-
European Journal of Cardio-thoracic... Apr 2019The optimal level of suction on digital chest drainage devices after lobectomy using video-assisted thoracoscopic surgery (VATS) is unknown and varies between thoracic... (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVES
The optimal level of suction on digital chest drainage devices after lobectomy using video-assisted thoracoscopic surgery (VATS) is unknown and varies between thoracic centres. In this randomized controlled trial, we assessed the potential benefits of low suction of -2 cmH2O compared to -10 cmH2O, using a digital drainage device.
METHODS
Two hundred and twenty-eight patients were randomized into 2 groups after VATS lobectomy for suspected or confirmed lung cancer. Primary outcome was time to chest drain removal. Drain data were obtained from the digital drainage devices, and patient data were obtained from medical records during admission, with a follow-up until postoperative day 30.
RESULTS
For the -2 cmH2O and -10 cmH2O groups, median (interquartile range) drainage duration was 27.4 h (23.3-71.2) and 47.5 h (24.5-117.8) (P = 0.047), and the incidence of prolonged air leak >5 days was 14.4% and 24.3% (P = 0.089), respectively. Median total fluid production was 566 h (329-1155) ml and 795 h (454-1605) ml (P = 0.007). Median time to consistent air leak cessation (<20 ml/min) was 5.2 h (0.3-34.2) and 23.7 h (0.8-90.8) (P < 0.001). There were no differences in the proportion or the size of the pneumothorax or subcutaneous emphysema after drain removal, and no differences were observed in postoperative morbidity. Median length of in-hospital stay was 2.0 days (2.0-5.8) and 3.0 days (2.0-9.0) (P = 0.18).
CONCLUSIONS
A low suction level significantly shortened drainage duration, time to air leak cessation and total fluid production, without increasing morbidity.
CLINICAL TRIAL REGISTRATION NUMBER
NCT02911259.
Topics: Aged; Chest Tubes; Device Removal; Enhanced Recovery After Surgery; Female; Humans; Length of Stay; Lung Neoplasms; Male; Pneumonectomy; Suction; Thoracic Surgery, Video-Assisted; Time Factors
PubMed: 30445572
DOI: 10.1093/ejcts/ezy361 -
Der Unfallchirurg Jan 1989The importance of wound drainage in casualty and plastic surgery is unquestioned. The most common form is suction drainage. This involves the disadvantage that the drain... (Clinical Trial)
Clinical Trial Comparative Study
The importance of wound drainage in casualty and plastic surgery is unquestioned. The most common form is suction drainage. This involves the disadvantage that the drain can become attached to the tissue by suction, stopping the flow and blocking the drain. In addition, the secretion reservoir must be made of rigid material, which means large package sizes are inevitable. Encouraged by our knowledge of silicone drains, we carried out a study comparing silicone drains (without vacuum) and PVC drains (with vacuum suction). Electron-microscope studies of the PVC drains used for suction drainage revealed adhesion of wound secretion and cell detritus to the inner wall and the drainage perforations after less than 24 h. No occlusion and almost no adherence was observed with silicone gravity drains. When compared in clinical use for joint drainage, neither system had any severe complications. Removal of gravity drains was considerably less painful than withdrawal of suction drains. In soft tissue drainage the volume of secretion drained off was more constant and obviously larger with gravity drainage. From these results we conclude that gravity drainage can replace suction drainage to considerable advantage.
Topics: Clinical Trials as Topic; Drainage; Humans; Microscopy, Electron, Scanning; Prospective Studies; Random Allocation; Silicones; Suction; Wounds and Injuries
PubMed: 2644695
DOI: No ID Found -
European Journal of Orthopaedic Surgery... Aug 2014The use of closed suction drainage systems for hip arthroplasty (HA) is a common practice. However, the effectiveness and safety are still questionable. Thus, the aim of... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
The use of closed suction drainage systems for hip arthroplasty (HA) is a common practice. However, the effectiveness and safety are still questionable. Thus, the aim of this meta-analysis was to review the advantages and adverse effects of closed suction drainage systems in hip arthroplasty.
METHODS
All randomized or quasi-randomized trials comparing the use of closed suction drainage systems with no drainage systems for hip arthroplasty were searched in PubMed, Medicine, EMBASE and other internet databases. We assessed the methodological quality of the studies and abstracted the relevant data independently.
RESULTS
Sixteen studies involving 1,663 participants with surgical wounds comparing HA with and without the use of drainage were included in our analysis. Our results demonstrated blood transfusion was required more frequently the same as the persistent discharge in those who received drains. No significant differences in the incidence of wound hematoma, dehiscence or deep vein thrombosis were found between those allocated to drains and the non-drained wounds. Wound infection and the range of movement of the joint after surgery were similar between the two groups.
