Post-Pneumonectomy Chest Tubes

To the Editor:

I read with interest the letter of Dr. Walker, ¹ the following reply, ² and the editorial commentary. ³ There are 2 reasons why a chest tube should be used routinely after pneumonectomy. First, it provides immediate information on the amount of blood that the patient may lose after the operation. Although as a rule the blood loss is insignificant and should not exceed 200 to 300 mL, instances are known of massive blood loss due to a slipped ligature or other cause. A pleural drain placed for 24 hours provides this information and prompts the surgeon to re-explore the chest immediately. The second reason for placing the pleural drain has been pointed out by Dr. Cooley: ³ it is to equalize intrathoracic pressure changes. When the patient is turned from the decubitus to the supine position after the operation, the mediastinum shifts, and air in the post-pneumonectomy space becomes compressed, often resulting in immediate subcutaneous emphysema, sometimes massive.

It is not the chest tube that is hazardous, but the suction applied to it. Because there is no lung tissue to expand, negative pressure in the post-pneumonectomy space serves no purpose at all. Moreover, it causes mediastinal shift, with all of its undesirable consequences. Suction should never be applied, and the tube should be removed after 24 hours.