Evaluation of Fluid Output Threshold for Safe Chest Tube Removal - A Potential Way to Decrease Length of Stay in Hospital and to Improve Postoperative Care After Lung Surgery?

Study Overview
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Brief Summary
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Previous studies have shown that the removal of the chest tube after lung surgery significantly improves pain symptoms and lung function. The criteria for chest tube removal still remain vague in modern thoracic surgery and rely on personal experience instead of evidence-based criteria. Every hospital has its own traditional standard fluid threshold and believes in that without adapting and comparing it not even after introduction of newer and more minimal-invasive operation technique. According to literature the traditional fluid threshold is varying from 100 to 500 or even more millilitre in 24 hours. Since pleural fluid resorption is proportional to body weight the investigators believe that a body weight related approach of chest tube management would improve safety and would allow an earlier chest tube removal without a higher rate of complication. In this way the investigators believe in improving pain management and in achieving earlier discharge of the patient.

Official Title
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Evaluation of Fluid Output Threshold for Safe Chest Tube Removal - A Potential Way to Decrease Length of Stay in Hospital and to Improve Postoperative Care After Lung Surgery?

Conditions
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Pleural Effusion Recurrence, Pulmonary Resection, Chest Tube Management

Intervention / Treatment
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* Procedure: Traditional
* Procedure: Test


Participation Criteria
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Eligibility Criteria
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Inclusion criteria: Lobectomy/ Bilobectomy Segmentectomy Signed consent Age of majority Exclusion criteria: Pneumonectomy Atypical resections Empyema Pleural effusion (not related to surgery) Pleurodesis Pregnancy

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: Group 1: Removal of the chest tube after air leakage has ceased and fluid Drainage is < 200ml/24h Group 2: Removal of the chest tube after air leakage has ceased and fluid Drainage is < 5ml/kg/24h
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Traditional<br>The chest tube in the traditional Group will be managed according to the current Guidelines of the investigators' department. | Procedure: Traditional<br>* Removal of the chest tube after air leakage has ceased and fluid drainage is 200ml/24h or less.<br>|
| Active Comparator: Test group<br>The chest tube in the Test Group will constitute the experimental Group. The chest tube will be removed when the fluid production over 24h has reached a weight related threshold. | Procedure: Test<br>* Removal of the chest tube after air leakage has ceased and fluid drainage is 5ml/kg/24h or less.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of recurrent pleural effusions after chest tube removal | Evaluation of recurrent pleural effusion after chest tube removal | up to 6 weeks postoperative | 
| Pain scores (VAS-Score) | Evaluation of Pain Scores after Chest tube removal | postoperative Period until 3 hours after Chest tube removal | 
| Time Point of chest tube removal | postoperative day of chest tube removal | Postoperative, expected to be up to 1 week after surgery | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Patient discharge | Time Point of Patient discharge | At time of discharge, on average 4-7 days |