In a patient with a chest tube drainage system showing significant bubbling in the water-seal chamber, what should the respiratory therapist recommend?

• A. Send the patient to surgery
• B. Implement an inspiratory retard
• C. Replace the chest tube drainage system
• D. Switch to pressure controlled ventilation

Answer: (A)

In a situation where significant bubbling is observed in the water-seal chamber of a chest tube drainage system, it is indicative of a potential air leak. The presence of continuous bubbling suggests that air is escaping from the pleural space or from the drainage system itself, which may compromise the effectiveness of the chest tube in re-establishing normal pleural pressure and resolving the patient's condition, such as a pneumothorax.

Recommending a surgical consultation is prudent because, in many cases, extensive air leaks or complications may require surgical intervention. The surgical team can assess the situation and determine if further procedures are necessary to either repair the source of the leak or manage the pleural space more effectively.

Other approaches listed, such as implementing an inspiratory retard, replacing the chest tube drainage system, or switching to pressure-controlled ventilation, may not address the underlying issue of an air leak and could delay necessary intervention. The focus should be on understanding whether the patient requires a surgical resolution to the problem contributing to the significant bubbling, hence prioritizing the surgical consultation is the most appropriate recommendation in this scenario.