Timing of Chest Tube Removal Following Adult Cardiac Surgery: A Cluster Randomized Controlled Trial.

IF 16.4 1区化学 Q1 CHEMISTRY, MULTIDISCIPLINARY

Accounts of Chemical Research Pub Date : 2024-12-01 Epub Date: 2023-12-19 DOI:10.1080/14017431.2023.2294681

Ali Imad El-Akkawi, Ara Shwan Media, Niels Eykens Hjørnet, Dorthe Viemose Nielsen, Ivy Susanne Modrau

{"title":"Timing of Chest Tube Removal Following Adult Cardiac Surgery: A Cluster Randomized Controlled Trial.","authors":"Ali Imad El-Akkawi, Ara Shwan Media, Niels Eykens Hjørnet, Dorthe Viemose Nielsen, Ivy Susanne Modrau","doi":"10.1080/14017431.2023.2294681","DOIUrl":null,"url":null,"abstract":"Objectives: Early chest tube removal following cardiac surgery may be associated with an increased risk of pleural or pericardial effusions following cardiac surgery. This study compares the effects of two fast-track chest tube removal protocols regarding the risk of pleural or pericardial effusions, requirement of opioids, respiratory function, and postoperative complications.Design: Prospective non-blinded cluster-randomized study with alternating chest tube removal protocol in adult patients undergoing elective cardiac surgery. Monthly changing allocation to scheduled chest tube removal on the day of surgery (Day 0) versus removal on the 1st postoperative day (Day 1) provided no air leakage and output < 200 mL within the last four hours.Results: A total of 527 patients were included in the study from September 1st 2020 until October 29th 2021 and randomly allocated to chest tube removal at day 0 (n = 255), and day 1 (n = 272). More than every fourth patient required drainage for pleural effusion with no significant difference between the groups. Earlier removal of chest tubes did not reduce requirement of analgesics, improve early respiratory function, or reduce postoperative complications. The study was halted for futility after halfway interim analysis showed insufficient promise of any treatment benefit.Conclusion: Fast-track protocols with chest tube removal within the first 24 h after cardiac surgery may be associated a high rate of pleural effusions.","PeriodicalId":1,"journal":{"name":"Accounts of Chemical Research","volume":null,"pages":null},"PeriodicalIF":16.4000,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Accounts of Chemical Research","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1080/14017431.2023.2294681","RegionNum":1,"RegionCategory":"化学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2023/12/19 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"CHEMISTRY, MULTIDISCIPLINARY","Score":null,"Total":0}

引用次数: 0

Abstract

Objectives: Early chest tube removal following cardiac surgery may be associated with an increased risk of pleural or pericardial effusions following cardiac surgery. This study compares the effects of two fast-track chest tube removal protocols regarding the risk of pleural or pericardial effusions, requirement of opioids, respiratory function, and postoperative complications.

Design: Prospective non-blinded cluster-randomized study with alternating chest tube removal protocol in adult patients undergoing elective cardiac surgery. Monthly changing allocation to scheduled chest tube removal on the day of surgery (Day 0) versus removal on the 1st postoperative day (Day 1) provided no air leakage and output < 200 mL within the last four hours.

Results: A total of 527 patients were included in the study from September 1st 2020 until October 29th 2021 and randomly allocated to chest tube removal at day 0 (n = 255), and day 1 (n = 272). More than every fourth patient required drainage for pleural effusion with no significant difference between the groups. Earlier removal of chest tubes did not reduce requirement of analgesics, improve early respiratory function, or reduce postoperative complications. The study was halted for futility after halfway interim analysis showed insufficient promise of any treatment benefit.

Conclusion: Fast-track protocols with chest tube removal within the first 24 h after cardiac surgery may be associated a high rate of pleural effusions.

查看原文本刊更多论文

成人心脏手术后拔除胸管的时机：分组随机对照试验。

目的：心脏手术后尽早拔除胸管可能会增加心脏手术后胸膜或心包积液的风险。本研究比较了两种快速拔除胸管方案对胸膜或心包积液风险、阿片类药物需求、呼吸功能和术后并发症的影响：设计：前瞻性非盲群组随机研究，在接受择期心脏手术的成人患者中采用交替胸管拔除方案。如果在最后四小时内没有漏气且排气量小于 200 毫升，则每月更换一次分配，分别在手术当天（第 0 天）和术后第 1 天（第 1 天）拔除胸管：从2020年9月1日到2021年10月29日，共有527名患者参与研究，随机分配在第0天（255人）和第1天（272人）拔除胸管。超过四分之一的患者需要引流胸腔积液，但两组之间无明显差异。提早拔除胸管并不能减少镇痛药的需求、改善早期呼吸功能或减少术后并发症。中途进行的中期分析表明，没有足够的希望获得任何治疗益处，因此该研究因徒劳无益而终止：结论：在心脏手术后 24 小时内拔除胸管的快速通道方案可能会导致胸腔积液的高发生率。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Accounts of Chemical Research 化学-化学综合

CiteScore

31.40

自引率

1.10%

发文量

312

审稿时长

2 months

期刊介绍： Accounts of Chemical Research presents short, concise and critical articles offering easy-to-read overviews of basic research and applications in all areas of chemistry and biochemistry. These short reviews focus on research from the author’s own laboratory and are designed to teach the reader about a research project. In addition, Accounts of Chemical Research publishes commentaries that give an informed opinion on a current research problem. Special Issues online are devoted to a single topic of unusual activity and significance. Accounts of Chemical Research replaces the traditional article abstract with an article "Conspectus." These entries synopsize the research affording the reader a closer look at the content and significance of an article. Through this provision of a more detailed description of the article contents, the Conspectus enhances the article's discoverability by search engines and the exposure for the research.