Myat Soe Thet1, Khin Phue Phue Han2,
Khun Eaint Hlwar2, Khaing Soe Thet2,
Aung Ye Oo3
1Department of Surgery & Cancer, Faculty of Medicine,
Imperial College London, London, UK
2 Mandalay General Hospital, University of Medicine,
Mandalay, Myanmar
3Department of Cardiothoracic Surgery, St
Bartholomew’s Hospital, London, UK
Abstract
Background: Chest X-rays are routinely obtained after removal
of chest drains in patients undergoing cardiac and thoracic surgical
procedures. However, a lack of guidelines and evidence could question
the practice. Routine chest X-rays increase exposure to ionising
radiation, increase healthcare costs and lead to overutilisation of
available resources. This review aims to explore the evidence in the
literature regarding the routine use of chest X-rays following the
removal of chest drains.
Materials & Method: A systematic literature search was
conducted in PubMed, Medline via Ovid, Cochrane central register of
control trials (CENTRAL) and ClinicalTrials.gov without any limit on the
publication year. The references of the included studies are manually
screened to identify potentially eligible studies.
Results: A total of 375 studies were retrieved through the
search and 18 studies were included in the review. Incidence of
pneumothorax remains less than 10% across adult cardiac, and paediatric
cardiac and thoracic surgical populations. The incidence may be as high
as 50% in adult thoracic surgical patients. However, the
re-intervention rate remains less than 2% across the populations.
Development of respiratory and cardiovascular symptoms can adequately
guide for a chest X-ray following the drain removal. As an alternative,
bedside ultrasound can be used to detect pneumothorax in the thorax
after the removal of a chest drain without the need for ionising
radiation.
Conclusion: A routine chest X-ray following chest drain removal
in adult and paediatric patients undergoing cardiac and thoracic surgery
is not necessary. It can be omitted without compromising patient safety.
Obtaining a chest X-ray should be clinically guided. Alternatively,
bedside ultrasound can be used for the same purpose without the need for
radiation exposure.
Keywords: Chest X-ray, Chest Drain, Chest Tube, Cardiac
surgery, Thoracic surgery