Are digital devices routinely useful in thoracic surgery or are they helpful only in selected cases?

We read with interest the article by Lijkendijk et al . [ 1 ] about the comparison between standard and electronic drainage system in terms of chest tube stay and length of hospitalization.

We think that it is a very well-done protocol for a fast-track tube management and removal, and the low percentage of complications makes this evidence stronger.

On the other hand, they do not report differences in terms of chest tube stay and length of hospitalization between the two groups, in disagreement with other data in literature [ 2 , 3 ].

However, they report a very rapid chest tube removal and short hospital stay in the majority of the patients, in both the electronic and traditional drainage systems, and maybe this is the biggest difference with the other studies.

This work explains some point of interest and discussion in the management of electronic, digital or analogical devices, because it shows that a safety fast track is possible also in conventional water seal systems.

First of all, it is important to note that electronic devices are extremely useful in air leak assessment, but in many cases the real stop is the amount of pleural effusion, because chest tube cannot be removed if the daily flow is higher than a value variable for every centre, and it could be in the range of 300–500 ml/day or less [ 3 , 4 ].

So air leak is not the only factor that could be considered using a fast-track protocol and maybe it could be justified the same duration of chest tube and hospitalization in the electronic and traditional group.

The second point of interest is the continuous and univocal evaluation of the air leak with the electric devices. In fact, with these instruments, it is possible to have data about the trend during the day just recalling the memory of the device, whereas this is not possible with traditional system because air leak assessment is instantaneous and continuous or past data are not available.

So, this kind of technology is useful for every patient or in selected cases?

It is useful in fast-track protocols, but this work explains that if the protocol is well defined and all the staff, nurses and doctors are correctly educated, you should have the same results also with traditional systems.

We think that electronic devices have a fundamental role in patients with a higher chest tube stay due to a prolonged air leak. In fact, also in this work, patients with a history of pleural adhesions or incomplete fissure presented a longer chest tube stay and hospitalization for the presence of air leak.

In these patients, electronic assessment could give a hand because it provides data about the trend of air leaks, avoid mistakes in the chest tube management or removal and maybe predict prolonged air leak, so it should be possible to perform a fast-track discharge using a Heimlich valve or the same device [ 5 ].

On the basis of the data reported, we would really appreciate the authors' reflections and reaction on the aspects debated.

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