Effect of timing of chest tube removal on development of pericardial effusion following cardiac surgery.
BACKGROUND
There are no standard criteria for the timing of drain removal. The objective of this study was to determine whether the macroscopic appearance of chest tube drainage fluid to serosanguineous may be used as a criteria for drain removal.


METHODS
2,359 patients were assessed retrospectively and 80 randomized patients were followed prospectively who underwent cardiac surgery. In both parts of the study, patients were divided into two groups according to the timing of drain removal. Group I consisted of patients whose chest tubes were removed as soon as the macroscopic appearance of the drainage fluid turned to serosanguineous. Group II consisted of patients whose chest tubes were removed at the second postoperative day when the drainage output declined to less than 50 mL in a five-hour period. In the retrospective part, cases of hemodynamically significant pericardial effusion observed within seven days postoperatively were reviewed. In the prospective part, just before the drain removal, the fluid sample hematocrit obtained from the drain lines and patients' blood hematocrit were measured and recorded. Patients were evaluated with echocardiography for pericardial effusion.


RESULTS
No statistically significant difference was detected in the frequency of hemodynamically significant pericardial effusion and incidence or amount of pericardial effusion between the two study groups. The drain hematocrit to blood hematocrit ratios before drain removal showed a significant correlation with pericardial effusion. The strength of correlation between the drain hematocrit to blood hematocrit ratios before drain removal and pericardial effusion was also studied using receiver operating characteristic curve, which suggests that a drain hematocrit to blood hematocrit ratio of < or = 0.3 is strongly predictive that pericardial effusion would be absent or mild between the fifth and seventh postoperative days.


CONCLUSIONS
It is safe to remove the chest tubes as soon as the macroscopic appearance of the drainage fluid turns to serosanguineous since this practically indicates cessation of active bleeding.
Gercekoglu
Hakan
H
Division of Cardiovascular Surgery, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Center, Istanbul, Turkey.
Aydin
Naz Bige
NB
Dagdeviren
Bahadir
B
Ozkul
Vedat
V
Sener
Tufan
T
Demirtas
Murat
M
Tezel
Tuna
T
Eren
Ergin
E
Ozler
Azmi
A
D000328:Adult; D000368:Aged; D006348:Cardiac Surgical Procedures / Q000295:instrumentation* / Q000379:methods; D015505:Chest Tubes; D020878:Device Removal; D004322:Drainage / Q000295:instrumentation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010490:Pericardial Effusion / Q000453:epidemiology / Q000517:prevention & control*; D011183:Postoperative Complications / Q000517:prevention & control; D011184:Postoperative Period; D011237:Predictive Value of Tests; D011300:Preoperative Care; D011336:Probability; D011446:Prospective Studies; D012189:Retrospective Studies; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D013997:Time Factors; D016896:Treatment Outcome