title: Determining optimal fluid and air leak cut off values for chest drain management in general thoracic surgery.
abstract: BACKGROUND
  Chest drain duration is one of the most important influencing aspects of hospital stay but the management is perhaps one of the most variable aspects of thoracic surgical care. The aim of our study is to report outcomes associated with increasing fluid and air leak criteria of protocol based management.
  
  
  METHODS
  A 6-year retrospective analysis of protocolised chest drain management starting in 2007 with a fluid criteria of 3 mL/kg increasing to 7 mL/kg in 2011 to no fluid criteria in 2012, and an air leak criteria of 24 hours without leak till 2012 when digital air leak monitoring was introduced with a criteria of <20 mL/min of air leak for more than 6 hours. Patient data were obtained from electronic hospital records and digital chest films were reviewed to determine the duration of chest tube drainage and post-drain removal complications.
  
  
  RESULTS
  From 2009 to 2012, 626 consecutive patients underwent thoracic surgery procedures under a single consultant. A total of 160 did not require a chest drain and data was missing in 22, leaving 444 for analysis. The mean age [standard deviation (SD)] was 57±19 years and 272 (61%) were men. There were no differences in the incidence of pneumothoraces (P=0.191), effusion (P=0.344) or re-interventions (P=0.431) for drain re-insertions as progressively permissive criteria were applied. The median drain duration dropped from 1-3 days (P<0.001) and accordingly hospital stay reduced from 4-6 days (P<0.001).
  
  
  CONCLUSIONS
  Our results show that chest drains can be safely removed without fluid criteria and air leak of less than 20 mL/min with median drain duration of 1 day, associated with a reduced length of hospital stay.
authors.affiliation: 1 Department of Thoracic Surgery, 2 Department Quality and Safety, Royal Brompton Hospital, London, UK.
authors.forename: Miguel
authors.initials: M
authors.lastname: Mesa-Guzman
authors.affiliation: 1 Department of Thoracic Surgery, 2 Department Quality and Safety, Royal Brompton Hospital, London, UK.
authors.forename: Perikleous
authors.initials: P
authors.lastname: Periklis
authors.affiliation: 1 Department of Thoracic Surgery, 2 Department Quality and Safety, Royal Brompton Hospital, London, UK.
authors.forename: Zakiyah
authors.initials: Z
authors.lastname: Niwaz
authors.affiliation: 1 Department of Thoracic Surgery, 2 Department Quality and Safety, Royal Brompton Hospital, London, UK.
authors.forename: Laura
authors.initials: L
authors.lastname: Socci
authors.affiliation: 1 Department of Thoracic Surgery, 2 Department Quality and Safety, Royal Brompton Hospital, London, UK.
authors.forename: Hilgardt
authors.initials: H
authors.lastname: Raubenheimer
authors.affiliation: 1 Department of Thoracic Surgery, 2 Department Quality and Safety, Royal Brompton Hospital, London, UK.
authors.forename: Ben
authors.initials: B
authors.lastname: Adams
authors.affiliation: 1 Department of Thoracic Surgery, 2 Department Quality and Safety, Royal Brompton Hospital, London, UK.
authors.forename: Lokesh
authors.initials: L
authors.lastname: Gurung
authors.affiliation: 1 Department of Thoracic Surgery, 2 Department Quality and Safety, Royal Brompton Hospital, London, UK.
authors.forename: Mohsin
authors.initials: M
authors.lastname: Uzzaman
authors.affiliation: 1 Department of Thoracic Surgery, 2 Department Quality and Safety, Royal Brompton Hospital, London, UK.
authors.forename: Eric
authors.initials: E
authors.lastname: Lim
keywords: Chest drain; air leak; chest drain-management; postoperative care; postoperative stay