New chest tube management maintained with negative pressure therapy.

Management of a chest tube, especially when lasting for a long period, becomes difficult. The orifice of thoracostomy where a tube is inserted is maintained sterile usually with water-tight sutures. The longer and tighter the sutures are placed, the more severely skin becomes sore by pressure. Recently not only pressure sores but also other various open wounds were successfully treated by negative pressure therapy. This study presents two cases of intrathoracic abscess which were successfully treated by chest tube maintained with negative pressure therapy. One case was a bed-ridden cerebral palsy patient with empyema thoracis and the other was a premature baby with lung abscess. Both needed a chest tube longer than a month. Negative pressure was applied not only in the abscess cavity but also in the wound of tube insertion, thus simultaneously draining the abscess and accelerating the wound healing of the tube insertion. It was gradually elevated from 20 to 50 H2O (14.7 to 36.7 mmHg), which is below the level of the physiologic forced inspiration, with a 10 cm H2O (7.4 mmHg) increase every other day. Both abscesses disappeared without a complication.