Document Detail


Reverse Airflow in Certain Chest Drains May be Misinterpreted as Prolonged Air Leakage.
MedLine Citation:
PMID:  21203757     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
BACKGROUND: Prolonged air leakage is common after lung resection. We observed that during deep inspiration some patients were able to empty the water-seal of commercial chest drainage systems and retract air back into the chest tube, which subsequently escaped during the following expiration, mimicking "true" air leakage. This led us to perform in vitro and in vivo pressure measurements in chest tube systems and investigate possible relationships with "false" air.
METHODS: Commercially available one- and three-chamber drainage systems were used as models for large and small water-seals, respectively. Digital pressure measurements were performed in vitro and in ten selected patients with clinical suspicion of reverse airflow.
RESULTS: Repeated measurements in the laboratory demonstrated that in three-chamber chest drainage systems with small water-seals a negative pressure below -30.4 cmH(2)O led to emptying of the water-seal with retrograde flow of air. Retrograde airflow was not possible in one-chamber chest drainage systems. In vivo measurements demonstrated that six of ten highly selected patients were able to create negative pressures below -30.4 cmH(2)O during deep inspiration.
CONCLUSION: During deep inspiration some patients are able to create negative pressure large enough to empty small water-seals in commercial chest drainage systems and retract air back into the chest tube. This excess air escapes during the following expiration and may mislead interpretation of continued air leakage even when there is none, subsequently resulting in prolonged and unnecessary chest tube drainage. Any surgeon who treats patients with chest tubes should be aware of this phenomenon.
Authors:
Anna Stouby; Kirsten Neckelmann; Peter B Licht
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  World journal of surgery     Volume:  35     ISSN:  1432-2323     ISO Abbreviation:  World J Surg     Publication Date:  2011 Mar 
Date Detail:
Created Date:  2011-02-03     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7704052     Medline TA:  World J Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  596-9     Citation Subset:  IM    
Affiliation:
Department of Cardiothoracic Surgery, Odense University Hospital, Sdr. Boulevard 29, 5000, Odense, Denmark.
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