Purpose: Pleural suction is used after lung resection in order to promote lung expansion and minimize air leak duration. Published randomized trials failed to prove this advantage but they are limited in number and underpowered in many cases. The aim of the AirINTrial study was to test the hypothesis that pleural suction may reduce the rate of prolonged air leak (PAL) in a large, randomized cohort.
Methods: All candidates to lung resection (with the exception of pneumonectomy) were considered eligible for this single-center study. At the end of operation, patients were stratified by the type of resection (anatomical versus non anatomical) and randomized into the pleural suction arm (-15 cmH2O, group A) or into the waterseal arm (group B) in a 1:1 ratio. Suction or waterseal was maintained for three days and then chest drains were either removed or connected to a Heimlich valve. The main end-point was to compare groups in terms of prolonged air leak (defined as the rate of patients having a chest drain still in place by POD 7).
Results: Starting in February 2010, 500 patients were randomized over a 32-month period: 250 in group A and 250 in group B. Twenty-one patients in group B (8.4%) required pleural suction due to large pneumothorax and/or diffuse subcutaneous emphysema. On POD 7, the chest drain was still in place in 25 patients in group A and in 34 patients in group B (10% and 14% respectively, p 0.26). Subgroup analysis showed that pleural suction reduced PAL rate in the subgroup of patients who underwent anatomical resection (n=296, 9.6% in group A and 16.8% in group B, p 0.054).
Conclusions: Results from the AirINTrial showed that the routine use of suction reduces the rate of prolonged air leak after anatomical lung resection. More accurate strategies of pleural suction based on the amount of air flow and the degree of lung expansion should probably be established in order to improve its effectiveness.

Source: STS.