CONCLUSIONS
Based on the current evidence, there is insufficient evidence to support the routine use of closed suction drainage in hip arthroplasty. At the same time, our meta-analysis study suggested that using of closed suction drainage in HA increased requirement for postoperative blood transfusion. However, there is a moderate possibility of selection bias and publication bias in this review. Because of the limited number of studies which may weaken the strength of the evidence of our results, more samples, high-quality randomized trials are needed to increase the reliability of evidences.
LEVEL OF EVIDENCE
II.
Topics: Arthroplasty, Replacement, Hip; Blood Transfusion; Hematoma; Hip Joint; Humans; Randomized Controlled Trials as Topic; Range of Motion, Articular; Suction; Surgical Wound Infection; Venous Thrombosis
PubMed: 23917702
DOI: 10.1007/s00590-013-1284-0 -
Nursing Nov 1997
Topics: Cutaneous Fistula; Humans; Skin Ulcer; Suction
PubMed: 9397834
DOI: 10.1097/00152193-199711000-00029 -
Progress in Pediatric Surgery 1977The neonatal pleural empyema, especially in its most serious form, following staphylococcal pneumonia, presents a surgical problem demanding immediate emergency...
The neonatal pleural empyema, especially in its most serious form, following staphylococcal pneumonia, presents a surgical problem demanding immediate emergency treatment. In 1957, we proposed that after diagnosis the empyema should immediately by drained by intercostal suction although in those times drainage was only an attempt after numerous aspirations. Children treated for pleural suppuration in the past were subjected to follow-up studies over a period of 14 to 15 years. Two comparative groups of "early-drained" and "late-drained" empyema cases showed that after immediate drainage there was definite improvement. Careful study of all the data of our 273 cases (up to 1970) shows that immediate continuous suction drainage with specific antibiotic and general supportive treatment have been very successful.
Topics: Adolescent; Empyema; Follow-Up Studies; Humans; Infant, Newborn; Positive-Pressure Respiration; Pulmonary Atelectasis; Spirometry; Suction; Time Factors
PubMed: 325603
DOI: No ID Found -
Medicine Jan 2024Thoracentesis is performed by 4 methods: gravity, manual aspiration, vacuum-bottle suction, and wall suction. This literature review investigates the safety of these... (Review)
Review
Thoracentesis is performed by 4 methods: gravity, manual aspiration, vacuum-bottle suction, and wall suction. This literature review investigates the safety of these techniques and determines if there is significant difference in complication rates. A comprehensive literature search revealed 6 articles studying thoracentesis techniques and their complication rates, reviewing 20,815 thoracenteses: 80 (0.4%) by gravity, 9431 (45.3%) by manual aspiration, 3498 (16.8%) by vacuum-bottle suction, 7580 (36.4%) by wall suction and 226 (1.1%) unspecified. Of the 6 studies, 2 were smaller with 100 and 140 patients respectively. Overall, there was a 4.4% complication rate including hemothoraces, pneumothoraces, re-expansion pulmonary edema (REPE), chest discomfort, bleeding at the site, pain, and vasovagal episodes. The pneumothorax and REPE rate was 2.5%. Sub-analyzed by each method, there was a 47.5% (38/80) complication rate in the gravity group, 1.2% (115/9431) in the manual aspiration group including 0.7% pneumothorax or REPE, 8% (285/3498) in the vacuum-bottle group including 3.7% pneumothorax or REPE, 4% (309/7580) in the wall suction group all of which were either pneumothorax or REPE, and 73% (166/226) in the unspecified group most of which were vasovagal episodes. Procedure duration was less in the suction groups versus gravity drainage. The 2 smaller studies indicated that in the vacuum groups, early procedure termination rate from respiratory failure was significantly higher than non-vacuum techniques. Significant complication rate from thoracentesis by any technique is low. Suction drainage was noted to have a lower procedure time. Symptom-limited thoracentesis is safe using vacuum or wall suction even with large volumes drained. Other factors such as procedure duration, quantity of fluid removed, number of needle passes, patients' BMI, and operator technique may have more of an impact on complication rate than drainage modality. All suction modalities of drainage seem to be safe. Operator technique, attention to symptom development, amount of fluid removed, and intrapleural pressure changes may be important in predicting complication development, and therefore, may be useful in choosing which technique to employ. Specific drainage modes and their complications need to be further studied.
