J Thorac Cardiovasc Surg 2008;136:536
© 2008 The American Association for Thoracic Surgery
Reply to the Editor:
Robert James Cerfolio, MD, FACS, FCCP
University of Alabama at Birmingham, Cardiothoracic Surgery, Birmingham, Ala
We appreciate Ozdemir and colleagues' letter concerning our article "Results of a Prospective Algorithm to Remove Chest Tubes After Pulmonary Resection with High Output." We are aware that some groups have evaluated the amount of protein in the pleural effluent to help guide the decision as to when it is safe to remove a tube. We believe this variable may be more important in the management of chest tubes in patients who present with a pleural effusion and not as important for those who have undergone elective pulmonary resection. Although chylothorax can occur after elective pulmonary resection, a clinically significant amount of chyle is usually easily detected once a patient is eating a regular diet because of the obvious milky nature of the effluent. However, as we described in our article, it may be safe to remove chest tubes after elective pulmonary resection even when the output is greater than 450 mL/d, and perhaps the protein content is a variable that should be tested along with a higher volume. We look forward to a peer-reviewed published article from Ozdemir and colleagues that critically and carefully tests this theory and the results.
