title: Optimizing postoperative care protocols in thoracic surgery: best evidence and new technology.
abstract: Postoperative clinical pathways have been shown to improve postoperative care and decrease length of stay in hospital. In thoracic surgery there is a need to develop chest tube management pathways. This paper considers four aspects of chest tube management: (I) appraising the role of chest X-rays in the management of lung resection patients with chest drains; (II) selecting of a fluid output threshold below which chest tubes can be removed safely; (III) deciding whether suction should be applied to chest tubes; (IV) and selecting the safest method for chest tube removal. There is evidence that routine use of chest X-rays does not influence the management of chest tubes. There is a lack of consensus on the highest fluid output threshold below which chest tubes can be safely removed. The optimal use of negative intra-pleural pressure has not yet been established despite multiple randomized controlled trials and meta-analyses. When attempting to improve efficiency in the management of chest tubes, evidence in support of drain removal without a trial of water seal should be considered. Inconsistencies in the interpretation of air leaks and in chest tube management are likely contributors to the conflicting results found in the literature. New digital pleural drainage systems, which provide a more objective air leak assessment and can record air leak trend over time, will likely contribute to the development of new evidence-based guidelines. Technology should be combined with continued efforts to standardize care, create clinical pathways, and analyze their impact on postoperative outcomes.
authors.affiliation: Division of Thoracic Surgery, University of Ottawa, The Ottawa Hospital-General Campus, Ottawa, ON, Canada.
authors.forename: Daniel G
authors.initials: DG
authors.lastname: French
authors.affiliation: Division of Thoracic Surgery, University of Ottawa, The Ottawa Hospital-General Campus, Ottawa, ON, Canada.
authors.forename: Michael
authors.initials: M
authors.lastname: Dilena
authors.affiliation: Division of Thoracic Surgery, University of Ottawa, The Ottawa Hospital-General Campus, Ottawa, ON, Canada.
authors.forename: Simon
authors.initials: S
authors.lastname: LaPlante
authors.affiliation: Division of Thoracic Surgery, University of Ottawa, The Ottawa Hospital-General Campus, Ottawa, ON, Canada.
authors.forename: Farid
authors.initials: F
authors.lastname: Shamji
authors.affiliation: Division of Thoracic Surgery, University of Ottawa, The Ottawa Hospital-General Campus, Ottawa, ON, Canada.
authors.forename: Sudhir
authors.initials: S
authors.lastname: Sundaresan
authors.affiliation: Division of Thoracic Surgery, University of Ottawa, The Ottawa Hospital-General Campus, Ottawa, ON, Canada.
authors.forename: James
authors.initials: J
authors.lastname: Villeneuve
authors.affiliation: Division of Thoracic Surgery, University of Ottawa, The Ottawa Hospital-General Campus, Ottawa, ON, Canada.
authors.forename: Andrew
authors.initials: A
authors.lastname: Seely
authors.affiliation: Division of Thoracic Surgery, University of Ottawa, The Ottawa Hospital-General Campus, Ottawa, ON, Canada.
authors.forename: Donna
authors.initials: D
authors.lastname: Maziak
authors.affiliation: Division of Thoracic Surgery, University of Ottawa, The Ottawa Hospital-General Campus, Ottawa, ON, Canada.
authors.forename: Sebastien
authors.initials: S
authors.lastname: Gilbert
keywords: Thoracic surgery clinical pathways; chest drain protocol; chest tube management; digital pleural drains