Management of air leaks after thoracic surgery: old style or digital drainage?

Prolonged air leak (PAL) is one of the most common complications after pulmonary resection, defined as air coming out of the operated lung until seventh, fifth or fourth postoperative day, according to different definitions and it is often associated with postoperative complications even causing higher hospital costs. The quantification of postoperative air leaks usually relies on a visual scale, being inherently prone to subjective interpretation and inter observer variations; for this reason, several companies have manufactured pleural drainage units that—thanks to electronic components—allow the digital quantification of air leaks and fluid drainage. Here we report recent series comparing digital systems to “old style” analogic system. In conclusion, the vast majority of published series reports a clear benefit from digital system compared to a standard analogic system in terms of duration of chest tube after lung resection for air leak, while—on the contrary—no benefit has been demonstrated in terms of total amount of pleural fluid collection. Good results even in terms of patients’ satisfaction assessed by questionnaire have been reported but some risks in management of emergency situation have been highlighted, suggesting intermediate step before home discharge.