuer-leitung/

9 https://www.kerckhoff-klinik.de/fileadmin/Verwaltung/SQB_fuer_Homepage_181115.pdf, Page 23