The Right Time for Chest Tube Removal in the Patient with Cardiac Surgery: A Systematic Review
Background: Chest tube insertion is recommended after cardiac surgery, and inserted annually for a large number of these patients. In addition to its benefits, the chest tube may have risks that are mismanaged. One of these risks is the possibility of pleural effusion, which can occur in high rates. Therefore, we conducted a systematic review to properly manage the chest tube and reduce its complications.
Methods: This systematic review of cohort study asked the question: Is there enough evidence to determine the right time to remove the chest tube? We searched ISI Web of Science, PubMed, Scopus and Embase from 1 January 2015 to 30 September 2019 to identify retrospective or prospective cohort studies.
Results: Three studies recommended early chest tube removal and two studies late removal. Of course, early and late removals in the studies had different meanings and time frames that were examined).
Conclusion: More evidences and studies are needed to determine the right timing and management of the chest tube removal but our systematic review based on the available evidences revealed that if the chest tube removal occurs about 24 hours postoperatively, and with less than 100 ml drainage within the last 8 hours, it will reduce the risk of pleural effusion and improve many other outcomes.
 Satoh Y. Management of chest drainage tubes after lung surgery. Gen Thorac Cardiovasc Surg. 2016; 64(6):305-8.
 Bertrandt RA, Saudek DM, Scott JP, Madrzak M, Miranda MB, Ghanayem NS, et al. Chest tube removal algorithm is associated with decreased chest tube duration in pediatric cardiac surgical patients. J Thorac Cardiovasc Surg. 2019; 158(4):1209-1217.
 Luketich J, Sugarbaker D. Chest wall and pleura. Sabiston textbook of surgery New York: Mc Grawhill. 2004;1723.
 Martino K, Merrit S, Boyakye K, Sernas T, Koller C, Hauser CJ, Lavery R, Livingston DH. Prospective randomized trial of thoracostomy removal algorithms. J Trauma. 1999; 46(3):369-71;
 Shahian DM, Blackstone EH, Edwards FH, Grover FL, Grunkemeier GL, Naftel DC, et al. Cardiac surgery risk models: a position article. Ann Thorac Surg. 2004; 78(5):1868-77.
 Granton J, Cheng D, editors. Risk stratification models for cardiac surgery. Seminars in cardiothoracic and vascular anesthesia; 2008: SAGE Publications Sage CA: Los Angeles, CA.
 Li H, Lin X, Tao J, Zou R, Yang S, Hua P. Development of a nomogram to predict prolonged drainage time after cardiac surgery. International Journal of Clinical and Experimental Pathology. 2017; 10(6):6635-44.
 Taylor AC, Bates KE, Kipps AK. Variability in paediatric cardiac postoperative chest tube management. Cardiol Young. 2018; 28(12):1471-4.
 Azzi JL, Gottlieb B, Maziak DE, Seely AJ, Shamji FM, Sundaresan S, et al., editors. Early identification of patients who will meet 24-hour fluid output threshold for chest tube removal after lung resection. Seminars in thoracic and cardiovascular surgery; 2019: Elsevier.
 Gür AK, Eker E, Esen A. When to remove drains after surgery? Science. 2018; 22(89):38-44.
 Younes RN, Gross JL, Aguiar S, Haddad FJ, Deheinzelin D. When to remove a chest tube? A randomized study with subsequent prospective consecutive validation. J Am Coll Surg. 2002; 195(5):658-62.
 Novoa NM, Jiménez MF, Varela G. When to remove a chest tube. Thorac Surg Clin. 2017; 27(1):41-6.
 Gao S, Zhang Z, Aragón J, Brunelli A, Cassivi S, Chai Y, et al. The Society for Translational Medicine: clinical practice guidelines for the postoperative management of chest tube for patients undergoing lobectomy. J Thorac Dis. 2017; 9(9):3255-64.
 Abramov D, Yeshaaiahu M, Tsodikov V, Gatot I, Orman S, Gavriel A, et al. Timing of chest tube removal after coronary artery bypass surgery. J Card Surg. 2005; 20(2):142-6.
 Kingma BF, Marges OM, Van Hillegersberg R, Ruurda JP. Routine chest X-rays after the removal of chest tubes are not necessary following esophagectomy. J Thorac Dis. 2019; 11(Suppl 5):S799.
 Johnson B, Rylander M, Beres AL. Do X-rays after chest tube removal change patient management? J Pediatr Surg. 2017; 52(5):813-5.
 McGrath E, Ranstrom L, Lajoie D, McGlynn L, Mooney D. Is a chest radiograph required after removal of chest tubes in children? J Pediatr Health Care. 2017; 31(5):588-93.
 Cooper J, Browne N. Chest Tube Management for Pleural Disease in Pediatrics. J Pediatric Surgical Nursing. 2019; 8(4):118-22.
 Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Int J Surg. 2010; 8(5):336-41.
 Penson D, Krishnaswami S, Jules A. Newcastle-Ottawa Quality Assessment Form for Cohort Studies. 2012. 2018.
 Gercekoglu H, Aydin NB, Dagdeviren B, Ozkul V, Sener T, Demirtas M, et al. Effect of timing of chest tube removal on development of pericardial effusion following cardiac surgery. J Card Surg. 2003; 18(3):217-24.
 Mirmohammad-Sadeghi M, Etesampour A, Gharipour M, Shariat Z, Nilforoush P, Saeidi M, et al. Early chest tube removal after coronary artery bypass graft surgery. N Am J Med Sci. 2009; 1(7):333.
 Andreasen JJ, Sørensen GV, Abrahamsen ER, Hansen-Nord E, Bundgaard K, Bendtsen MD, et al. Early chest tube removal following cardiac surgery is associated with pleural and/or pericardial effusions requiring invasive treatment. Eur J Cardiothorac Surg. 2015; 49(1):288-92.
 Faraoni D, Schaefer ST. Randomized controlled trials vs. observational studies: why not just live together? BMC anesthesiology. 2016;16(1):102.
 Colak MC, Colak C, Erdil N, Sandal S. Potential risk factors for early large pleural effusion after coronary artery bypass grafting surgery. Biomedical Research; 2017; 28(2):625-9.
 Ramos Dos Santos PM, Aquaroni Ricci N, Aparecida Bordignon Suster É, de Moraes Paisani D, Dias Chiavegato L. Effects of early mobilisation in patients after cardiac surgery: a systematic review. Physiotherapy. 2017;103(1):1-12.
|Issue||Vol 7 No 1 (2021): Winter|
|Chest tube Removal Cardiac surgery|
|Rights and permissions|
|This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.|