Is it safe not to drain the pneumonectomy space?
A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was whether it is safe not to position any chest drain into the pneumonectomy space at the conclusion of the procedure. Altogether 381 relevant studies were identified of which 11 represented the best evidence to answer the question. The author, journal, date, country of publication, alternative methods of postpneumonectomy space (PPS) management, complications and relevant outcomes are tabulated. The majority of studies are on the basis of expert opinion or small cohorts. Major cohorts, by which the pneumonectomy outcomes have been examined, demonstrated that the rates of complications related to pneumonectomy space management such as empyema, bronchopleural fistula, mediastinal shift and major bleeding requiring reopening are very low. In a large cohort where 408 patients underwent pneumonectomy the rate of relevant complications was low and also it was concluded that the PPS drainage is not necessary. Two separate expert opinions were in agreement that needle aspiration in the absence of a drainage system is adequate for the management of PPS and avoiding a mediastinal shift. One small cohort and one institutional audit directly examined the impact of a drainage versus no drainage approach in the management of PPS. Although neither study could show a significant superiority of one method over another, they recommended adopting a unified institutional protocol for current departmental practice. They also emphasized that larger cohorts are required to examine the superiority of different strategies for PPS management. In a cohort of 291 patients, it was demonstrated that patients with drainage with underwater seal are more at risk of postpneumonectomy oedema. A recent review published as a book chapter appraised the relevant literature in both humans and animals. The authors concluded that the simplicity of a no-drainage system is notable; however, a balanced drainage might be recommended for local protocols. We conclude that although the current evidence is not adequate to examine the different aforementioned approaches, not draining the pneumonectomy space can be performed safely.
Department of Thoracic Surgery, Golden Jubilee National Hospital, Clydebank, UK.
Karim
K
Morcos
Kasra
K
Shaikhrezai
Alan J B
AJ
Kirk
D004322:Drainage / Q000009:adverse effects / Q000379:methods; D006801:Humans; D061214:Patient Safety; D018579:Patient Selection; D011013:Pneumonectomy / Q000009:adverse effects; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome
Drain; Pneumonectomy; Pneumonectomy space