In a patient with high PEEP, how might chest-tube management be affected?

• A. Increased intrathoracic pressure can reduce drainage or worsen air leaks; adjust ventilation and suction per protocol.
• B. High PEEP always increases drainage
• C. PEEP can reduce drainage or worsen air leaks
• D. PEEP eliminates air leaks

Answer: (A)

Raising PEEP raises intrathoracic pressure, which changes the drainage dynamics of a chest tube. The drainage system relies on a pressure gradient between the pleural space and the chest-tube circuit; when intrathoracic pressure increases, that gradient decreases, so the amount of fluid or air drawn out can fall. If an air leak is present, the higher pleural pressure can also push air through the leak toward the chest tube, potentially making the leak seem worse. Because of this, ventilation and suction should be adjusted per protocol to optimize drainage and minimize complications. High PEEP does not guarantee more drainage and does not eliminate air leaks.