Determining Optimal Air Leak Resolution Criteria When Using Digital Pleural Drainage Device After Lung Resection

OBJECTIVE There is limited clinical evidence to support any specific parenchymal air leak resolution criteria when using digital pleural drainage devices following lung resection. The aim of this study is to determine optimal air leak resolution criteria, where duration of chest tube drainage is minimized while avoiding complications from premature chest tube removal. METHODS Airflow data averaged at 10-minute intervals was collected prospectively using a digital pleural drainage device (Thopaz-TM Medela, Bar, Switzerland) in 400 patients from 2015 to 2019. All permutations of air leak resolution criteria from < 10-100 mL/min for 4-12 hours were applied retrospectively to the pleural drainage data to determine air leak duration, and air leak recurrence frequency and volume. Air leak recurrence indicates potential for rather than occurrence of adverse events. Descriptive statistics were used to identify the optimal criteria based on patient safety (low frequency and volume of air leak recurrences), and efficiency (shortest initial air leak duration). RESULTS The majority of the 400 patients underwent lobectomies (57% [227/400]), wedge resections (29% [115/400]), or segmentectomies (8% [32/400]) for lung cancer (90% [360/400]). An airflow threshold of <50 mL/min resulted in longer air leak duration prior to meeting criteria for air leak resolution (p <0.0001). Air leak recurrence frequency and volume were greater in patients with a monitoring period of <8-consecutive hours (p <0.0001). CONCLUSIONS When using a digital pleural drainage device, a postoperative air leak resolution criteria of < 50 mL/min for 8 consecutive hours was associated with the best safety and efficiency profile. Word count: 250 words