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Eur J Cardiothorac Surg 2005;27:391-394
© 2005 Elsevier Science NL
a Guy's Hospital, London SE1 9RT, UK
b Clinical Operational Research Unit, University College London, London, UK
Received 28 September 2004; received in revised form 29 November 2004; accepted 6 December 2004.
* Corresponding author. Tel.: +44 7957 168 754; fax +44 2077 018 737. (E-mail: tom.treasure{at}ukgateway.net).
Objective: Practice varies as to whether or not suction is applied to under-water seal drains following lung surgery. We tested the null hypothesis that there is no difference with respect to air leak duration. Methods: Patients undergoing thoracotomy or video assisted thoracoscopic surgery for lobectomy or wedge resection had either low-pressure suction or no suction applied to their underwater seal bottles postoperatively. Patients were allocated using minimization, a method of unbiased allocation ensuring balance between the arms of a trial with respect to known or suspected confounding factors. The trial was powered for duration of air leak. If an air leak persisted on the 7th post-operative day, the surgeon determined further management. Kaplan–Meier survival analysis of air leak duration and a log rank test were performed on an intention-to-treat basis, with observations censored at 144h (6 complete days). Results: Of the 254 patients that entered the trial, data were available for analysis for 239 (123 no-suction and 116 suction). There was no significant difference in the cumulative persistence of air leaks between the two groups (P=0.62) and inspection of the Kaplan–Meier curves suggests that any difference is negligible. Conclusions: Applying suction to the underwater seal drains following lung surgery makes no difference in terms of air leak duration. In the light of this finding we have adopted a uniform policy of no suction being applied to the underwater seal, from the time of surgery, unless a specific clinical judgment is made to use it. The anticipated gains are that this will reduce work and cost and aid mobilization.
Key Words: Prospective randomized trial • Lung resection • Suction • Chest drains
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