The Impacts of Intermittent Chest Tube Clamping on Chest Tube Drainage Duration and Postoperative Hospital Stay After Lung Cancer Surgery
Condition: Management of Lung Cancer Patients
MeSH terms: Lung Neoplasms
Study type: Interventional

Summary: 
      All patients undergo lateral thoracotomy or video-assisted thoracoscopic surgery (VATS) and
      are operated on by the same thoracic surgical team. All patients are managed with gravity
      drainage (water seal only, without suction) on the day of operation. Eligible patients are
      randomized to control group or clamping group at a 1:1 ratio before 3pm on the postoperative
      day. Patients in control group and those in clamping group are managed with different
      protocols after 3pm on the postoperative day.
    

Detailed description: 
      All patients undergo lateral thoracotomy or video-assisted thoracoscopic surgery (VATS) and
      are operated on by the same thoracic surgical team. At the end of operation, the lung
      parenchyma is submerged in sterile saline to test for air leakage, and a single 24-Fr chest
      tube is placed in each patient. All patients are managed with gravity drainage (water seal
      only, without suction) on the day of operation.

      Once a radiograph is confirmed re-expansion of the lung on the morning of the first
      postoperative day and no air leak is detected, the patient is a candidate for inclusion in
      the trial. Eligible patients are randomized to control group or clamping group before 3pm on
      the postoperative day.

      Patients in control group are managed with gravity drainage unchangeably, while patients in
      clamping group are managed with clamping protocol after 3pm on the postoperative day as
      follow: the chest tube will be clamped, and the nurses will check the patient every 6 h. If
      the patient has no problems with compliance, the clamp will be removed for half an hour in
      the morning to record the drainage volume every 24 h. If patients develops intolerable
      abnormal symptoms, such as dyspnea, pneumothorax, and severe subcutaneous emphysema after
      chest tube clamping, the clamp will be removed for 30 min and be reapplied after the symptoms
      have been resolved. Such patients will be placed under more rigorous surveillance after
      re-clamping, which requires the medical staff to check on the patients every 2-4 hours in
      order to promptly detect abnormal symptoms. If abnormal symptoms occur frequently, this
      clamping protocol will be continued until another radiograph excluded the presence of
      pneumothorax.

      The daily output of pleural fluid was recorded. The criteria for chest tube removal were as
      follows: (a) drainage volume≤250 mL in 24 h, (b) absence of air leakage and intrathoracic
      hemorrhage, and (c) absence of signs of purulent pleural effusion and atelectasis.
    

Intervention name(s): clamping group
Intervention type(s): Procedure
Intervention description(s): Clamping group are managed with clamping protocol after 3pm on the postoperative day as follow: the chest tube will be clamped, and the nurses will check the patient every 6 h. If the patient has no problems with compliance, the clamp will be removed for half an hour in the morning to record the drainage volume every 24 h.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: lung cancer; surgery; chest tube clamping; duration of chest tube drainage; postoperative stay