Case report
The benefits of digital thoracic drainage system for outpatients undergoing pulmonary resection surgery
Vantagens do sistema de drenagem torácica digital para doentes em ambulatório para cirurgia de ressecção pulmonar
Thoracic Surgery Service, Sagrat Cor University Hospital, Barcelona, Spain
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"apellidos" => "Sersar" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0873215911000456?idApp=UINPBA00004E" "url" => "/08732159/0000001700000005/v2_201509041523/S0873215911000456/v2_201509041523/en/main.assets" ] "en" => array:19 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case report</span>" "titulo" => "The benefits of digital thoracic drainage system for outpatients undergoing pulmonary resection surgery" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "225" "paginaFinal" => "227" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "J.M. Mier, J.J. Fibla, L. Molins" "autores" => array:3 [ 0 => array:4 [ "nombre" => "J.M." "apellidos" => "Mier" "email" => array:1 [ 0 => "jmmo50@hotmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "J.J." "apellidos" => "Fibla" ] 2 => array:2 [ "nombre" => "L." "apellidos" => "Molins" ] ] "afiliaciones" => array:1 [ 0 => array:1 [ "entidad" => "Thoracic Surgery Service, Sagrat Cor University Hospital, Barcelona, Spain" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Vantagens do sistema de drenagem torácica digital para doentes em ambulatório para cirurgia de ressecção pulmonar" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 534 "Ancho" => 1477 "Tamanyo" => 72971 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">DTDS show us objective numeric parameters like de suction pressure and air leak flow. It represents these parameters in graphics that can be downloaded.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">One of the most frequent complications of lung surgery is prolonged air leak,<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a> which leads to more time of thoracic drainage, longer hospital stays and increased hospital costs. From the time the first DTDS came onto the market,<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,4</span></a> there have been many studies aimed at demonstrating that with this system the subjective appreciation of air leak can be eliminated.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Prospective, comparative protocols were early introduced in order to demonstrate that drainage time is indeed shortened,<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6,7</span></a> this includes our study which compares two different types of DTDS with the traditional system.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> Based on our experience that this system works and having enough proven experience in Outpatient Thoracic Surgery Programmes,<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> we considered the possibility of offering this system to some carefully selected patients.</p><p id="par0015" class="elsevierStylePara elsevierViewall">This study was reviewed and approved by the Hospital Universitari Sagrat Cor ethics committee. All the patients gave their consent, approved their inclusion in this protocol and were instructed on how to use the device.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Clinical observation</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Case 1</span><p id="par0020" class="elsevierStylePara elsevierViewall">A 53-year-old patient, with a history of COPD and a pulmonary nodule in the right upper lobe, was diagnosed with squamous carcinoma by CT guided fine needle aspiration. There were also multiple bilateral emphysematous bullae, without significant adenopathies in the mediastinum. A right upper lobectomy plus lymphadenectomy was performed, using anterior amiotomic thoracotomy, with a final Stage IA T1aN0M0.