The routine use of chest drainage tube after lobectomy aids pleural effusion that is discharged from the body, eliminate the residual cavity of the chest and promote the reexpansion of the lung. It is very important to reduce pulmonary infection and timely detect intrathoracic bleeding and other postoperative complications. Therefore, when selecting the chest drainage tube, the safety and effectiveness of patients should be considered first. With the promotion and use of the concept of ERAS, minimally invasive surgery has deeply rooted in the hearts of the people in recent years. With this, we realized that postoperative pain and diaphragm stimulation caused by thick chest tubes might not be conducive in accelerating the recovery of patients after operation. So, it is of great clinical significance to explore whether an 8F ultrathin chest drainage tube is safe and reliable when compared with traditional thick chest drainage tube for accelerating the recovery of patients.
Due to the pressure of the drainage tube on the intercostal nerve and diaphragm, the placement of closed thoracic drainage tube can causes postoperative chest pain.This study showed statistically significant differences in pain scores between the two groups on POD 1, 2 and 3 after surgery (3.72 ± 0.65point vs 3.94 ± 0.67point, P = 0.027; 2.72 ± 0.93point vs 3.13 ± 1.04point, P = 0.016; and 1.87 ± 0.65point vs 2.39 ± 1.22point, P = 0.005). Pain scores of group A were significantly better than those in group B. Postoperative pain that affects the recovery of patients' respiratory function and the risk of postoperative respiratory complications were increased. The postoperative pain was reduced, which in turn enhanced the initiation of cough and sputum, promoted lung expansion, reduced lung infection, and was more conducive to ambulation.
The insertion of an 8F ultrafine chest drainage tube is simple, and extubation remains to be more convenient and quick. After extubation, the incision was closed naturally and cannot be easily injected into air by just apply the normal dressing externally. However, in order to avoid the intake of air or leakage of drainage outlet after extubation of 24F chest drainage tube, vaseline gauze or reserved suture ligation is warranted, but it is more complicated and risky. This leaves a long surgical scar after healing, and affects the appearance, leaving a psychological trauma that is difficult to heal for the patient. After switching to an ultrafine chest drainage tube, the incision remained small, the perivascular tissue inflammatory response was shown to be mild, and the postoperative scar was small, making it more beautiful.
In this study, the drainage days in group A were shorter than those in group B (4.25 ± 1.79d vs 6.04 ± 1.96d, P = 0.000), and the postoperative hospital stay in group A was shorter than those in group B (8.46 ± 2.48d vs 9.37 ± 1.70d, P = 0.014), and the total postoperative drainage volume was also lower than that in group B (1100.42 ± 701.57 ml vs 1369.39 ± 624.25 ml, P = 0.021), showing statistically significant differences. The inner wall of an ultrafine chest drainage tube is smooth, with strong anti-coagulation ability and good flexibility. It can be coiled in the costophrenic angle or followed between the lung and chest wall, making the drainage tube more smooth and sufficient. However, due to thick texture of the 24F chest drainage tube, it is not easy to be completely placed in the costophrenic angle or followed between the chest wall and the lung lobe. Therefore, it might compress the lung lobe and diaphragm muscle, stimulating pleural effusion.See Fig. 2.
Although the inner diameter of an 8F ultrafine chest drainage tube is smaller than that of traditional 24F drainage tube, patients ambulate earlier, promote fluid accumulation and faster drainage due to its advantage in pain management, and the risk of atelectasis and pulmonary infection does not increase significantly when compared with thick drainage tube (5.97% vs 10.45%, 5.97% vs 8.96%, P > 0.05). If the lung was well recovered and had cough without bubble overflow, the patients using an 8F ultrafine chest drainage tube can replace the water-sealed drainage bottle as the drainage bag, and so the patients can ambulate more easily, making it more convenient for thin drainage tube.
For patients with postoperative air leakage, high glucose can be injected into the chest to promote thoracic adhesion. The operation of an 8F ultrafine chest drainage tube is simple and aseptic, while drug injection into the thoracic cavity through traditional 24F chest drainage tube remains tedious and easily contaminated.
Among the 67 patients in group A, 2 patients had intrathoracic hemorrhage in the postoperative resuscitation room and so underwent secondary surgery for hemostasis, and all of them were cured and discharged. Although the 8F ultrafine chest drainage tube had a thicker and smaller inner diameter, intrathoracic hemorrhage in time and effectively could still be found.
An 8F ultrafine chest drainage tube is also associated with several problems: (1) among the cases in group A, the reason for chest tube reinsertion in 3 patients was drainage tube dislocation. Therefore, the depth of the catheter should be flexibly grasped according to the thickness of the chest wall in clinical practice. It should not be too shallow or too deep, in which too shallow might depart the drainage tube, and too deep might bend the drainage tube into an angle in the chest cavity that affects the drainage; and (2) the ultrafine chest drainage tube should be placed at another puncture point, and not through surgical incision. This is because if the tissue around the tube is not dense enough, then there might be fluid seepage around the mouth of the tube; and exudation of drainage orifice might also occur after extubation.