| NEWBORNS Newborns with idiopathic respiratory distress syndrome (hyaline membrane disease) may develop multiple pneumothoraces requiring multiple chest tubes. Newborn lung tissue is immature and delicate, and the lack of surfactant makes the lungs stiff and difficult to ventilate. To overcome this stiffness, relatively high positive airway pressure may be necessary during mechanical ventilation, which may be associated with pneumothorax. Within the Pleur-evac line are units specifically designed for neonatal and infant use, with smaller collection chambers having finer calibrations to allow more accurate measurement of small drainage volumes (figure 19). The connecting tube has a narrower diameter to allow connection to the smaller chest tubes used in these patients. MASSIVE PLEURAL AIR LEAK Massive pleural air leaks can be seen in patients with necrotizing pneumonia or massive chest trauma and in those receiving mechanical ventilation with high positive airway pressures. Studies have shown that air from such large air leaks has participated in gas exchange, and need not be compensated for in mechanical ventilator settings. Such massive air leaks may overwhelm the suction flow capacity through a chest drainage system. Turning up the source suction will increase air flow through the system, not suction pressure. In the case of a massive pleural leak, increased air flow may be necessary to pull the air through the system fast enough to evacuate the pleural cavity before the next breath. With wet suction, you will see vigorous bubbling in the water seal chamber and no bubbling in the suction control chamber if suction flow capacity has been overwhelmed. With dry suction, the orange float will not appear in the window. Again, turn up the suction source until the orange float reappears. |
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CHEST DRAINAGE AS A THERAPEUTIC INTERVENTION
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Special Considerations
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