</p><p id="par0025" class="elsevierStylePara elsevierViewall">In the post-operative period the patient developed a prolonged air leak between 100 and 150<span class="elsevierStyleHsp" style=""></span>ml/min, and so on post-operative day 7, she was offered the possibility of being discharged with the digital thoracic drainage device (Thopaz Medela Switzerland<span class="elsevierStyleSup">®</span>), having been instructed on how to use it. The patient was placed under the daily supervision of one of the surgeons in the team, in 24-hour contact by telephone in case of unforeseen circumstances. (<a class="elsevierStyleCrossRefs" href="#fig0005">Figs. 1 and 2</a>)</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">Six days after leaving hospital and 13 after the operation, thoracic drainage was withdrawn as the air leak in the previous 24<span class="elsevierStyleHsp" style=""></span>hours had been less than 10<span class="elsevierStyleHsp" style=""></span>ml/min. This was after assessing the existence of correct clinical re-expansion and no pneumothorax on the chest x-rays.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Case 2</span><p id="par0035" class="elsevierStylePara elsevierViewall">This case relates to a 36-year-old female patient with a chest x-ray that showed complete atelectasis of the upper left lobe. Fiberoptic bronchoscopy revealed a mass occluding 100% of the upper left lobe bronchus and protruding towards the main bronchus which biopsy proved to be a carcinoid tumour.</p><p id="par0040" class="elsevierStylePara elsevierViewall">A postero-lateral thoracotomy for an upper left lobectomy with bronchoplasty of the main bronchus and mediastinal lymphadenectomy was performed. After 7 days in hospital and radiographic evidence of pulmonary re-expansion, with an air leak of 750-950<span class="elsevierStyleHsp" style=""></span>ml/hour, having ruled bronchial fistula, the patient was discharged with digital drainage (Thopaz, Medela Switzerland<span class="elsevierStyleSup">®</span>).</p><p id="par0045" class="elsevierStylePara elsevierViewall">Fifteen days after hospital discharge (22 days after surgery) a gradual reduction of the air leak was verified. Correct clinical and radiographic re-expansion was checked, the digital thoracic drainage air leak had been 0<span class="elsevierStyleHsp" style=""></span>ml/min for at least the previous 24<span class="elsevierStyleHsp" style=""></span>hours with no subsequent complications and therefore thoracic drainage was withdrawn.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Case 3</span><p id="par0050" class="elsevierStylePara elsevierViewall">A 44-year-old female patient with a left-sided spontaneous pneumothorax which had been drained. After persistent air leak for over 7 days we proceeded to undergo surgery via video-assisted thoracoscopy performing resection of bullae and abrasive pleurodesis. After 5 days without complete re-expansion of the lung and with the air leak quantified at 950<span class="elsevierStyleHsp" style=""></span>ml/minute, discharge was proposed with digital thoracic drainage (Thopaz Medela Switzerland<span class="elsevierStyleSup">®</span>)</p><p id="par0055" class="elsevierStylePara elsevierViewall">Fifteen days after hospital discharge and 20 after surgery, and with a gradual decrease of the air leak until it was less than 10<span class="elsevierStyleHsp" style=""></span>ml/min, and with clinical and chest x-ray evidence of pulmonary re-expansion, drainage was withdrawn.</p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Discussion</span><p id="par0060" class="elsevierStylePara elsevierViewall">Without doubt the use of DTDS is becoming increasingly popular in more thoracic surgery units, because it has been demonstrated that early withdrawal of thoracic drainage is possible, due to the safety offered by the objective data of air leak in real time and with monitoring from the moment it is attached.