Describe the role of a thoracostomy tube following pulmonary resection, and describe the system used for pleural drainage.
Before chest closure, thoracostomy tubes are placed to drain air and fluid as well as to keep remaining lung tissue expanded. One tube is placed anteriorly at the apex for air drainage, and another is placed posteriorly for fluid drainage. The chest tubes are connected to underwater seals with negative 15–20 cm H2O pressure (suction). Inadequate suction may lead to tension pneumothorax if the rate of air removal from the pleural space is less than the rate of air leakage into the pleural space. In this case, an underwater seal without suction would be safer. Thoracostomy tubes are usually not placed following pneumonectomy because there is no remaining lung tissue to re-expand.