Assessment of pleural air leakage using digital chest drainage system after surgical pulmonary resection: Comparison of visible alveolar air leakage with the digital value measured by a digital chest drainage system

Mori, Ryo; Yamazaki, Koji; Fukushima, Shoji; Kouso, Hidenori; Ushijima, Chie; Miura, Naruhisa; Takenaka, Tomoyoshi; Takeo, Sadanori

doi:10.1371/journal.pone.0187705

Cited by 3 publications

(1 citation statement)

References 17 publications

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“…In vivo models do not permit direct observation of air leaks or the isolation of leak sites under negative pressure (closed chest) conditions. Though new digital chest tube devices enable the quantification of air leaks, the collection and quantification of site-specific air leaks are not possible in such models 15–17. Further, ventilation parameters under negative pressure are difficult to monitor or control.…”

Section: Introductionmentioning

confidence: 99%

Preclinical quantification of air leaks in a physiologic lung model: effects of ventilation modality and staple design

Eckert¹,

Harris²,

Wong³

et al. 2018

MDER

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PurposeThoracic air leaks are a common complication following pulmonary resections. Limitations in clinical studies and preclinical models have hindered efforts to understand the pathophysiology of air leaks. With an emphasis on staple-line specific air leaks, we hypothesize that ventilation modality – intraoperative positive pressure vs postoperative negative pressure – and stapler design may play a role in air leaks.MethodsUsing a novel physiologic lung model, air leaks associated with graduated and uniform staple designs were evaluated under positive and negative pressure ventilation, simulating perioperative breathing in porcine lungs. Air leak incidence, air leak volume, and air leak rate were captured along with ventilation pressure and tidal volume.ResultsIn all cases, negative pressure ventilation was associated with a higher occurrence of leaks when compared to positive pressure ventilation. Lungs leaked more air and at a faster rate under negative pressure ventilation compared to positive pressure ventilation. Graduated staple designs were associated with higher occurrence of leaks as well as larger leak rates when compared to uniform staples. Tissue thickness was not associated with differences in air leaks when tested with appropriate staple heights.ConclusionUsing a novel lung model to investigate the pathophysiology of air leaks, we have identified breathing modality and staple design as two important variables that may impact air leaks. This work will help guide device design and drive future studies in human tissue, and it may help inform clinical practice to ultimately improve patient outcomes.

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Section: Introductionmentioning

confidence: 99%

Preclinical quantification of air leaks in a physiologic lung model: effects of ventilation modality and staple design

Eckert¹,

Harris²,

Wong³

et al. 2018

MDER

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Bronchopleural Fistula in the Mechanically Ventilated Patient: A Concise Review

Grotberg

Hyzy

Cardenas

et al. 2020

Critical Care Medicine

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Objective: To describe the physiology of air leak in bronchopleural fistula in mechanically ventilated patients and how understanding of its physiology drives management of positive-pressure ventilation. To provide guidance of lung isolation, mechanical ventilator, pleural catheter, and endobronchial strategies for the management of bronchopleural fistula on mechanical ventilation. Data Sources: Online search of PubMed and manual review of articles (laboratory and patient studies) was performed. Study Selection: Articles relevant to bronchopleural fistula, mechanical ventilation in patients with bronchopleural fistula, independent lung ventilation, high-flow ventilatory modes, physiology of persistent air leak, extracorporeal membrane oxygenation, fluid dynamics of bronchopleural fistula airflow, and intrapleural catheter management were selected. Randomized trials, observational studies, case reports, and physiologic studies were included. Data Extraction: Data from selected studies were qualitatively evaluated for this review. We included data illustrating the physiology of driving pressure across a bronchopleural fistula as well as data, largely from case reports, demonstrating management and outcomes with various ventilator modes, intrapleural catheter techniques, endoscopic placement of occlusion and valve devices, and extracorporeal membrane oxygenation. Themes related to managing persistent air leak with mechanical ventilation were reviewed and extracted. Data Synthesis: In case reports that demonstrate different approaches to managing patients with bronchopleural fistula requiring mechanical ventilation, common themes emerge. Strategies aimed at decreasing peak inspiratory pressure, using lower tidal volumes, lowering positive end-expiratory pressure, decreasing the inspiratory time, and decreasing the respiratory rate, while minimizing negative intrapleural pressure decreases airflow across the bronchopleural fistula. Conclusions: Mechanical ventilation and intrapleural catheter management must be individualized and aimed at reducing air leak. Clinicians should emphasize reducing peak inspiratory pressures, reducing positive end-expiratory pressure, and limiting negative intrapleural pressure. In refractory cases, clinicians can consider lung isolation, independent lung ventilation, or extracorporeal membrane oxygenation in appropriate patients as well as definitive management with advanced bronchoscopic placement of valves or occlusion devices.

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Use of a Digital Air Leak Detection Device to Decrease Chest Tube Duration

Patel,

Ruppert,

Cao

et al. 2023

Critical Care Nurse

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Background The aim of this evidence-based practice project was to determine if a digital air leak detection device could speed the identification of chest tube air leak cessation in patients after pulmonary lobectomy. Staff members assessing air leaks have varying levels of expertise, and the digital device is a limited resource in the study institution. A chest tube management algorithm is necessary to standardize care and determine which patients are most likely to benefit. Implementation Twenty-five consecutive patients who underwent pulmonary lobectomy during the study period and continued to have a chest tube air leak on postoperative day 3 were monitored with digital air leak detection devices. The Mann-Whitney U test was used to compare chest tube duration and hospital length of stay between patients with digital devices and 259 patients who had traditional analog air leak detection devices (historical data from the departmental database over the previous 2 years). Evaluation Median chest tube duration and hospital stay were 1 day less in patients with digital devices than in those with traditional analog devices (P = .01 and P = .004, respectively), with a cost savings of $2659 per hospital day. Reductions in chest tube duration and length of stay aided in the development of a chest tube management algorithm. Conclusions Critical care nurses are valued team members who treat patients after lung resections. Digital air leak detection devices can help them assess air leaks more accurately, benefiting the patients in their care.

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Assessment of pleural air leakage using digital chest drainage system after surgical pulmonary resection: Comparison of visible alveolar air leakage with the digital value measured by a digital chest drainage system

Cited by 3 publications

References 17 publications

Preclinical quantification of air leaks in a physiologic lung model: effects of ventilation modality and staple design

Preclinical quantification of air leaks in a physiologic lung model: effects of ventilation modality and staple design

Bronchopleural Fistula in the Mechanically Ventilated Patient: A Concise Review

Use of a Digital Air Leak Detection Device to Decrease Chest Tube Duration

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