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Mediastinal chest drain clearance for cardiac surgery
M Wallen1, A Morrison, D Gillies
1Centre for Evidence-Based Paediatric Practice, The Children's Hospital at Westmead, Locked Bag 4001, Westmead, NSW, Australia, 2145. margarew@chw.edu.au
The Cochrane Database of Systematic Reviews
|June 22, 2002
Summary
Limited research exists on effective chest drain management after cardiac surgery. Current evidence is insufficient to determine the best methods for preventing chest tube blockage and cardiac tamponade.
Area of Science:
- Cardiovascular Surgery
- Critical Care Medicine
- Thoracic Surgery
Background:
- Cardiac tamponade is a risk after cardiac surgery due to fluid accumulation in the pericardial space.
- Mediastinal chest drains are standard post-operative to prevent tamponade.
- Drain manipulation techniques (milking, stripping, etc.) are used to prevent blockage.
Purpose of the Study:
- To compare chest drain clearance methods (suction, manipulation) for preventing cardiac tamponade post-cardiac surgery.
Main Methods:
- Searched multiple databases (Cochrane, MEDLINE, EMBASE, CINAHL) and clinical trial registries.
- Included randomized, quasi-randomized, or systematically allocated trials of chest tube manipulation in post-cardiac surgery patients.
- Two independent reviewers assessed quality and extracted data; authors were contacted for further information.
Main Results:
- Three studies with 471 participants were included; meta-analysis was not possible due to data limitations.
- No significant differences were found between groups regarding chest tube blockage, cardiac tamponade, or re-operation based on single studies.
- Inadequate data prevented analysis of varying suction levels or combined manipulation techniques.
Conclusions:
- Insufficient comparative studies exist to support or refute the efficacy of different chest drain clearance techniques.
- The necessity of manipulating chest drains cannot be confirmed or denied based on current randomized controlled trial (RCT) evidence.