V-216 Safety and efficacy of the coaxial thoracic drain after lobectomy: preliminary results ofa randomized controlled study

Objectives Pleural drainage is fundamental after lobectomy because it leads to air and fluids removal, avoiding lung collapse and intrapleural fluids collection. Usually, the drains are left in place since no air-leak has been detected and pleural effusion has been less than 200-400ml in 24 hours. Recently, a new coaxial tube has been introduced with a combination of an external spiral drain to facilitate fluid and an internal coaxial for air drainage. This prospective randomized study aims to assess safety and efficacy of the new coaxial chest drain after lobectomy.

Methods From 10/2020 to 03/2021 43 patients undergoing lobectomy, were blindly randomized in two groups according. Coaxial drain in 21 patients (Study Group); standard drain in 22 (Control Group). This randomized controlled study was approved by the Ethic Committee (protocol number: 19-1668) of university hospital. The following variables were compared between groups: air-leak duration, pleural effusion volume on the first three postoperative days, chest tube duration, postoperative length of stay. All patients received a follow-up including a postoperative checkup and a x-ray in our outpatient clinic 10 days after discharge.

Results No differences were identified between Study and Control Group, in terms of postoperative air-leak duration, postoperative chest tube stay (5.3±2.6 vs 5.3±3.0 days; p-value=0.85) and postoperative length of stay (6.7±5.2 vs 7.1±5.2 days; p-value=0.78) However, a higher pleural effusion drained volume was recorded in Study Group on postoperative day (606.8±198.9ml vs 500.9±204.2ml p=0.01). Pleural effusion volume did not differ on the following postoperative days. Patients from the study group underwent a left upper lobe resection significantly more often than control group (30% vs. 8.7%; P=0.007). Patients in the study group tended to develop significantly fewer pneumonias with the necessity of the administration of antibiotics (3% vs 21.7%; p<0.01). No significant differences were observed in terms of pleural effusion or pneumothorax at the follow-up 10 days after discharge.

Conclusions In this randomized controlled trial, the new coaxial drain was safe, efficient, and well tolerated by patients undergoing lobectomy, suggesting it could also be used as an alternative to standard drains. But the higher price is not justified.

Publication History

Article published online:
06 September 2021