New Chest Drainage Unit with Integrated CO2-Detector Demonstrates False Air Leak

2021 ◽  
pp. 155335062110474
Author(s):  
Jens Eckardt ◽  
Marike Lijkendijk ◽  
Peter B. Licht ◽  
Michael Stenger
Keyword(s):  
Porcine Model ◽  
Postoperative Management ◽  
Chest Drain ◽  
Thoracic Cavity ◽  
Air Leakage ◽  
Air Leak ◽  
Chest Drainage ◽  
Parenchymal Lesion ◽  
Direct Assessment ◽  
Color Indicator

Background Postoperative observed air leakage does not always originate from parenchymal defects but may arise from defects in the chest drainage unit, connections or reverse airflow in water seals. We investigated such false air leakage using a new chest drainage unit with a built-in CO2-detector and an electronic chest drainage unit. Methods Two types of chest drainage units were tested in a simple porcine model: A well-known electronic chest drainage unit and a new chest drainage unit with integrated CO2-detector. We created a setup of true air leakage—a parenchymal lesion, and false air leakage—allowing air to flow into the thoracic cavity alongside the chest drain. Results We demonstrated that the new chest drainage unit with a built-in CO2-detector can distinguish between experimentally induced true air leakage and false air leakage. Conclusion Available chest drainage systems do not allow direct assessment of true or false air leakage, which may increase chest drain duration unnecessarily. The integration of a CO2-sensitive color indicator into a chest drainage unit allows simple distinction between false air leak and true air leak, which may improve postoperative management.

scholarly journals Air leak pattern shown by digital chest drainage system predict prolonged air leakage after pulmonary resection for patients with lung cancer

2018 ◽  
Vol 10 (6) ◽  
pp. 3714-3721 ◽  
Author(s):  
Yasushi Shintani ◽  
Soichiro Funaki ◽  
Naoko Ose ◽  
Tomohiro Kawamura ◽  
Ryu Kanzaki ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Pulmonary Resection ◽  
Drainage System ◽  
Air Leakage ◽  
Air Leak ◽  
Chest Drainage ◽  
Digital Chest

scholarly journals In Vitro Evaluation of Facial Pressure and Air Leak with a Newly Designed Cushion for Non-Invasive Ventilation Masks

Healthcare ◽  
2020 ◽  
Vol 8 (4) ◽  
pp. 523
Author(s):  
Hui-Ling Lin ◽  
Yu-Chi Lee ◽  
Ssu-Hui Wang ◽  
Li-Ying Chiang ◽  
Jui-Fang Liu
Keyword(s):  
Contact Pressure ◽  
Positive Airway Pressure ◽  
Pressure Sensors ◽  
Air Leakage ◽  
Air Leak ◽  
Non Invasive ◽  
Bilevel Positive Airway Pressure ◽  
Non Invasive Ventilation ◽  
The Face

Background: The aim of this study was to evaluate the effect of a newly designed foam cushion on the air leakage and pressure when applied to the face. Methods: A teaching manikin connected to a bilevel positive airway pressure ventilator attached to four different brands of oronasal masks (Amara, Mirage, Forma, and Wizard) was used. The foam cushions of 5-mm and 10-mm-thickness were attached to the masks, and each mask was tested without a cushion. Six pressure sensors were placed on the manikin’s face, and data were recorded. Inspiratory volume and air leak flow from the ventilator were observed. Results: Air leakage was influenced by both the mask brand and the presence of a cushion. The presence of a cushion did not affect the Wizard mask in terms of leakage (p = 0.317) or inspiratory volume (p = 0.726). The Wizard and Amara masks generated the lowest contact pressure on the frontal forehead (p < 0.001) compared to the other five points. Conclusions: Utilisation of a cushion reduces air leakage and maintains greater inspiratory volume regardless of its thickness. The contact pressure varies depending on the brand of the mask, which would require a difference in the thickness of the cushion for pressure reduction.

scholarly journals The Influence of Suction on Chest Drain Duration After Lobectomy Using Electronic Chest Drainage

2019 ◽  
Vol 107 (6) ◽  
pp. 1621-1625 ◽  
Author(s):  
Marike Lijkendijk ◽  
Peter B. Licht ◽  
Kirsten Neckelmann
Keyword(s):  
Chest Drain ◽  
Chest Drainage

scholarly journals Use of endo-bronchial end-tidal CO2 test for location of the pleural air leakage in patients with intractable pneumothorax

2018 ◽  
Vol 12 ◽  
pp. 175346581875656
Author(s):  
Yi-Ming Zeng ◽  
Yun-Feng Chen ◽  
Hui-Huang Lin ◽  
Xiao-Bin Zhang
Keyword(s):  
Confidence Interval ◽  
Main Bronchus ◽  
Balloon Occlusion ◽  
Air Leakage ◽  
Air Leak ◽  
Occlusion Test ◽  
Air Leaks ◽  
Balloon Occlusion Test ◽  
End Tidal ◽  
End Tidal Co2

