Application of the Coaxial Drain in Patients with a Large Air Leak Following Anatomic Lung Resection: A Prospective Multicenter Phase II Analysis of Efficacy and Safety

Below is a summary of the multicenter analysis of the Redax Coaxial Drain conducted by Francesco Guerrera, Pier Luigi Filosso, Cecilia Pompili, Stefania Olivetti, Matteo Roffinella, Andrea Imperatori and Alessandro Brunelli. To review the article in its entirety, click here.

Background:

Air leakage following lung resection remains a frequent problem, even when minimally invasive approaches are used. Such incidences may prolong a patient’s hospital stay and increase hospital costs. Previous studies documented the efficacy of a soft, flexible chest tube in thoracic surgery patients, noting the drain reduced pain, improved comfort and efficiently managed typical postoperative bleeding and air leaks. Using a similar drain to manage massive air or fluid leakage was questionable and difficult to evaluate.

Objective:

This multicenter study aimed to verify the safety and effectiveness of the Coaxial chest tube in a consecutive series of selected patients who underwent anatomical pulmonary resection with an active and large air leak at the end of the procedure, objectively measured using a digital chest drainage system.

Methods:

Forty-eight patients (33 from the Leeds Center, UK and 15  from the Torino Center, Italy) who underwent anatomical lung resection with an air leak greater than 50 mL/min (measured with a digital drainage system) were included in the study. Surgical procedures were performed either through video-assisted thoracic surgery (VATS) or muscle-sparing thoracotomy. At the end of each procedure, a single 28 Fr Coaxial Drain was placed on -20 cmH2O) suction. Air and fluid were monitored using a digital drainage system.

Results:

The median duration of the chest tube was 13 days. The median duration of air leaks was 9 days. The median postoperative hospital stay was 7.5 days. No patient had undrained postoperative pleural effusion warranting an additional chest tube. Twenty-three patients were discharged with the chest tube in place. There were 12 cases of clinically or radiological significant surgical emphysema, however, additional procedures were not required and they were treated by increasing the level of suction.  Patients did not report any problems with chest tube management at home or any drainage-related complications.

Discussion:

The Coaxial Drain is a flexible silastic drain characterized by a round corrugated profile combined with an internal coaxial lumen. This combination allows the independent evacuation of fluid and air that could promote more effective drainage and prevent tube occlusion due to kinking or twisting. The Coaxial is designed to overcome the limitations of small silastic drains, maintaining the flexibility and capillarity effect of the grooved profile.

We did not experience any complications such as dislodgement, occlusion, pneumothorax or unrecognized bleeding requiring an additional chest tube. This was presumably related to the addition of the non-collapsible internal coaxial lumen within the corrugated profile, allowing optimal fluid and air evacuation and preventing kinking and occlusion of the tube.

Conclusion:

Our experience with this novel Coaxial Drain was satisfactory with no clinically relevant complication attributable to its use. No replacements or additional drains were required. The duration of air leaks and chest tubes, as well as the incidence of subcutaneous emphysema, is comparable to what is observed in the daily practice in this selected population. Based on these results, the Coaxial Drain is now systematically used in all our patients undergoing lung resections.

To review the article in its entirety, click here.

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