Article Abstract

The Society for Translational Medicine: clinical practice guidelines for the postoperative management of chest tube for patients undergoing lobectomy

Authors: Shugeng Gao, Zhongheng Zhang, Javier Aragón, Alessandro Brunelli, Stephen Cassivi, Ying Chai, Chang Chen, Chun Chen, Gang Chen, Haiquan Chen, Jin-Shing Chen, David Tom Cooke, John B. Downs, Pierre-Emmanuel Falcoz, Wentao Fang, Pier Luigi Filosso, Xiangning Fu, Seth D. Force, Martínez I. Garutti, Diego Gonzalez-Rivas, Dominique Gossot, Henrik Jessen Hansen, Jianxing He, Jie He, Bo Laksáfoss Holbek, Jian Hu, Yunchao Huang, Mohsen Ibrahim, Andrea Imperatori, Mahmoud Ismail, Gening Jiang, Hongjing Jiang, Zhongmin Jiang, Hyun Koo Kim, Danqing Li, Gaofeng Li, Hui Li, Qiang Li, Xiaofei Li, Yin Li, Zhijun Li, Eric Lim, Chia-Chuan Liu, Deruo Liu, Lunxu Liu, Yongyi Liu, Kevin W. Lobdell, Haitao Ma, Weimin Mao, Yousheng Mao, Juwei Mou, Calvin Sze Hang Ng, Nuria M. Novoa, René H. Petersen, Hiroyuki Oizumi, Kostas Papagiannopoulos, Cecilia Pompili, Guibin Qiao, Majed Refai, Gaetano Rocco, Erico Ruffini, Michele Salati, Agathe Seguin-Givelet, Alan Dart Loon Sihoe, Lijie Tan, Qunyou Tan, Tang Tong, Kosmas Tsakiridis, Federico Venuta, Giulia Veronesi, Nestor Villamizar, Haidong Wang, Qun Wang, Ruwen Wang, Shumin Wang, Gavin M. Wright, Deyao Xie, Qi Xue, Tao Xue, Lin Xu, Shidong Xu, Songtao Xu, Tiansheng Yan, Fenglei Yu, Zhentao Yu, Chunfang Zhang, Lanjun Zhang, Tao Zhang, Xun Zhang, Xiaojing Zhao, Xuewei Zhao, Xiuyi Zhi, Qinghua Zhou

Abstract

The Society for Translational Medicine and The Chinese Society for Thoracic and Cardiovascular Surgery conducted a systematic review of the literature in an attempt to improve our understanding in the postoperative management of chest tubes of patients undergoing pulmonary lobectomy. Recommendations were produced and classified based on an internationally accepted GRADE system. The following recommendations were extracted in the present review: (I) chest tubes can be removed safely with daily pleural fluid of up to 450 mL (non-chylous and non-sanguinous), which may reduce chest tube duration and hospital length of stay (2B); (II) in rare instances, e.g., persistent abundant fluid production, the use of PrRP/B <0.5 when evaluating fluid output to determine chest tube removal might be beneficial (2B); (III) it is recommended that one chest tube is adequate following pulmonary lobectomy, except for hemorrhage and space problems (2A); (IV) chest tube clearance by milking and stripping is not recommended after lung resection (2B); (V) chest tube suction is not necessary for patients undergoing lobectomy after first postoperative day (2A); (VI) regulated chest tube suction [−11 (−1.08 kPa) to −20 (1.96 kPa) cmH2O depending upon the type of lobectomy] is not superior to regulated seal [−2 (0.196 kPa) cmH2O] when electronic drainage systems are used after lobectomy by thoracotomy (2B); (VII) chest tube removal recommended at the end of expiration and may be slightly superior to removal at the end of inspiration (2A); (VIII) electronic drainage systems are recommended in the management of chest tube in patients undergoing lobectomy (2B).