Chest drainage management

Chest drainage management is used to preserve respiratory function and haemodynamic stability. The generation of an active sub-atmospheric pressure or vacuum builds the basis of chest drainage management. A vacuum is defined as “space with zero pressure” generating a difference in pressure between the pleural space and the atmosphere creates sub-atmospheric pressure in the pleural space, which is used to generate a vacuum in chest drainage management.

The so-called “central vacuum” was the first sub-atmospheric pressure device available. Sub-atmospheric pressure of around 100 cm of water column was historically generated at a central location in the hospital. This “central vacuum” was available throughout the entire hospital, as it was proved via a tubing system. It was referred to as “wall suction”.

Reduction valves that reduce the negative pressure to a therapeutically reasonable range were commercially available later. Due to this, multi-chamber suction – the use of three-chamber systems – was developed. In the 1960s, the first pumps (Emerson-Pump) were available. These and other systems launched later generated a fixed “negative pressure”. These pumps couldn’t compensate for an inadequate position of the collection chamber of a siphon. Since 2008, an electronically driven and regulated system is available, generating a “negative pressure” on demand.

External suction (previously referred to as active suction) is used to create a sub-atmospheric pressure at the tip of a catheter. As the atmospheric pressure is lower compared to the intrapleural pressure, the lack of external suction (which was previously referred to as passive suction) is used to drain air and fluids. Traditional drainage systems are not able to suction sub-atmospheric pressure in the pleural space. These systems only allow for a regulation of pressure via the system itself but cannot regulate sub-atmospheric pressure in the pleural space.

Two different principles are used in chest drainage management: The Heber-Drain principle and the Bülau-Drain principle. The “Heber-Drain” is based on the Heber principle, which uses hydrostatic pressure to transfer fluid from the chest to a collection canister. It produces permanent passive suction. As the Heber drain is a classical gravity drain, the canister must be placed below chest level to be active. The difference in height between the floor and the patient bed determines the resultant sub-atmospheric pressure. With a difference, for example, of 70 cm in height, a pressure of minus 70 cm of water is created. A water seal component is always combined with a Heber-Drain.

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Wikipedia