Background: Location of the affected bronchus of pleural air leaks is the most important step of trans-bronchoscopic bronchial occlusion for the treatment of intractable pneumothorax. The balloon occlusion test is the most commonly used technique, but has failed in some cases. The aim of the present study was: (1) to determine if endo-bronchial end-tidal CO2 (EtCO2) measurement can identify the affected bronchus that is the source of a persistent pleural air leak; and (2) to establish a methodology for endo-bronchial EtCO2 testing in locating affected bronchus in intractable pneumothorax. Methods: A total of 28 patients with intractable pneumothorax underwent bronchoscopy with (1) the balloon occlusion test for the identification of the affected bronchus; and (2) endo-bronchial EtCO2 measurement (EtCO2 test) at the orifices of the bronchus of the affected lung. The effectiveness of these two methods of affected bronchus identification were compared. The threshold EtCO2 (T-EtCO2) was determined. Results: The positive rates of locating the affected bronchus by the endo-bronchial EtCO2 test, balloon occlusion test, and combination of the two techniques were 60.7% (17/28), 64.3% (18/28) and 96.4% (27/28), respectively. The average differences in EtCO2 between the affected bronchus and the main carina, main bronchus, and non-affected bronchus were (in mmHg) 4.41 ± 1.99 (95% confidence interval: 3.5, 5.3), 4.73 ± 2.10 (3.80, 5.66 ) and 5.57 ± 2.53 (4.45, 6.69), respectively. Conclusions: (1) The endo-bronchial EtCO2 test is complementary to the balloon occlusion test of the leading bronchus. (2) A threshold (T-EtCO2) value of >5 mmHg is optimal for this technique.

scholarly journals PROLONGED AIR LEAK AFTER LUNG RESECTION

2018 ◽  
Vol 3 (4) ◽  
pp. 36-40
Author(s):  
E A Korymasov ◽  
A S Benyan
Keyword(s):  
Lung Resection ◽  
Drainage System ◽  
Diagnostic Algorithm ◽  
Air Leakage ◽  
Air Leak ◽  
Prolonged Air Leak ◽  
Common Causes ◽  
Resection Line ◽  
Lung Resections

Objectives - to analyze the causes of postoperative air leak and to propose a therapeutic and diagnostic algorithm for this complication. Material and methods. The study includes the analysis of the prolonged air leak causes after various lung resections, the classification of the causes according to their affiliation, the designed definitions of basic concepts. Results. The most common causes of prolonged air leakage are the incompetence of the lung resection line, the undetected (unresolved) cause of pneumothorax, the inadequate drainage system function. Various tactical approaches to this problem were described. Depending on the effectiveness of the auxiliary techniques, the indications for repeated operations were determined. Conclusion. Knowledge of the causes of postoperative prolonged pathological air leak is the basis for the optimal management of patients after lung resection.

scholarly journals Multicenter randomized study on comparison between electronic and traditional chest drainage systems

2019 ◽  
Author(s):  
Giuseppe Marulli ◽  
Giovanni Maria Comacchio ◽  
Mario Nosotti ◽  
Lorenzo Rosso ◽  
Paolo Mendogni ◽  
...  
Keyword(s):  
Interobserver Variability ◽  
Chest Drain ◽  
Chest Drainage ◽  
Drainage Systems ◽  
Traditional System ◽  
Air Leaks ◽  
Tube Removal ◽  
Space Effect ◽  
Digital Chest ◽  
Chest Tube Removal

Abstract Background In patients submitted to major pulmonary resection, post-operative length of stay is mainly influenced by duration of air leaks and chest tube removal. The measurement of air leaks largely relies on traditional chest drainage systems which are prone to subjective interpretation. Difficulty to differentiate between active air leaks and bubbles due to a pleural space effect may also lead to tentative drain clamping and prolonged time for chest drain removal. New digital systems allow continuous monitoring of air leaks, identifying subtle leakage that may be not visible during daily patient evaluation. Moreover, an objective assessment of air leaks may lead to a reduced interobserver variability and to an optimized timing of chest tube removal. Methods This study is a prospective randomized, interventional, multicenter trial designed to compare the electronic chest drainage system (Drentech™ Palm Evo) with the traditional system (Drentech™ Compact) in a cohort of patients undergoing pulmonary lobectomy through a standard 3-ports VATS approach for benign or malignant disease. It will enroll 382 patients in 3 Italian centers. Duration of chest drainage and length of hospital stay will be evaluated in the two groups. Moreover, it will be evaluated if the use of a digital chest system compared with a traditional system reduces the interobserver variability. Finally, it will be evaluated the possible advantages of the digital drain system to distinguish an active air leak from a pleural space effect, by the evaluation of intrapleural differential pressure, and to identify potential predictors of prolonged air leaks. Discussion To date few studies have been performed to evaluate clinical impact of digital drainage systems. The proposed prospective randomized trial will provide new knowledge to this research area by investigating and comparing the difference between digital and traditional chest drain systems. In particular, the objectives of this project are to evaluate the feasibility and usefulness of utilizing the digital chest drain and to provide new tools to identify patients at higher risk of developing prolonged air leaks. Trial registration number NCT03536130, Registered 24 May 2018 - Retrospectively registered, https://clinicaltrials.gov/ct2/results?cond=&term=NCT03536130&cntry=&state=&city=&dist=

