title: Suction vs water seal after pulmonary resection: a randomized prospective study.
abstract: OBJECTIVE
  To evaluate whether suction or water seal is superior in the management of chest tubes after pulmonary resection.
  
  
  METHODS
  A prospective, randomized, controlled trial. After an initial, brief period of suction, patients were randomized to water seal or - 20 cm H(2)O suction.
  
  
  METHODS
  University hospital.
  
  
  METHODS
  Sixty-eight patients who underwent wedge resection, segmentectomy, or lobectomy were included in the study. Those patients who underwent reoperative surgery or lung volume reduction surgery were excluded.
  
  
  RESULTS
  There were 34 patients in each group. The two groups were evenly matched for age, sex, operation performed, severity of lung disease, and nutritional status. Fifteen patients in each group (44%) had an air leak at the completion of surgery. The duration of the air leak was shorter in the water seal group than in the suction group (mean +/- SEM, 1.50 +/- 0.32 days vs 3.27 +/- 0.80 days, respectively; p = 0.05). The mean times to removal of chest tubes were 3.33 +/- 0.35 days in the water seal group and 5.47 +/- 0.98 days in the suction group (p = 0.06). The length of stapled parenchyma was measured for each patient and averaged 24.9 cm for the water seal group and 18.5 cm for the suction group (p = 0.18). When corrected for the length of staple lines, the duration of air leaks and days with chest tube were dramatically lower in the water seal group (p = 0.02 and p = 0.02, respectively).
  
  
  CONCLUSIONS
  Placing chest tubes on water seal after a brief period of suction after pulmonary resection shortens the duration of the air leak and likely decreases the time that the chest tubes remain in place. Adoption of this practice may result in lower morbidity and lower hospital costs.
authors.affiliation: Section of General Thoracic Surgery, Division of Cardiothoracic Surgery, Department of Surgery, University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA.
authors.forename: M Blair
authors.initials: MB
authors.lastname: Marshall
authors.forename: Maher E
authors.initials: ME
authors.lastname: Deeb
authors.forename: Joshua I S
authors.initials: JI
authors.lastname: Bleier
authors.forename: John C
authors.initials: JC
authors.lastname: Kucharczuk
authors.forename: Joseph S
authors.initials: JS
authors.lastname: Friedberg
authors.forename: Larry R
authors.initials: LR
authors.lastname: Kaiser
authors.forename: Joseph B
authors.initials: JB
authors.lastname: Shrager
mesh_terms: D000368:Aged; D015505:Chest Tubes; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy; D011030:Pneumothorax / Q000601:surgery*; D011183:Postoperative Complications / Q000601:surgery*; D011446:Prospective Studies; D013396:Suction; D013907:Thoracostomy