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6–8</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">We are still a long way off the ideal thoracic drainage that some authors propose,<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> but we are on the right track and work is being done on this. One example is the appearance of other digital drainage systems on the market like those by Redax (Smiths Medical International)<span class="elsevierStyleSup">®</span> and the purchase by Medela of the technology offered by another commercial brand (DigiVent Millicore Sweden<span class="elsevierStyleSup">®</span>). The introduction of a digital device that gives information in real time of the patient's air leak, not just at the bedside, plus the fact that in the future it may be possible to send this information through a PDA, makes it even more feasible for more patients to benefit from short-stay surgery programmes or even outpatient surgery. Our small contribution of three cases serves to demonstrate that this type of monitoring can be carried out with carefully selected patients. All of them lived less than 15<span class="elsevierStyleHsp" style=""></span>minutes from the hospital, had the knowledge and understanding necessary to be able to use the device, had given their consent and were under 24-hour supervision by the surgeons in charge. It is a real advantage for the patient that although this system requires chest tube aspiration, it does not require connection to a centralised system and it can be monitored at all times, resulting in more comfort at home. It has been shown that intra-hospital costs are reduced with the use of these devices: in one study by €476 per patient per day.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">When we compare the use of the digital device with another ambulatory system like the Heimlich valve we can say, that the safety system alarm of the Thopaz in obstruction of the system, makes the digital drainage system a very trustworthy one. With the Heimlich valve, the withdrawal of the drainage is a subjective decision of the surgeon, with the digital device we have a numerical, objective parameter in ml/min that supports our decision. In addition, the Thopaz does not need to be cleaned every day nor the valve changed for the organic residue.</p><p id="par0075" class="elsevierStylePara elsevierViewall">To conclude this preliminary study, which will have to be confirmed by multicentric prospective studies, we make the case that digital thoracic drainage apparatus is safe, comfortable and well accepted by patients. Furthermore, it reduces the number of days in hospital and can be used on outpatients with prolonged air leak.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:8 [ 0 => array:2 [ "identificador" => "xres547908" "titulo" => "Abstract" ] 1 => array:2 [ "identificador" => "xpalclavsec565777" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres547909" "titulo" => "Resumo" ] 3 => array:2 [ "identificador" => "xpalclavsec565778" "titulo" => "Palavras-chave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Clinical observation" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Case 1" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Case 2" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Case 3" ] ] ] 6 => array:2 [ "identificador" => "sec0030" "titulo" => "Discussion" ] 7 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2010-12-07" "fechaAceptado" => "2011-02-14" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec565777" "palabras" => array:3 [ 0 => "Digital thoracic drainage" 1 => "Prolonged air leak" 2 => "Outpatient thoracic surgery" ] ] ] "pt" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palavras-chave" "identificador" => "xpalclavsec565778" "palabras" => array:3 [ 0 => "Drenagem torácica digital" 1 => "Entrada de ar prolongada" 2 => "Cirurgia torácica em doente de ambulatório" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Since digital thoracic drainage system (DTDS) came onto the market, a number of its advantages have become clear, for example that of eliminating the differences between observers. The withdrawal of thoracic drainage has been found to be comfortable, safe and well tolerated by patients; it helps to reduce or eliminate the cost of hospital stay, because, according to the different series published in recent months, it is possible to withdraw drainage sooner and thus discharge patients earlier. Prospective studies are underway, but as yet nothing has been written about the possible benefits in outpatient surgery programmes. In this report we present our findings of 3 cases of patients undergoing pulmonary resection who were treated with continuous intra-domiciliary DTDS. Pending the results of a prospective study now underway our observation is that with properly selected patients this is a safe method.