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

Cardiac herniation is a serious postoperative complication of extrapleural pneumonectomy (EPP) and is reportedly preventable by reducing the suction pressure of the chest drain.

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 cmH₂O) was chosen as an alternative to the setting typically used for postoperative drainage (- 15 cmH₂O). As a result, the wound in the chest wall functioned as an antireflux check valve, leading to the development of impending tension pneumothorax.

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.