scholarly journals Safety model for chest drainage in pandemic by COVID-19

2020 ◽  
Vol 47 ◽  
Author(s):  
ERLON DE AVILA CARVALHO ◽  
MARINA VARELA BRAGA DE OLIVEIRA
Keyword(s):  
Personal Protective Equipment ◽  
Health Professionals ◽  
Healthcare Professionals ◽  
Protective Equipment ◽  
Infection Rates ◽  
Air Leak ◽  
Chest Tubes ◽  
Chest Drainage ◽  
Death Toll

ABSTRACT Over one million cases of the SARS-CoV-2 virus have been confirmed worldwide, with the death toll exceeding 50,000 people. An important issue to be addressed concerns the exposure of health professionals to this new virus. The first reports from Wuhan province, China, described infection rates of up to 29% among healthcare professionals before the use of personal protective equipment (PPE) was fully regulated. There are several protocols on the correct use of PPE during aerosol-generating procedures. However, there is no specific guidance on how to proceed in cases of need for chest tubes in patients with positive COVID-19 active air leak. The objective of this work is to assist surgeons of the most diverse specialties during the chest drainage of a patient with COVID-19 and to avoid a risk of contamination to the professional and the environment.

scholarly journals Complications after Chest Tube Removal and Reinterventions in Patients with Digital Drainage Systems

2019 ◽  
Vol 8 (12) ◽  
pp. 2092
Author(s):  
Yi-Ying Lee ◽  
Po-Kuei Hsu ◽  
Chien-Sheng Huang ◽  
Yu-Chung Wu ◽  
Han-Shui Hsu
Keyword(s):  
Predictive Factors ◽  
Lung Resection ◽  
Drainage System ◽  
Drainage Tube ◽  
Air Leak ◽  
Chest Drainage ◽  
Drainage Systems ◽  
Air Leaks ◽  
Thoracic Drainage ◽  
Tube Removal

Introduction: Digital thoracic drainage systems are a new technology in minimally invasive thoracic surgery. However, the criteria for chest tube removal in digital thoracic drainage systems have never been evaluated. We aim to investigate the incidence and predictive factors of complications and reinterventions after drainage tube removal in patients with a digital drainage system. Method: Patients who received lung resection surgery and had their chest drainage tubes connected with a digital drainage system were retrospectively reviewed. Results: A total of 497 patients were monitored with digital drainage systems after lung resection surgery. A total of 175 (35.2%) patients had air leak-related complications after drainage tube removals, whereas 25 patients (5.0%) required reintervention. We identified that chest drainage duration of five days was an optimal cut-off value in predicting air leak-related complications and reinterventions. In multiple logistic regression analysis, previous chest surgery history; small size (16 Fr.) drainage tubes; the presence of initial air leaks, defined as air leaks recorded by the digital drainage system immediately after operation; and duration of chest drainage ≥5 days were independent factors of air leak-related complications, whereas the presence of initial air leaks and duration of chest drainage ≥5 days were independent predictive factors of reintervention after drainage tube removal. Conclusion: Air leak-related complications and reinterventions after drainage tube removals happened in 35.2% and 5.0% of patients with digital thoracic drainage systems. The management of chest drainage tubes in patients with predictive factors, i.e., the presence of initial air leaks and duration of chest drainage of more than five days, should be treated with caution.

scholarly journals Analysis of pneumothorax recurrence risk factors in 843 patients who underwent videothoracoscopy for primary spontaneous pneumothorax: results of a multicentric study

2020 ◽  
Vol 31 (1) ◽  
pp. 78-84
Author(s):  
Maria Cattoni ◽  
Nicola Rotolo ◽  
Maria Giovanna Mastromarino ◽  
Giuseppe Cardillo ◽  
Mario Nosotti ◽  
...  
Keyword(s):  
Risk Factors ◽  
Spontaneous Pneumothorax ◽  
Primary Spontaneous Pneumothorax ◽  
Chest Drain ◽  
Air Leak ◽  
Old Patients ◽  
Multicentric Study ◽  
Prolonged Air Leak ◽  
Pleural Abrasion

