Use of Blake drains following lung resection

Abstract

We read with great interest the article by Icard and coworkers 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