Effectiveness of digital system in post-operative thoracic surgery

• Grant number: 15/07064-0
• Support Opportunities: Scholarships in Brazil - Scientific Initiation
• Start date: July 01, 2015
• End date: December 31, 2015
• Field of knowledge: Health Sciences - Medicine - Surgery
• Principal Investigator: Altair da Silva Costa Júnior
• Grantee: Luiz Augusto Lucas Martins de Rizzo
• Host Institution: Escola Paulista de Medicina (EPM). Universidade Federal de São Paulo (UNIFESP). Campus São Paulo. São Paulo , SP, Brazil

Abstract

In recent years, the assessment of many of our patients' indicators, as well as many other parts of our lives, everyday, has used digital technology. Many signs at the bedside or in the intensive care unit, such as blood pressure, heart rate, oxygen saturation and temperature are continuously reported. This type of recording data led to more accurate assessment of the patient's condition and the more rapid application of therapy. However, until now, the only form of evaluation of the chest tube was a subjective way. There are doubts about the amount of fluid loss and especially on the air. In recent years, studies of digital systems showed an objective evaluation of these parameters. This study also demonstrated the advantages of measuring continuous and digital air leaks compared with the traditional system. First, it provides a more accurate assessment of air loss and without doubt among observers. The increased pressure exerted by society in all profession requires the optimization and standardization of routines, to improve it. Protocols are needed: assistance to care, standardize and minimize postoperative complications and length of stay. Nowadays we need a method for quick detection of the problem and immediate action to minimize possible damage. Thus, we avoid unnecessary procedures, preventing further suffering of patients and unnecessary costs. In addition, the consistent management of the main factors that avoid late hospital discharge after lung resection brings a benefit to: Medical team, who is pleased by the good service provided. For the patient, that was well treated. For the hospital that has no unnecessary expenses. In general, these main factors are: management of drainage, air loss and pain. Some systems for digital evaluation of chest drainage were reported. It is able to continuously monitor and record the amount of air leakage, debit and intrapleural pressure. The system has the major advantage of providing objective and reproducible data, reducing inter-observer variability assessment of air leakage, which can be a major factor in delay in the removal of the drain. The impact of this system in routine nursing has not been studied. The time spent by the employee to take care of the drain was not mentioned in any study consulted. The nursing staff must: replacement of water seal, measure the amount of fluid drained, making the installation and testing of vacuum system, continuous assessment the system (clogs, tube bent, accidental disconnection, drain closed to transportation, among others). Objective this study aimed to evaluate the effectiveness of the digital system over the traditional system of water seal. Method Prospective randomized clinical trial Project duration: 12 months. Inclusion criteria: - Patients who require muscle-sparing thoracotomy and elective surgeries. Age 19 to 75 years. Exclusion criteria: - Kidney or liver failure - High-risk patients - Neurological dysfunction - Reoperation - Emergency operation - Chemotherapy or radiotherapy prior -Thoracectomy Sample size Two groups of 25 patients each Evaluation 1 - Questionnaire for nursing assessment, with the following areas: security, convenience, handling and degree of difficulty. 2 - Agreement between the team of drainage parameters (air loss / debit drain). Digital protocol and traditional protocol (subjective visual assessment of air leakage and chest output). 3 - Length of hospital stay, duration of drainage, ICU stay and complications.