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Comparison of Function of Commercially Available Pleural Drainage Units and Catheters: Smaller-bore PDCs

This catheter had the highest flows at all pressures tested. Catheters < 16F may be considered small bore and deliver significantly less flow than the only larger-bore PDC tested, the Cook C-TQTS-2400. Various clinical conditions outlined above may have bronchopleural fistula flow rates of up to 16 L/min. The clinician, however, must be vigilant for air leaks > 16 L/min, as noted earlier. The Arrow AK-01600 and AK-01601 are the only two < 16F PDCs tested able to accommodate the arbitrary value of 16 L/min of flow at — 20 cm H2O. Patients with spontaneous pneumothoraces who are not receiving mechanical ventilation are likely not at high risk of a large bronchopleural fistula and may be appropriate for a < 16F PDC. The ACCP spontaneous pneumothorax guidelines suggest initial placement of a chest tube and hospital admission as preferred management of an unstable patient with a large (> 3 cm lung collapse) primary spontaneous pneumothorax, or any secondary spontaneous pneumothorax patient with a large pneumothorax or with clinical instability. Specifically, patients with a primary spontaneous pneumothorax (unlikely at risk for a large air leak) suitable for chest tube placement should have their lung re-expanded using a smallbore catheter (< 14F) or placement of a 16F to 22F chest tube. this
When to place a chest tube and what size to select is less well defined for nonspontaneous pneumothoraces. A recent review suggests, based on available evidence, placement of larger-bore PDCs (28F to 36F) for noniatrogenic traumatic pneumothoraces, particularly in the patient receiving mechanical ventilation, to drain both an ongoing air leak and potential accompanying hemothorax. Iatrogenic traumatic pneumothoraces may be treated with smaller-bore PDCs as long as patients are not receiving mechanical ventilation. Perhaps in both spontaneous and nonspontaneous pneumothoraces the selection of a PDC with flow rate reserve would be wise to provide a safety net in case of unanticipated increased air flow rates.