Respiratory failure caused by impending tension pneumothorax after extrapleural pneumonectomy: a case report

Abstract

Background: Cardiac herniation is a serious postoperative complication of extrapleural pneumonectomy (EPP) and is reportedly preventable by reducing the suction pressure of the chest drain. Case presentation: We describe a patient in whom respiratory failure, which was caused by impending tension pneumothorax after EPP, was successfully treated via normal suction pressure of the chest drain. A lower suction pressure (− 7 cmH 2 O) was chosen as an alternative to the setting typically used for postoperative drainage (− 15 cmH 2 O). As a result, the wound in the chest wall functioned as an antireflux check valve, leading to the development of impending tension pneumothorax. Conclusions: Impending tension pneumothorax presents with an abnormal elevation of intrapleural pressure on the affected side. This phenomenon can be effectively treated by increasing the suction pressure in the chest drain.

Tensioned space after pneumonectomy for cancer with mediastinal shift and cardiac tamponade‑causes and treatment (Review)

“…Study screening and selection. After a rigorous search, a total of 19 case reports that matched the selection criteria were identified (2,(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20). Of these cases, 18 were with liquid in tension and 1 with air in tension into the post-pneumonectomy space, all after pneumonectomy for malignancy, as presented in Table II.…”

“…Tension pneumothorax. One case of tension pneumothorax after pneumonectomy for malignancy was reported, which was attributed by the authors to the chest wall damage after extrapleural pneumonectomy and a lower suction pressure of the chest drain was selected in order to avoid cardiac herniation (19). It occurred on the first post-operative day (case 18-Table II).…”