Another Indication for Chest Tube after Pneumonectomy

To the Editor:

We are writing in regard to the communications by Drs. Walker, ¹ Nazari, ² and Cooley ³ published recently in the Texas Heart Institute Journal. In our opinion, there is one indication for leaving a chest tube in place after pneumonectomy that was not adequately discussed in these letters and editorial commentary.

Pneumonectomy for acute, subacute, or chronic sepsis that does not respond to intensive medical treatment is still common in developing nations. The underlying origin of the sepsis may be fulminant pneumonia, lung abscess, tuberculosis, bronchiectasis, or long-standing empyema with a chronically collapsed lung. The lung may be destroyed due to long-term pleuropulmonary sepsis with or without a bronchopleural fistula. In such situations, pneumonectomy entails extensive, painstaking dissection, which can require the affected lung to be pressed, squeezed, or retracted forcibly. Invariably, large numbers of microbes are released into the pleural cavity. Despite all diligent precautions to remove these microbes, the fluid often continues to grow organisms for several days. Generally, removing the primary focus of the sepsis ultimately causes the pleural fluid to become sterile. However, until this occurs, the patient needs a properly functioning chest tube to avoid an accumulation of fluid teeming with microbes. Such fluid can worsen the pleural sepsis and seep through the wound, endangering its integrity.