Efficacy of Chest X-Rays after Drain Removal in Adult and Paediatric
Patients Undergoing Cardiac and Thoracic Surgery: A Systematic Review
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.