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Eur J Cardiothorac Surg 2006;30:952
© 2006 Elsevier Science NL

Letters to the Editor

Use of Blake drains following lung resection

Department of Cardiothoracic Surgery, Sir Charles Gairdner Hospital, Nedlands, WA 6009, Australia

Received 15 September 2006; accepted 3 October 2006.

^_* Corresponding author. Tel.: +61 8 9346 3333; fax: +61 8 9346 2344. (Email: drpankajsaxena{at}hotmail.com).

Key Words: Drainage • Lobectomy • Wedge resection

We read with great interest the article by Icard and co-workers on the use of a single 24 F Blake drain (Johnson & Johnson, Somerville, NJ) [1]. We first reported the use of Blake drains for drainage of pleural cavity in patients undergoing thoracotomy [2]. We used 19 F drains in 37 patients undergoing various thoracic surgical procedures. A single drain was placed in the pleural cavity, which was secured apically to the chest wall with a stitch. This particular positioning secured the fluted portion of drain to lie along the length of the pleural cavity. Suction of –5 kPa was applied to the drainage system. It was not discontinued at any stage contrary to the practice used by the authors of this paper. We agree with the authors that only a single tube is usually sufficient in comparison to two conventional chest drains in providing effective pleural drainage; they cause less post-operative pain; are cosmetically attractive and are less painful to remove. This is in contrast to the conventionally used large sized rigid pleural drains, which may affect the post-operative recovery by limiting ambulation and interfere with effective chest physiotherapy.

Post-operative air leak can be an important issue in patients undergoing wedge resection, patients with incompletely developed fissures, presence of emphysema, presence of intrapleural adhesions or patients requiring decortication of lung. We do have some concerns about the efficacy of silastic drains in these situations. Icard and co-workers do not seem to have any problem with this issue. This could possibly be related to the use of larger size drain (24 F) in comparison to our smaller drains (19 F). In two of our patients an additional standard drain was inserted to manage continued air leak beyond 10 days. Both of these patients had bilobectomy involving right middle and lower lobe. There is a gradual blockage of the drain by fibrinous deposits and hence the efficacy to evacuate air from the pleural cavity can be compromised. Presently we would advocate and use Blake drains in only those patients where no extensive dissection of fissures is performed during lung resection and no significant air leak is noticed at the end of the procedure. We also think that the drainage of the pleural space following lower lobectomy is not very effective with a single Blake drain. In these patients best form of drainage is with two standard drains including a basal drain placed over the diaphragm. We also notice that Icard and co-workers positioned a single drain posteriorly in the paravertebral recesses in patients undergoing lower lobectomy. We wonder if they had any issues with residual pleural space apically in these patients.

We feel that two issues are important with these drains. The drain should be secured to the apex to keep the tube in position and also suction should be maintained at all times. These measures improve the evacuation of air from the pleural cavity. More studies are required to finally define the role of these drains in the practice of thoracic surgery.

References

1. Icard P, Chautard J, Zhang X, Juanico M, Bichi S, Lerochais JP, Flais F. A single 24 F Blake drain after wedge resection or lobectomy: a study on 100 consecutive cases. Eur J Cardiothorac Surg 2006;30:649-651.[Abstract/Free Full Text]
2. Kejriwal N, Newman MAJ. Use of a single silastic chest drain following thoracotomy: Initial evaluation. ANZ J Surg 2005;75:710-712.[CrossRef][Medline]

This article has been cited by other articles:

				P. Icard Reply to Saxena et al. Eur. J. Cardiothorac. Surg., December 1, 2006; 30(6): 952 - 953. [Full Text] [PDF]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Pankaj Saxena Nand Kejriwal Mark A.J. Newman Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Saxena, P. Articles by Newman, M. A.J. Search for Related Content PubMed PubMed Citation Articles by Saxena, P. Articles by Newman, M. A.J. Related Collections Lung - other Pleura