الفهرس 
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Abstract
This study aimed to find out the role of respiratory phase during which pleural drain is removed in the occurrence of post removal post drain removal pneumothorax. 291 patients were allocated into four different groups as follows: 72 patients in end-expiratory group (P group) in which recurrent insignificant pneumothorax occurred in 6 patients. 75 patients were allocated in Valsalva maneuver after full inspiration group (Q group), In which recurrent insignificant pneumothorax occurred in 8 patients. 73 patients were assigned in Valsalva maneuver after full expiration group (R group) in which recurrent insignificant pneumothorax occurred in 7 patients and recurrent significant pneumothorax occurred in 2 patients in this group. and finally, 71 patients were allocated in end-inspiratory group (S group) in which recurrent insignificant pneumothorax occurred in 5 patients.
Thus, we have a total of 28 patient of 291 had post drain removal pneumothorax. Post drain removal pneumothorax was radiologically and clinically insignificant in 26 patients and they were managed by conservative measures that included oxygen supplementation and physiotherapy which were enough to obtain a near total resolution within 3 days and no intervention was needed. There were two patients who had a significant post drain removal pneumothorax and required intercostal tube re-insertion, one of them totally improved after 3 days and the other needed an additional aggressive physiotherapy to improve.
After statistical analysis we can say that in post CABG patients, the respiratory phase during which the pleural drain is removed has no role in occurrence of post drain removal pneumothorax and it’s not necessary to ask the patient to adapt the painful Valsalva maneuver during the removal procedure.
After considering the results of this study and the results of similar studies that aimed to detect the effect of respiratory phase during pleural drain removal on the rate of occurrence of post drain removal pneumothorax, We can conclude that under normal circumstances where the pleural drain is removed in proper timing by a well-trained physician while the patient is holding his/her with proper closure of thoracostomy wound, the post drain removal pneumothorax can’t be attributed to the removal technique regarding the respiratory phase which the patient is asked to adapt during the removal procedure.