A case requiring re-thoracotomy due to a significant reduction of tidal volume after commencement of chest tube drainage under pressure control ventilation following lower lobectomy

The effects of chest drainage on pressure-controlled ventilation

BACKGROUND

The use of pressure-controlled ventilation (PCV) for anesthesia management is becoming more commonly used. Chest drainage is commonly performed after thoracic surgery, and the negative pressure it generates might affect the transpulmonary pressure (TPP). In the present study, we investigated how chest drainage could affect ventilating conditions during PCV.

METHODS

We created a hand-made simple thoracic and lung model, which was connected to an anesthesia machine. The tidal volume (TV) was measured with positive end-expiratory pressure (PEEP) 0 and no chest drainage (baseline), followed by 10 cmH₂O PEEP/no drainage, 10 cmH₂O PEEP/drainage with - 10 cmH₂O and 10 cmH₂O PEEP/drainage with - 20 cmH₂O. Finally, TV with 20 cmH₂O and 30 cmH₂O PEEP/no drainage was measured. Driving (inspiratory) pressure was maintained at 20 cmH₂O during the whole experiment.

RESULTS

TV was significantly increased by applying 10 cmH₂O PEEP compared with baseline, further increased by applying - 10 cmH₂O by drainage, similar to the value with PEEP 20 cmH₂O with no drainage (end-tidal TPP of 20 cmH₂O for both). TV decreased to < 50% of the baseline by applying 10 cmH₂O PEEP with - 20 cmH₂O by drainage, which was similar to that with 30 cmH₂O PEEP with no drainage (end-tidal TPP of 30 cmH₂O for both).

CONCLUSIONS

TV was maintained at similar levels with the same TPP, regardless of PEEP or negative pressure by chest drainage change, suggesting that negative intrapleural pressure by the chest tube drainage system might mimic PEEP from the point of TV.