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Original Articles: General Thoracic

The Benefits of Continuous and Digital Air Leak Assessment After Elective Pulmonary Resection: A Prospective Study

Division of Cardiothoracic Surgery, University of Alabama at Birmingham, Birmingham, Alabama

Accepted for publication April 9, 2008.

^_* Address correspondence to Dr Cerfolio, Department of Surgery, Division of Cardiothoracic Surgery, University of Alabama at Birmingham, 703 19th St S, ZRB 739, Birmingham, AL 35294 (Email: rcerfolio{at}uab.edu).

Background: Air leaks remain the most common pulmonary complication after elective pulmonary resection, yet their assessment, unlike other clinical bedside indicators, remains analogue and not digital.

Methods: This prospective randomized study compared a digital air leak system with the current analogue air leak system in 100 patients that underwent elective pulmonary resection.

Results: The digital and analogue patient groups each had 50 patients. Pulmonary function, types of pulmonary resection, number of chest tubes, and pathology were not statistically different between the groups. The digital system confirmed the air leak status in 5 patients that were equivocal on the analogue system. The ability to assess the air leak status continuously afforded quicker chest tube removal in the digital group (mean, 3.1 vs 3.9 days, p = 0.034) and reduced hospital stay (mean, 3.3 vs 4.0 days, p = 0.055). Three patients were discharged home with the device, without complications.

Conclusions: The digital and continuous measurement of air leaks instead of the currently used static analogue systems reduces hospital length of stay by more accurately and reproducibly measuring air leaks. This leads to quicker chest tube management decisions because the average size of an air leak during the last several hours can be determined. Intrapleural pressure curves may also help predict the optimal chest tube setting for each patient's air leak and eliminate the need for chest roentgenograms. Further studies on the pleural pressure curves and this device are needed.

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