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Publication Detail
A prospective randomized controlled trial of suction versus non-suction to the under-water seal drains following lung resection.
  • Publication Type:
    Journal article
  • Publication Sub Type:
    Clinical Trial
  • Authors:
    Alphonso N, Tan C, Utley M, Cameron R, Dussek J, Lang-Lazdunski L, Treasure T
  • Publication date:
  • Pagination:
    391, 394
  • Journal:
    Eur J Cardiothorac Surg
  • Volume:
  • Issue:
  • Status:
  • Country:
  • Print ISSN:
  • PII:
  • Language:
  • Keywords:
    Adult, Aged, Chest Tubes, Female, Humans, Male, Middle Aged, Pneumonectomy, Pneumothorax, Postoperative Care, Prospective Studies, Suction, Thoracic Surgery, Video-Assisted
OBJECTIVE: Practice varies as to whether or not suction is applied to under-water seal drains following lung surgery. We tested the null hypothesis that there is no difference with respect to air leak duration. METHODS: Patients undergoing thoracotomy or video assisted thoracoscopic surgery for lobectomy or wedge resection had either low-pressure suction or no suction applied to their underwater seal bottles postoperatively. Patients were allocated using minimization, a method of unbiased allocation ensuring balance between the arms of a trial with respect to known or suspected confounding factors. The trial was powered for duration of air leak. If an air leak persisted on the 7th post-operative day, the surgeon determined further management. Kaplan-Meier survival analysis of air leak duration and a log rank test were performed on an intention-to-treat basis, with observations censored at 144h (6 complete days). RESULTS: Of the 254 patients that entered the trial, data were available for analysis for 239 (123 no-suction and 116 suction). There was no significant difference in the cumulative persistence of air leaks between the two groups (P=0.62) and inspection of the Kaplan-Meier curves suggests that any difference is negligible. CONCLUSIONS: Applying suction to the underwater seal drains following lung surgery makes no difference in terms of air leak duration. In the light of this finding we have adopted a uniform policy of no suction being applied to the underwater seal, from the time of surgery, unless a specific clinical judgment is made to use it. The anticipated gains are that this will reduce work and cost and aid mobilization.
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