Fluid Drainage and Air Evacuation Characteristics of Blake and Conventional Drains Used After Pulmonary Resection

Abstract

The Blake drain (BD) has recently begun to be used as a chest tube after pulmonary resection; however, its fluid drainage and air evacuation characteristics remain unclear. We compared the performance of the 19F BD with that of the 32F conventional drain (CD). We studied 148 consecutive patients (74 with BD; 74 with CD) who underwent pulmonary resection. Postoperative drainage rates (daily drainage and total drainage) were analyzed to assess fluid drainage. Air evacuation was evaluated to determine whether subcutaneous emphysema or insufficient residual lung expansion developed when air leakage occurred. The BD group was initially managed with water seal or suction, whereas the CD group was managed with water seal. Furthermore, we experimentally measured the evacuation pressure required to expel a constant volume of air through various chest tubes to determine basic air evaluation performance of the tubes. Drainage rates on the operative day were significantly lower in the BD group than in the CD group, but were similar in both groups on the following day with greater variation in the water-sealed BD group. Among cases with air leakage, air evacuation insufficiency was more frequent in the BD group (16 of 22, 73%) than in the CD group (4 of 17, 24%; p = 0.004). The experiment revealed that air evacuation performance of the 19F BD was equivalent to that of the 12F CD, indicating that the BD requires higher intrathoracic pressure for air evacuation. Suction is required for the BD to obtain fluid drainage performance comparable to that of the water-sealed CD. When air leakage occurs, air evacuation by the BD tends to be insufficient, irrespective of suction conditions.