eComment. Concordance in air leak assessment: Is it a device issue or a matter of experience?

We read with interest the article by McGuire et al. [1] on the concordance of air leak assessment using digital devices and the analogue system. We think this is a very interesting topic, first of all for its implications on patient management including chest drain stay, hospitalization and air leak management. It also has important implications in terms of cost-effectiveness [2].

In the literature, it is noted that digital devices may help clinical practice and reduce chest tube duration, hospitalization and mistakes when used in high volume centres with adequate staff experience [3]. Furthermore, digital systems allow an easier recognition of air leaks compared to analogue devices. It is interesting to note that there is a high variability how young doctors (residents) and non-medical staff recognize air leaks. Therefore, it should be useful to know whether this reflects a different level of experience or a lack of training among staff members. In such a case, an intensive training is warranted for all medical and non-medical staff operating in the thoracic surgical ward. Perhaps, this may allow a unique and standardized way to look at the analogue system and also improve the competencies with the use of digital device.

Another point of interest is how one assesses air leaks. Indeed, the analogue device usually allows only an "instant assessment", whereas a digital device enables one to obtain a historical curve and register the precedent hours in order to obtain more information on the air leak trend. In this way, we think this allows for a more objective evaluation of the air leak and is better than a subjective interpretation. The next decision should be taken with sure and undisputable data in order to avoid mistakes in chest tube management.

Based on the data reported, we would really appreciate the Authors' reflections and reaction on the aspects debated.

Conflict of interest: none declared.

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