Drainagemanagement nach Lungenresektionen

 

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Zusammenfassung

Die große Variationsbreite im Umgang mit Thoraxdrainagesystemen war in der Vergangenheit dadurch bedingt, dass es sehr wenig reproduzierbare Behandlungsparameter gab. In den vergangenen 10 Jahren zeichnet sich mit neuen elektromechanischen Drainagepumpen, die gleichzeitig Messwerte während der gesamten Behandlung liefern, ein Wandel ab. Die Komponenten und Parameter von Thoraxdrainagesystemen treten zunehmend als Stellglieder und Regelgrößen eines Regelkreises in das Bewusstsein der Thoraxchirurgen. Damit werden multizentrische Studien möglich, die den Weg von erfahrungsbasierten zu evidenzbasierten Konzepten freimachen. Auf der Basis jahrzehntelanger eigener Ergebnisse, folgerichtiger physikalischer Betrachtungen und erster monozentrischer Studien wurden Empfehlungen zur Optimierung der postoperativen Drainagetherapie erarbeitet. Die Leitkriterien waren Sicherheit, Patientenkomfort, Arbeitsaufwand und Gesamtkosten.

Abstract

The wide variability in postoperative chest tube management following lung resections is based on the fact that nearly no reproducible treatment parameters were available in the past. New electromechanical suction devices, however, providing continuous objective flow values seem to have induced a change in postoperative chest tube management. Thoracic surgeons have become more and more aware that components and parameters of chest tube systems are actuators and regulators of a closed loop system. This concept is the basis for multicentre trials leading to evidence-based options. Initial results from international single centre studies, logical physical considerations of pleural pressure combined with our own experience over decades form the basis for new recommendations to optimise postoperative chest tube management. Main criteria are safety, patient comfort, workload and costs.

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