Utility of Objective Chest Tube Management After Pulmonary Resection Using a Digital Drainage System Kazuya Takamochi, MD, Kota Imashimizu, MD, Mariko.

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Utility of Objective Chest Tube Management After Pulmonary Resection Using a Digital Drainage System Kazuya Takamochi, MD, Kota Imashimizu, MD, Mariko Fukui, MD, Tatsuo Maeyashiki, MD, Mikiko Suzuki, MD, Takuya Ueda, MD, Hironori Matsuzawa, MD, Shunki Hirayama, MD, Takeshi Matsunaga, MD, Shiaki Oh, MD, Kenji Suzuki, MD The Annals of Thoracic Surgery Volume 104, Issue 1, Pages 275-283 (July 2017) DOI: 10.1016/j.athoracsur.2017.01.061 Copyright © 2017 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Patterns of air leakage. The blue line indicates the rate of air leakage. (A) Type A, no air leak (air leak <20 mL/min) was observed until the removal of the chest tube. (B) Type B, air leak gradually decreased. (C) Type C, although no air leak was observed immediately after the operation, delayed air leak occurred postoperatively. (D) Type D, repeated exacerbation and remission of air leak was observed. (E) Type E, air leak was observed without a trend toward improvement. The Annals of Thoracic Surgery 2017 104, 275-283DOI: (10.1016/j.athoracsur.2017.01.061) Copyright © 2017 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Patterns of pleural pressure. The blue line indicates the rate of air leakage, and the red line indicates pleural pressure. The green arrow indicates the time of air leak resolution. (A) Type I, fluctuations of pleural pressure ≥5 cm H2O were continuously observed. (B) Type II, fluctuations of pleural pressure <5 cm H2O were continuously observed. (C) Type III, increased fluctuations in pleural pressure appeared just after the air leak level decreased to <20 mL/min. The Annals of Thoracic Surgery 2017 104, 275-283DOI: (10.1016/j.athoracsur.2017.01.061) Copyright © 2017 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 The treatment strategy for patients with postoperative air leak based on the Thopaz system’s (Medela Healthcare, Baar, Switzerland) estimation of the rate of peak air leakage during the first 24 hours after the operation and the pattern of air leakage over the first 72 hours after the operation. (FEV1 = forced expiratory volume in 1 second.) The Annals of Thoracic Surgery 2017 104, 275-283DOI: (10.1016/j.athoracsur.2017.01.061) Copyright © 2017 The Society of Thoracic Surgeons Terms and Conditions