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Intraoperative Ventilatory Collapse from Negative Pleural Suction in a Ruptured Pulmonary Hydatid Cyst.
Sharek Abdul Nazir1, Subrata Kumar Singha, Ananya Rao
1Department of Anesthesia, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India.
Annals of Cardiac Anaesthesia
|July 13, 2026
Summary
Negative pleural suction can cause dangerous ventilatory collapse after lung surgery for hydatid cysts. Clamping the drain immediately restored breathing, confirming suction-induced lung injury. This highlights risks associated with negative pleural suction post-parenchymal leak repair.
Area of Science:
- Thoracic Surgery
- Pulmonary Medicine
- Critical Care Medicine
Background:
- Hydatid cysts can rupture, necessitating surgical intervention like thoracotomy and cyst excision.
- Post-operative management after lung surgery, especially with parenchymal air leaks, requires careful attention to pleural drainage.
- Negative pleural suction is a common technique for managing air leaks but carries potential risks.
Purpose of the Study:
- To report a case of sudden ventilatory collapse and refractory hypotension following negative pleural suction after hydatid cyst surgery.
- To identify the cause of the ventilatory collapse and highlight the potential hazards of negative pleural suction in specific surgical contexts.
- To emphasize the importance of prompt diagnosis and alternative management strategies for post-operative complications.
Main Methods:
- A 52-year-old male patient underwent thoracotomy and cyst excision for a ruptured right hydatid cyst.
- Following repair of parenchymal air leaks, negative pleural suction was applied, leading to complications.
- Diagnostic interventions included clinical assessment, response to interventions (drain clamping, vasopressors), and ultrasound imaging.
Main Results:
- Application of negative pleural suction resulted in sudden ventilatory collapse and refractory hypotension.
- Clamping the pleural drain immediately restored tidal volumes, confirming suction-mediated negative-pressure failure.
- Ultrasound confirmed lung re-expansion without pneumothorax, but pink frothy secretions suggested re-expansion pulmonary edema.
Conclusions:
- Negative pleural suction can be hazardous after repair of diffuse parenchymal air leaks, particularly in the context of hydatid cyst surgery.
- Sudden ventilatory collapse and hypotension unresponsive to standard treatments can be caused by excessive negative pressure.
- Switching to a water-seal drain, optimizing ventilation, and supportive care led to patient recovery, underscoring the need for cautious use of negative pleural suction.
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