title: Suction on chest drains following lung resection: evidence and practice are not aligned.
abstract: OBJECTIVE
  A best evidence topic in Interactive CardioVascular and Thoracic Surgery (2006) looked at application of suction to chest drains following pulmonary lobectomy. After screening 391 papers, the authors analysed six studies (five randomized controlled trials [RCTs]) and found no evidence in favour of postoperative suction in terms of air leak duration, time to chest drain removal or length of stay. Indeed, suction was found to be detrimental in four studies. We sought to determine whether clinical practice is consistent with published evidence by surveying thoracic units nationally and performing a meta-analysis of current best evidence.
  
  
  METHODS
  We systematically searched MEDLINE, EMBASE and CENTRAL for RCTs, comparing outcomes with and without application of suction to chest drains after lung surgery. A meta-analysis was performed using RevMan(©) software. A questionnaire concerning chest drain management and suction use was emailed to a clinical representative in every thoracic unit.
  
  
  RESULTS
  Eight RCTs, published 2001-13, with 31-500 participants, were suitable for meta-analysis. Suction prolonged length of stay (weighted mean difference [WMD] 1.74 days; 95% confidence interval [CI] 1.17-2.30), chest tube duration (WMD 1.77 days; 95% CI 1.47-2.07) and air leak duration (WMD 1.47 days; 95% CI 1.45-2.03). There was no difference in occurrence of prolonged air leak. Suction was associated with fewer instances of postoperative pneumothorax. Twenty-five of 39 thoracic units responded to the national survey. Suction is routinely used by all surgeons in 11 units, not by any surgeon in 5 and by some surgeons in 9. Of the 91 surgeons represented, 62 (68%) routinely used suction. Electronic drains are used in 15 units, 10 of which use them routinely.
  
  
  CONCLUSIONS
  Application of suction to chest drains following non-pneumonectomy lung resection is common practice. Suction has an effect in hastening the removal of air and fluid in clinical experience but a policy of suction after lung resection has not been shown to offer improved clinical outcomes. Clinical practice is not aligned with Level 1a evidence.
authors: Department of Cardiac Surgery, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK peter.lang@bsuh.nhs.uk.
authors: Peter
authors: P
authors: Lang
authors: Department of Cardiac Surgery, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK.
authors: Menaka
authors: M
authors: Manickavasagar
authors: Cambridge Centre for Cardiovascular Research Excellence, Cambridge, UK.
authors: Clare
authors: C
authors: Burdett
authors: Clinical Operational Research Unit, University College London, London, UK.
authors: Tom
authors: T
authors: Treasure
authors: Department of Cardiothoracic Surgery, National Heart and Lung Institute, Imperial College London, London, UK.
authors: Francesca
authors: F
authors: Fiorentino
mesh_terms: D015505:Chest Tubes; D019317:Evidence-Based Medicine; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D019538:Health Care Surveys; D006801:Humans; D015233:Models, Statistical; D010043:Outcome and Process Assessment, Health Care; D011013:Pneumonectomy; D011182:Postoperative Care / Q000295:instrumentation / Q000379:methods* / Q000706:statistics & numerical data; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D013396:Suction / Q000295:instrumentation / Q000379:methods / Q000706:statistics & numerical data*; D006113:United Kingdom
keywords: Air leak; Chest drains; Chest tubes; Lung resection; Pulmonary resection; Suction