Postoperative chest tube management: measuring air leak using an electronic device decreases variability in the clinical practice

• Published in: European journal of cardio-thoracic surgery 2009-01, Vol.35 (1), p.28-31
• Main Authors: Varela, Gonzalo, Jiménez, Marcelo F., Novoa, Nuria Maria, Aranda, José Luis
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Biological and medical sciences; Cardiology. Vascular system; Chest drainage; Chest Tubes; Decision Making; Device Removal; Drainage; Electronics, Medical - instrumentation; Humans; Lung resection; Medical sciences; Middle Aged; Observer Variation; Pneumology; Pneumonectomy - adverse effects; Pneumothorax - diagnosis; Pneumothorax - etiology; Postoperative Care - instrumentation; Postoperative Care - methods; Pressure; Prospective Studies; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; Variations in clinical practice; Young Adult
• ISSN: 1010-7940; 1873-734X
• DOI: 10.1016/j.ejcts.2008.09.005

Objectives: Since there are no data in the literature regarding variability in the management of postoperative pleural drainages, we have designed a prospective randomized study aimed at measuring inter-observer variability in deciding when to withdraw chest tubes after lung resection and to evaluate if the use of an electronic device to measure postoperative air leak decreases clinical practice variations. Methods: Sixty-one patients undergoing pulmonary resection were randomly assigned to one of the following groups: digital group (electronic measure of pleural air leak using Millicore AB DigiVent™ chest drainage system) or traditional group (standard water seal pleural chamber). Chest tube withdrawal criteria were established in advance. During morning rounds, two thoracic surgeons with comparable clinical experience and blinded to the decision of their counterpart, evaluated chest tube withdrawal criteria and noted whether the tube should be withdrawn or not. Inter-observer variability kappa index and global, positive, and negative agreement rates were calculated on 2 × 2 tables. Each observation episode was considered in the calculation. Results: Fifty-four observations were recorded in the traditional group. Kappa coefficient was 0.37 (overall agreement rate: 0.58; positive agreement rate: 0.72; and negative agreement rate: 0.64). In the digital group, 67 observations were recorded. Kappa coefficient was 0.88 (overall agreement rate: 0.94; positive agreement rate 0.94; and negative agreement rate 0.94). Conclusions: We have demonstrated a high rate of disagreement related to the indication to remove chest tubes after lung resection and the improvement of the agreement rate with the use of an electronic device to measure postoperative air leak and pleural pressures.