</p></span>" ] "pt" => array:2 [ "titulo" => "Resumo" "resumen" => "<span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Desde que o sistema de drenagem torácica digital (DTDS) apareceu no mercado, várias das suas vantagens tornaram-se óbvias, como por exemplo o facto de eliminar as diferenças entre os observadores. A remoção do dreno torácico é confortável, segura e bem tolerada pelos doentes; ajuda a reduzir ou a eliminar o custo da estadia hospitalar uma vez que, de acordo com as diferentes séries publicadas nos últimos meses, é possível remover o dreno mais cedo e, assim, dar alta ao doente mais cedo. Estão a ser elaborados estudos, mas ainda não há nada escrito sobre as possíveis vantagens em programas de cirurgia de ambulatório. Neste trabalho apresentamos a nossa experiência em 3 casos de doentes em ambulatório com ressecção pulmonar, que foram tratados com DTDS intra-domiciliar contínua. Até aos resultados de um futuro estudo em elaboração, constatamos que este é um método seguro para doentes devidamente seleccionados.</p></span>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 642 "Ancho" => 1392 "Tamanyo" => 100876 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Thopaz Medela is a comfortable and safe device.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 534 "Ancho" => 1477 "Tamanyo" => 72971 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">DTDS show us objective numeric parameters like de suction pressure and air leak flow. It represents these parameters in graphics that can be downloaded.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prolonged air leak" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "T.W. Rice" 1 => "T.T.J. Kirby" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Chest Surg Clin North Am" "fecha" => "1992" "volumen" => "2" "paginaInicial" => "803" "paginaFinal" => "811" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Predictors of prolonged air leak after pulmonary lobectomy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "A. Brunelli" 1 => "M. Monteverde" 2 => "A. Borri" 3 => "M. Salati" 4 => "R.D. Marasco" 5 => "A. Fianchini" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.athoracsur.2003.10.082" "Revista" => array:6 [ "tituloSerie" => "Ann Thorac Surg" "fecha" => "2004" "volumen" => "77" "paginaInicial" => "1205" "paginaFinal" => "1210" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15063235" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Initial experience with the world's first digital drainage system. The benefits of recording air leaks with graphic representation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "L. Dernevik" 1 => "A. Belboul" 2 => "G. 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Fritz" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ejcts.2006.03.026" "Revista" => array:6 [ "tituloSerie" => "Eur J Cardiothorac Surg" "fecha" => "2006" "volumen" => "29" "paginaInicial" => "867" "paginaFinal" => "872" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16675248" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Postoperative chest tube management: measuring air leak using an electronic device decreases variability in the clinical practice" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "G. Varela" 1 => "M.J. Jiménez" 2 => "N.M. Novoa" 3 => "J.L. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 21 | 10 | 31 |
| 2024 October | 119 | 47 | 166 |
| 2024 September | 88 | 38 | 126 |
| 2024 August | 114 | 40 | 154 |
| 2024 July | 103 | 39 | 142 |
| 2024 June | 102 | 29 | 131 |
| 2024 May | 133 | 55 | 188 |
| 2024 April | 115 | 35 | 150 |
| 2024 March | 78 | 30 | 108 |
| 2024 February | 78 | 26 | 104 |
| 2024 January | 84 | 21 | 105 |
| 2023 December | 85 | 33 | 118 |
| 2023 November | 82 | 30 | 112 |
| 2023 October | 96 | 32 | 128 |
| 2023 September | 110 | 31 | 141 |
| 2023 August | 93 | 24 | 117 |
| 2023 July | 104 | 27 | 131 |
| 2023 June | 80 | 16 | 96 |
| 2023 May | 95 | 31 | 126 |
