Quoting from an article published in the Journal of cardiothoracic surgery, “In
an ideal world a chest drainage system should be reliable, simple, safe,
portable, cost efficient and offer objective real time data to help clinicians in
the decision making of chest drain management” (1).
Digital drainage systems (DDS), like other chest drainage devices, endeavor
to address these criteria. The distinctive value of digital drainage systems
seems to lie firstly in reducing inter-observer variability, especially in decisionmaking related to chest tube removal. Several single-center, as well as one
multicenter study (191 patients), report shorter duration of chest tube
placement and hospital stay when using DDS, for this very reason (2;3;4;5;6).
This advantage is associated with the way in which the air leak is defined, i.e.
objectively as a quantifiable value (DDS) vs. subjectively by observing
bubbling in an air leak chamber (Multi-chamber systems). The former results
in more consistent decision making by clinicians, i.e. reduced ‘inter-observer
variability’ (1;5;6;7;9;10;11;12).
A second reason for the shorter duration of chest tube placement and hospital
stay is related to the regulated pressure delivered by the digital system, which
may promote accelerated sealing of air leaks (2). The third key benefit
pertains to the ability to offer portable suction (8). Other DDS benefits that are
mentioned include (a) reduced noise levels (12) (b) the facilitation of mobility
and efficient rehabilitation due to the light weight and compact design (13) as
well as (c) to be able to send patients home with these devices in situ (8).
(In several of these above-mentioned studies, researchers disclose either a
financial or other relationship with the distributing company (2;5;7;9;10;11;14).
THE OTHER SIDE OF THE COIN
In a recent study (2013) published in Poland (64 patients), no difference was
found between Water seal (WS) systems and DDS in terms of duration of
hospital stay or tube placement. They reasoned that this was because the
acceptable daily fluid volume of 350 ml/day (used in their study as the value at
which the drain could be removed) was too low to demonstrate a clinical
difference. (13).
An even more recent study published by Lijkendijk et al. (2015: 105 patients)
report that electronic drainage systems did not reduce either of the above
significantly, compared to traditional WS drainage when a strict algorithm for
chest time removal was used. Patients’ chest tubes were observed and