-8 cm H₂ O, the new paradigm in chest drain management following thoracoscopic lung resection?

Chest drain suction of -20 cm H₂ O has been used universally after lung resection. After introducing new guidelines,-8 cm H₂ O was used routinely for all non-pneumonectomy, thoracoscopic lung resections. We conducted a review to determine outcomes and safety.

After introduction of the guidelines data were collected in the study institutions' thoracic surgical database and subsequently analysed.

A total of 155 patients underwent thoracoscopic lung resection. Mean patient age was 61.5 ± 13.6 years. Video-assisted thoracoscopic surgery was performed in 92.2% (144/155) of patients and robotically-assisted thoracoscopic surgery was performed in 7.8% (12/155) of patients. Lobectomy was performed in 56.8% (88/155) of patients, segmentectomy was performed in 11.6% (18/155) of patients and wedge resection was performed in 31.6% (49/155) of patients. Median ICC duration time was 1 day (IQR 1-3). Median length of stay was 3 days (IQR 2-6). For patients undergoing lobectomy median ICC time was 2 days (IQR 1-4.5) and median length of stay was 3.5 days (IQR 2-7), for segmentectomy median ICC time was 1 day (IQR 1-5) and median length of stay was 2 days (IQR 1-5) and for wedge resection median ICC time was 1 day (IQR 1-1) and median admission time was 2 days (IQR 1-4).

A suction level -8 cm H₂ O is safe to use for thoracoscopic lung resections from day 0 post-operatively. A dedicated, prospective study comparing levels of suction should be performed.