| 2023 April | 107 | 20 | 127 |
| 2023 March | 161 | 25 | 186 |
| 2023 February | 97 | 20 | 117 |
| 2023 January | 99 | 40 | 139 |
| 2022 December | 119 | 31 | 150 |
| 2022 November | 141 | 38 | 179 |
| 2022 October | 149 | 40 | 189 |
| 2022 September | 93 | 38 | 131 |
| 2022 August | 167 | 46 | 213 |
| 2022 July | 101 | 60 | 161 |
| 2022 June | 100 | 50 | 150 |
| 2022 May | 130 | 46 | 176 |
| 2022 April | 83 | 49 | 132 |
| 2022 March | 79 | 42 | 121 |
| 2022 February | 117 | 32 | 149 |
| 2022 January | 128 | 45 | 173 |
| 2021 December | 85 | 48 | 133 |
| 2021 November | 76 | 31 | 107 |
| 2021 October | 116 | 35 | 151 |
| 2021 September | 66 | 38 | 104 |
| 2021 August | 60 | 24 | 84 |
| 2021 July | 94 | 21 | 115 |
| 2021 June | 49 | 29 | 78 |
| 2021 May | 72 | 29 | 101 |
| 2021 April | 174 | 73 | 247 |
| 2021 March | 94 | 39 | 133 |
| 2021 February | 69 | 15 | 84 |
| 2021 January | 43 | 23 | 66 |
| 2020 December | 39 | 18 | 57 |
| 2020 November | 63 | 23 | 86 |
| 2020 October | 44 | 9 | 53 |
| 2020 September | 93 | 24 | 117 |
| 2020 August | 99 | 26 | 125 |
| 2020 July | 157 | 30 | 187 |
| 2020 June | 105 | 21 | 126 |
| 2020 May | 94 | 12 | 106 |
| 2020 April | 67 | 18 | 85 |
| 2020 March | 80 | 16 | 96 |
| 2020 February | 118 | 33 | 151 |
| 2020 January | 115 | 20 | 135 |
| 2019 December | 96 | 17 | 113 |
| 2019 November | 110 | 14 | 124 |
| 2019 October | 106 | 17 | 123 |
| 2019 September | 103 | 17 | 120 |
| 2019 August | 160 | 17 | 177 |
| 2019 July | 143 | 15 | 158 |
| 2019 June | 137 | 9 | 146 |
| 2019 May | 188 | 23 | 211 |
| 2019 April | 134 | 21 | 155 |
| 2019 March | 246 | 17 | 263 |
| 2019 February | 209 | 9 | 218 |
| 2019 January | 223 | 24 | 247 |
| 2018 December | 169 | 9 | 178 |
| 2018 November | 72 | 2 | 74 |
| 2018 October | 73 | 9 | 82 |
| 2018 September | 46 | 6 | 52 |
| 2018 August | 41 | 27 | 68 |
| 2018 July | 68 | 20 | 88 |
| 2018 June | 65 | 11 | 76 |
| 2018 May | 112 | 19 | 131 |
| 2018 April | 109 | 20 | 129 |
| 2018 March | 135 | 21 | 156 |
| 2018 February | 54 | 7 | 61 |
| 2018 January | 46 | 31 | 77 |
| 2017 December | 53 | 17 | 70 |
| 2017 November | 45 | 15 | 60 |
| 2017 October | 48 | 11 | 59 |
| 2017 September | 41 | 11 | 52 |
| 2017 August | 71 | 12 | 83 |
| 2017 July | 33 | 18 | 51 |
| 2017 June | 105 | 22 | 127 |
| 2017 May | 48 | 23 | 71 |
| 2017 April | 16 | 2 | 18 |
| 2017 March | 35 | 64 | 99 |
| 2017 February | 63 | 14 | 77 |
| 2017 January | 36 | 11 | 47 |
| 2016 December | 41 | 15 | 56 |
| 2016 November | 29 | 12 | 41 |
| 2016 October | 64 | 13 | 77 |
| 2016 September | 151 | 7 | 158 |
| 2016 August | 35 | 13 | 48 |
| 2016 July | 19 | 10 | 29 |
| 2016 June | 5 | 7 | 12 |
| 2016 May | 34 | 0 | 34 |
| 2016 April | 58 | 4 | 62 |
| 2016 March | 79 | 15 | 94 |
| 2016 February | 68 | 23 | 91 |
| 2016 January | 68 | 18 | 86 |
| 2015 December | 76 | 17 | 93 |
| 2015 November | 68 | 13 | 81 |
| 2015 October | 68 | 15 | 83 |
| 2015 September | 88 | 17 | 105 |
| 2015 August | 70 | 15 | 85 |
| 2015 July | 122 | 6 | 128 |
| 2015 June | 61 | 8 | 69 |
| 2015 May | 90 | 10 | 100 |
| 2015 April | 96 | 24 | 120 |
| 2015 March | 99 | 11 | 110 |
| 2015 February | 147 | 12 | 159 |
| 2015 January | 147 | 7 | 154 |
| 2014 December | 139 | 19 | 158 |
| 2014 November | 143 | 11 | 154 |
| 2014 October | 154 | 9 | 163 |
| 2014 September | 162 | 14 | 176 |
| 2014 August | 122 | 10 | 132 |
| 2014 July | 132 | 12 | 144 |
| 2014 June | 111 | 6 | 117 |
| 2014 May | 136 | 13 | 149 |
| 2014 April | 149 | 10 | 159 |
| 2014 March | 156 | 12 | 168 |
| 2014 February | 161 | 13 | 174 |
| 2014 January | 161 | 10 | 171 |
| 2013 December | 150 | 14 | 164 |
| 2013 November | 134 | 15 | 149 |
| 2013 October | 99 | 12 | 111 |
| 2013 September | 99 | 11 | 110 |
| 2013 August | 114 | 23 | 137 |
| 2013 July | 88 | 25 | 113 |
| 2013 June | 90 | 12 | 102 |
| 2013 May | 67 | 15 | 82 |
| 2013 April | 92 | 21 | 113 |
| 2013 March | 65 | 18 | 83 |
| 2013 February | 75 | 22 | 97 |
| 2013 January | 59 | 18 | 77 |
| 2012 December | 59 | 15 | 74 |
| 2012 November | 45 | 10 | 55 |
| 2012 October | 20 | 9 | 29 |
| 2012 September | 18 | 6 | 24 |
| 2012 January | 299 | 0 | 299 |
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