The values of intrapleural pressure before the removal of chest tube in non-complicated pulmonary lobectomies.
OBJECTIVE
Digitalized chest drainage systems allow for quantification of air leak and measurement of intrapleural pressure. Little is known about the value of intrapleural pressure during the postoperative phase and its role in the recovering process after pulmonary resection. The objective of this investigation was to measure the values of pleural pressure immediately before the removal of chest tube after different types of pulmonary lobectomy.


METHODS
Prospective observational analysis on 203 consecutive patients submitted to pulmonary lobectomy during a 12-month period at two centres. Multiple measurements were recorded in the last hour before the removal of chest tube and averaged for the analysis. All patients were seated in bed in a 45° up-right position or in a chair, had a single chest tube and were not connected to suction during the evaluation period. Analysis of variance (ANOVA) was used to assess the differences in pleural pressure between different types of lobectomies.


RESULTS
The average maximum, minimum and differential pressures were -6.1, -19.5 and 13.3 cmH(2)O, respectively. The average pressures were similar in all types of lobectomies (ANOVA, P = 0.2) and ranged from -11 to -13 cmH(2)O, with the exception of right upper bilobectomy (-20 cmH(2)O, all P-values vs. other types of lobectomies <0.05). Similar values were also recorded for maximum pressures (range -4.4 to -8.4 cmH(2)O) and minimum pressures (-31.6 cmH(2)O vs. ranged from -15.4 to -20.5 cmH(2)O, all P-values <0.01). The average pleural pressure was not associated with FEV1 (P = 0.9), DLCO (P = 0.2) or FEV1/FVC ratio (P = 0.6), when tested with linear regression. Similarly, the average pleural pressure was similar in patients with and without COPD (-12.1 vs. -13.0 cmH(2)O, P = 0.4). The ANOVA test was used to assess differences in pressures between different lobectomies.


CONCLUSIONS
The so-called water seal status may actually correspond to intrapleural pressures ranging from -13 to -20 cmH(2)O. Modern electronic chest drainage devices allow a stable control of the intrapleural pressure. Thus, the values found in this study may be used as target pressures for different types of lobectomies, in order to favour lung recovery after surgery.
Thoracic Surgery Department,  United Hospitals of Ancona, Ancona,  Italy.
Majed
M
Refai
Alessandro
A
Brunelli
Gonzalo
G
Varela
Nuria
N
Novoa
Cecilia
C
Pompili
Marcelo F
MF
Jimenez
José Luis
JL
Aranda
Armando
A
Sabbatini
D015505:Chest Tubes; D020878:Device Removal / Q000379:methods*; D005541:Forced Expiratory Volume / Q000502:physiology; D006801:Humans; D035422:Pleural Cavity / Q000503:physiopathology*; D011013:Pneumonectomy; D011182:Postoperative Care / Q000379:methods; D011312:Pressure; D011446:Prospective Studies; D013396:Suction / Q000379:methods; D014797:Vital Capacity / Q000502:physiology