Abstract OBJECTIVES Risk factors for pneumothorax recurrence after videothoracoscopy for primary spontaneous pneumothorax are still being debated. The goal of this study was to assess whether the pleurodesis technique and other variables are possibly associated with the postoperative ipsilateral recurrence of pneumothorax. METHODS We retrospectively collected data of 1178 consecutive ≤40-year-old patients who underwent videothoracoscopy for primary spontaneous pneumothorax in 9 centres between 2007 and 2017. We excluded patients with hybrid pleurodesis and/or incomplete follow-up, leaving for analysis 843 cases [80% men; median age (interquartile range) 22 (18–28) years]. Univariable and multivariable analyses were performed by logistic regression and tested by Cox regression model to assess factors related to ipsilateral pneumothorax recurrence including age, gender, body mass index, smoking habit, cannabis smoking, respiratory comorbidity, dystrophic severity score, surgical indication, videothoracoscopy port number and side, lung resection, pleurodesis technique and postoperative prolonged air leak (&gt;5 days). RESULTS Blebs/bullae resection was performed in 664 (79%) patients. Pleurodesis was achieved by partial pleurectomy in 228 (27%) cases; by pleural electrocauterization in 176 (21%); by pleural abrasion in 121 (14%); and by talc poudrage in 318 (38%). During a median follow-up period of 70.0 months (95% confidence interval 66.6–73.4), pneumothorax recurred in 79 patients (9.4%); among these, 29 underwent redo surgery; 34, chest drain/talc slurry; and 16, clinicoradiological observation. The only independent risk factor for recurrence was postoperative prolonged air leak (P &lt; 0.001) that was significantly related to blebs/bullae resection (P = 0.03). CONCLUSIONS In this multicentric series, postoperative ipsilateral pneumothorax recurrence was remarkable and independently related to prolonged postoperative air leak; besides the retrospective study setting, the pleurodesis method did not have an impact on recurrence. To prevent prolonged air leak, blebs/bullae treatment should be accurate and performed only if indicated.

scholarly journals Multicenter randomized study on the comparison between electronic and traditional chest drainage systems

Trials ◽  
2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Giuseppe Marulli ◽  
Giovanni M. Comacchio ◽  
Mario Nosotti ◽  
Lorenzo Rosso ◽  
Paolo Mendogni ◽  
...  
Keyword(s):  
Interobserver Variability ◽  
Chest Drain ◽  
Chest Drainage ◽  
Drainage Systems ◽  
Traditional System ◽  
Air Leaks ◽  
Tube Removal ◽  
Space Effect ◽  
Digital Chest ◽  
Chest Tube Removal

Abstract Background In patients submitted to major pulmonary resection, the postoperative length of stay is mainly influenced by the duration of air leaks and chest tube removal. The measurement of air leaks largely relies on traditional chest drainage systems which are prone to subjective interpretation. Difficulty in differentiating between active air leaks and bubbles due to a pleural space effect may also lead to tentative drain clamping and prolonged time for chest drain removal. New digital systems allow continuous monitoring of air leaks, identifying subtle leakage that may be not visible during daily patient evaluation. Moreover, an objective assessment of air leaks may lead to a reduced interobserver variability and to an optimized timing for chest tube removal. Methods This study is a prospective randomized, interventional, multicenter trial designed to compare an electronic chest drainage system (Drentech™ Palm Evo) with a traditional system (Drentech™ Compact) in a cohort of patients undergoing pulmonary lobectomy through a standard three-port video-assisted thoracic surgery approach for both benign and malignant disease. The study will enroll 382 patients in three Italian centers. The duration of chest drainage and the length of hospital stay will be evaluated in the two groups. Moreover, the study will evaluate whether the use of a digital chest system compared with a traditional system reduces the interobserver variability. Finally, it will evaluate whether the digital drain system may help in distinguishing an active air leak from a pleural space effect, by the digital assessment of intrapleural differential pressure, and in identifying potential predictors of prolonged air leaks. Discussion To date, few studies have been performed to evaluate the clinical impact of digital drainage systems. The proposed prospective randomized trial will provide new knowledge to this research area by investigating and comparing the difference between digital and traditional chest drain systems. In particular, the objectives of this project are to evaluate the feasibility and usefulness of digital chest drainages and to provide new tools to identify patients at higher risk of developing prolonged air leaks. Trial registration ClinicalTrials.gov, NCT03536130. Retrospectively registered on 24 May 2018.

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