Topics: Humans; Thoracentesis; Pneumothorax; Thoracic Surgical Procedures; Drainage; Suction; Pulmonary Edema; Respiratory Aspiration
PubMed: 38181250
DOI: 10.1097/MD.0000000000036850 -
International Journal of Surgery... Jul 2019There is no level 1a evidence regarding the impact of passive drainage to gravity (PDG) and closed-suction drainage (CSD) following pancreatoduodenectomy on clinical... (Meta-Analysis)
Meta-Analysis
Passive drainage to gravity and closed-suction drainage following pancreatoduodenectomy lead to similar grade B and C postoperative pancreatic fistula rates. A meta-analysis.
INTRODUCTION
There is no level 1a evidence regarding the impact of passive drainage to gravity (PDG) and closed-suction drainage (CSD) following pancreatoduodenectomy on clinical outcomes. The aim of this meta-analysis was to evaluate the impact of PDG versus CSD on surgical outcomes following pancreaticoduodenectomy in high risk patients who would benefit from pancreatic drainage.
METHODS
The Pubmed, EMBASE, and Cochrane Library were systematically searched. Postoperative pancreatic fistula (POPF) rate was the primary endpoint. A subgroup meta-analysis of randomized controlled trials (RCT) was performed in addition to a meta-analysis of all eligible studies. Mantel-Haenszel method (random-effects model) with odds ratios and 95% confidence intervals (OR (95%CI)) as an effect measure was utilized.
RESULTS
Six studies, whereof 3 RCTs, involving 1519 patients (806 PDG and 713 CSD) were included. In meta-analysis of all studies, overall [OR (95%CI) = 0.81 (0.42, 1.56); p = 0.53; I = 79%; Tau = 0.54]; grade A [OR (95%CI) = 0.71 (0.33, 1.53); p = 0.39; I = 65%; Tau = 0.47]; grade B [OR (95%CI) = 1.23 (0.74, 2.05); p = 0.42; I = 0%]; and grade C [OR (95%CI) = 1.08 (0.56, 2.09); p = 0.82; I = 5%] POPF rates did not differ. Subgroup analysis of RCTs confirmed the finding that grade B and C POPF rates did not significantly differ with low heterogeneity [OR (95%CI) = 1.55 (0.79, 3.04); p = 0.20; I = 0%]. No publication bias was found (t = 0.48; p = 0.64).
CONCLUSION
This meta-analysis found no difference in short-term clinical outcomes including, clinically relevant, grade B and C POPF rates between PDG and CSD. Furthermore, postoperative complication rates were similar with the use of either drain.
Topics: Drainage; Humans; Length of Stay; Odds Ratio; Pancreas; Pancreatic Fistula; Pancreaticoduodenectomy; Postoperative Complications; Suction
PubMed: 31078675
DOI: 10.1016/j.ijsu.2019.05.001 -
International Journal of Gynecological... 2001The present study was undertaken in the Department of Gynecologic Oncology, Kidwai Memorial Institute of Oncology, Bangalore between October 1998 and July 1999. One... (Clinical Trial)
Clinical Trial Comparative Study
The present study was undertaken in the Department of Gynecologic Oncology, Kidwai Memorial Institute of Oncology, Bangalore between October 1998 and July 1999. One hundred and forty three consecutive patients with various gynecological malignancies undergoing pelvic +/- aorto-caval lymphadenectomy as part of definitive surgical procedures, were analyzed. Sixty nine patients had closed suction retroperitoneal pelvic drainage (Group A) and 74 patients had no suction drainage and no pelvic reperitonealization (Group B). The mean postoperative hospitalization was 10 days in both groups. Six patients in Group A and four patients in Group B developed paralytic ileus which responded to conservative line of management. Five patients in Group A and two patients in Group B developed lymphocysts (P > 0.05). The present study demonstrates that closed suction retroperitoneal pelvic drainage following pelvic + aorto-caval lymphadenectomy confers no advantage over no drainage & no pelvic reperitonealization. The partial closure of pelvic peritoneum with no drainage was associated with increased lymphocyst formation (7/25 cases, 28%) during the period immediately before this modified study was undertaken.
