Randomized Multicenter Trial of -8 cm H₂O vs -15 cm H₂O Intrathoracic Pressure Digital Thoracic Drainage for Air...

Digital pleural drainage systems are commonly used for chest tube management after lung resection, but the optimal intrathoracic pressure setting for digital pleural drainage systems in patients with air leaks remains unclear.

The study was a multicenter, prospective, randomized controlled trial including patients with moderate air leaks (100-1000 mL/min) after segmentectomy or lobectomy. Patients were randomized to group A (physiologic pressure mode, -8 cm H₂O) and group B (-15 cm H₂O). The primary end point was prolonged air leak incidence.

Of 2379 registered patients, 93 in group A and 106 in group B received the assigned treatment. There was no significant difference in prolonged air leak incidence between the groups (67.7% vs 60.4%; P = .303). The duration of air leak (median, 6 vs 5 days; P = .429), chest tube placement (7 vs 7 days; P = .568), and postoperative hospital stay (median, 9 vs 9.5 days; P = .550) were similar. The frequency of pleurodesis due to air leak after postoperative day 5 was 43.0% in group A and 31.1% in group B (P = .105). The proportion of respiratory adverse events (grade 2 or higher) was 1.1% in group A and 6.6% in group B (P = .069).

Intrathoracic pressure setting did not affect the earlier remission of air leaks. Air leaks after anatomic pulmonary resection may be appropriately managed by adjusting the negative intrathoracic pressure above -8 cm H₂O according to the state of the patients.