Intermittent inspiratory chest tube occlusion: a modification for patients with empyema

In critical ill patients, significant bronchopleural cutaneous fistulae (BPCF) may lead to the loss of a substantial portion of mechanically delivered inspiratory volume. This leads to maldistribution of ventilation and ventilation-perfusion mismatch with resulting arterial hypoxemia and hypercarbia. In such patients, attempts at surgical closure are frequently inadvisable. The use of intermittent inspiratory chest tube occlusion (IICTO) using a pneumatic valve has proven to be a useful adjunct in this clinical situation. In patients with empyema, as others, thick proteinaceous pleural fluid poses an unusual problem. As drying and caking of drainage occurs, the valving mechanism is impaired. A modification of the original technique is described, which eliminates this problem.