Topics: Adolescent; Adult; Aged; Child; Female; Genital Neoplasms, Female; Hospitalization; Humans; Intestinal Pseudo-Obstruction; Length of Stay; Lymph Node Excision; Lymphocele; Middle Aged; Pelvis; Postoperative Complications; Retroperitoneal Space; Suction
PubMed: 11328413
DOI: 10.1046/j.1525-1438.2001.011002143.x -
Archives of Orthopaedic and Trauma... Nov 2014Primary aim of this meta-analysis of randomized controlled trials (RCTs) was to compare blood loss, transfusion rate and postoperative hemoglobin levels at 24-48 h... (Comparative Study)
Comparative Study Meta-Analysis
PURPOSE
Primary aim of this meta-analysis of randomized controlled trials (RCTs) was to compare blood loss, transfusion rate and postoperative hemoglobin levels at 24-48 h after primary total hip arthroplasty (THA) between autologous blood transfusion (ABT) drainage and no drainage/closed-suction drainage and to obtain a powerful conclusion which way of drainage had the best clinical efficacy. Secondary aim was to compare the postoperative complication rates during the first year to indentify which way of drainage was safest.
METHODS
We searched the PubMed, Embase and Cochrane Central Register of Controlled Trials and identified 12 RCTs (including a total of 1,574 patients) for the meta-analysis. Methodological quality was assessed by the Physiotherapy Evidence Database scale. Two researchers extracted relevant data including study characteristics, blood loss, transfusion rate, hemoglobin levels, hospital stay and complications. After data extraction, we compared results using fixed-effects or random-effects models depending on the heterogeneity of the included studies.
RESULTS
Autologous blood transfusion drainage had less total blood loss and lower superficial infection rate than no drainage/closed-suction drainage. While there were no statistical differences in postoperative pain, hematoma, hemoglobin levels, hospital stay and other complications between ABT drainage and no drainage/closed-suction drainage.
CONCLUSIONS
Autologous blood transfusion drainage and no drainage/closed-suction drainage have similar clinical efficacy and safety in primary THA with regard to clinical outcomes and complication rates.
Topics: Arthroplasty, Replacement, Hip; Blood Loss, Surgical; Blood Transfusion, Autologous; Drainage; Hematoma; Humans; Postoperative Complications; Suction; Surgical Wound Infection
PubMed: 25288027
DOI: 10.1007/s00402-014-2090-9 -
BMC Cancer Jan 2005Suction drains are routinely used after modified radical mastectomy and are an important factor contributing to increased hospital stay as the patients are often... (Comparative Study)
Comparative Study Randomized Controlled Trial
BACKGROUND
Suction drains are routinely used after modified radical mastectomy and are an important factor contributing to increased hospital stay as the patients are often discharged only after their removal. Amongst various factors that influence the amount of postoperative drainage, the negative suction pressure applied to the drain has been reported to be of great significance. While a high negative suction pressure is expected to drain the collection and reduce the dead space promptly, it may also prevent the leaking lymphatics from closing and lead to increased drainage from the wound. Against this background a prospective randomized clinical study was conducted to compare the amount and duration of drainage between a half negative suction and full vacuum suction drainage in patients following modified radical mastectomy. The associated postoperative morbidity was also compared between the two groups.
METHODS
85 FNAC (fine needle aspiration cytology) proven cases of locally advanced breast cancer were randomized. (Using randomly ordered sealed envelops, which were opened immediately before the closure of the wound) in to 50 patients with full vacuum suction (pressure = 700 g/m2) and 35 cases in to half vacuum suction drainage (pressure = 350 g/m2) groups. The two groups were comparable in respect of age, weight, and technique of operation and extent of axillary dissection. Surgery was performed by the same surgical team comprising of five surgeons (two senior and three resident surgeons) using a standardized technique with electrocautery. External compression dressing was provided over the axilla for first 48 hrs and following that patients were encouraged to do active and passive shoulder exercises. The outcomes measured were postoperative morbidity and the length of hospital stay. Statistical methods used: Descriptive studies were performed with SPSS version 10 and group characteristics were compared using student t-test.
RESULTS
Half vacuum suction drains were removed earlier than the full suction vacuum suction drains. There was no significant difference in the incidence of seroma formation in the two groups and there was a significant reduction in the total hospital stay in patients with half vacuum suction drainage systems as compared to the full suction drainage group (p < 0.001) without any added morbidity.
CONCLUSIONS
Half negative suction drains provide an effective compromise between no suction and full or high suction drainage after modified radical mastectomy by reducing the hospital stay and the post operative morbidity including post operative seromas.
Topics: Adult; Aged; Biopsy, Fine-Needle; Breast Neoplasms; Female; Follow-Up Studies; Humans; Length of Stay; Mastectomy, Modified Radical; Middle Aged; Negative-Pressure Wound Therapy; Neoplasm Staging; Pain Measurement; Postoperative Care; Postoperative Complications; Probability; Prospective Studies; Reference Values; Statistics, Nonparametric; Suction; Survival Analysis; Treatment Outcome; Wound Healing
PubMed: 15676064
DOI: 10.1186/1471-2407-5-11