Calculation of individual expected pleural drainage from total body lymph flow: a guide for fast-tracking removal of chest drains

We read with great interest the recent original research article by Bjerregaard et al. [1]. By reporting pertinent 30-day outcomes for fasttrack chest tube removal following video-assisted thoracoscopic (VATS) lobectomy with <500 ml in 24 h, this paper has the potential to change thoracic surgical practice regarding safe acceptable upper limits of pleural fluid drainage. As mentioned in the Discussion section on study limitations, we propose that it may be interesting for the authors to pursue their 24-h pleural fluid output data prior to chest tube removal. It is unclear how many of the analysed patients actually had pleural fluid drainage approaching the stated upper limit of 500 ml in 24 h. If they are not a majority, this might change the ultimate study conclusion, with implications for patient management. Understanding that the national database employed for this research limited the authors to providing data on ‘<500 ml in 24 h’, we would like to know if the authors consider it feasible to conduct an institutional level chart review on their reported cases with the following two goals: