Elsevier

The Annals of Thoracic Surgery

Volume 80, Issue 3, September 2005, Pages 1052-1055
The Annals of Thoracic Surgery

Original article
General thoracic
Alternate Suction Reduces Prolonged Air Leak After Pulmonary Lobectomy: A Randomized Comparison Versus Water Seal

https://doi.org/10.1016/j.athoracsur.2005.03.073Get rights and content

Background

The objective of the present study was to compare in a prospective randomized fashion two different management schemes for chest tubes after lobectomy: water seal versus alternate suction (suction overnight and water seal during the day).

Methods

Ninety-four patients with air leak on the morning of the first postoperative day were randomly assigned to two groups: group 1 (water seal alone), 47 patients; or group 2 (alternate suction), 47 patients. The groups were then compared in terms of preoperative, operative, and postoperative variables.

Results

Alternate suction patients showed a reduced incidence of air leak longer than 4 days (p = 0.04) and longer than 7 days (p = 0.02), a shorter duration of chest tubes in place (p = 0.002), and a shorter postoperative hospital stay (p = 0.004).

Conclusions

Alternate suction was superior to water seal alone in reducing the incidence of prolonged air leak and postoperative hospital stay after lobectomy. As suction was applied only overnight, this modality has the same advantage of water seal in terms of early mobilization of patients.

Section snippets

Patients and Methods

One hundred and ninety-four patients underwent pulmonary lobectomy or bilobectomy for nonsmall-cell carcinoma (NSCLC) at our institution from April 2003 through December 2004 and were enrolled in the study after informed consent. The local ethical committee of the hospital approved this study.

Patients underwent chest wall resection, and bronchoplastic procedures were excluded from the analysis. Resectability was evaluated by means of computed tomography (CT) scan, bronchoscopy, and when

Results

Table 1 shows that the two groups were evenly matched for preoperative and operative variables. Two patients in the water seal group and 4 patients in the alternate suction group received preoperative systemic steroids.

As shown in Table 2, the alternate suction group had a reduced presence of PAL (p = 0.02), less days required for chest tubes removal (p = 0.002) and shorter length of postoperative hospital stay (p = 0.004). In group 2, only 8 patients had an air leak lasting more than 4 days

Comment

The objective of the present study was to compare a combined modality of chest tube management (water seal during the day and suction overnight) to water seal alone in a randomized group of patients submitted to lobectomy.

This study was prompted by the results of our previous analysis [4] that showed that water seal was not superior to continuous suction in reducing air leak after lobectomy. Nevertheless, in that study, we showed that water seal was safe and well tolerated by the patients, as

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