After introduction of the three-bottle, water-seal system for pleural cavity drainage, many commercially available adaptations of this system have become available. These commercial pleural drainage units (PDUs) appear to dominate the marketplace to the extent that the original three-bottle system is a rarity in practice today. Portability, ease of use, and disposability are significant advantages of available PDUs; however, the question remains, how reliable are these devices? The only available assessments of commercial PDUs were published in the 1980s, noting flow rates for these devices. The four assessed devices are no longer available. No assessment of PDU-generated pressure accuracy has been published.
Similarly, no manufacturer-independent analysis of the myriad of commercially available pleural drainage catheters (PDCs) has been published. there
Given the recent American College of Chest Physicians (ACCP) recommendations for use of smallbore catheters in certain settings of spontaneous pneumothorax, and their use in traumatic and iatrogenic pneumothoraces, knowledge of the potential air flow rate limitations of these small-bore catheters is key, especially in the setting of a bronchopleural fistula.
Limitation in the flow rates accommodated by the PDU or the PDC can lead to the development of a tension pneumothorax. PDU-delivered pressures may also affect device efficiency; hence, knowledge of the flow rate limitations of commercially available PDUs and PDCs and of the accuracy of PDU-delivered pressure would be valuable to the daily management of pneumothoraces.
Materials and Methods
Eight PDU models were supplied free of charge by three leading manufacturers (Table 1). These models appear to be the most widely used units in the United States per information supplied by the respective manufacturers.
Table 1—PDU Models, Manufacturer, and Flow Rates
|PDUs Manufacturer/Model||Suction Level, cm H2O|
|– 10||– 20||– 40|
|Atrium Medical Corporation (Hudson, NH)|
|Atrium Ocean 20021||25.4 ± 1.3||40.7 ± 0.3||no – 40 setting|
|Atrium 36001||20.5 ± 0.8||34.0 ± 0.8||42.8 ± 0.0|
|Atrium 3612 (pediatric device)!||11.5 ± 1.3||20.3 ± 0.6||32.4 ± 0.0|
|Sherwood Medical (Tullamore, Ireland)|
|Argyle Aqua-Sealf||25.9 ± 0.4||42.1 ± 1.0||no – 40 setting|
|Argyle Thora-Seal IIIf||26.2 ± 0.5||39.6 ± 1.2||no – 40 setting|
|Argyle Sentinel Sealf||6.3 ± 1.2||10.8 ± 0.6||no – 40 setting|
|Deknatel (Fall River, MA)|
|Pleur-evac A-6000 (Code #A-6000)j||20.5 ± 0.8||33.1 ± 0.6||50.5 ± 2.3|
|Pleur-evac SAHARA (Code #S11000FS)J||12.5 ± 1.0||20.5 ± 1.0||35.6 ± 1.9|