Lung Injury Resulting from Fluted Silastic Soft Drain Extraction under Negative Pressure Suction*

We experienced two cases of lung injury resulting from fluted silastic drain extraction under reservoir-generated negative pressure suction. In the first case, a 67-year-old man underwent coronary artery bypass grafting. A 19 Fr BLAKE drain was placed at the pericardial cavity, the mediastinum, and the left thoracic cavity. All three drains were connected to J-VAC reservoirs. After removing the drains (which maintained the negative pressure), subcutaneous emphysema and hemopneumothorax occur. A trocar catheter was inserted. Bleeding and the air leak terminated within a day. In the second case, a 73-year-old man underwent aortic valve replacement. Right pneumothorax occurred after the removal of the pleural cavity drain, which maintained the negative pressure generated by the reservoir. We inserted a trocar catheter, and the air leak terminated within a day. We hypothesized that the reservoir-generated negative pressure causes the pleura to enter the groove of the drain and become damaged during extraction. We stopped using a reservoir to connect to the fluted silastic drain placed at the pleural cavity and removed the negative pressure when extracting the pleural cavity drain. Since implementing this change, we have not experienced a similar lung injury in more than 500 cardiac surgery patients.