Intraoperative ventilatory leak predicts prolonged air leak after lung resection: A retrospective observational study

Abstract

Prolonged air leak (PAL), defined as air leak more than 5 days after lung resection, has been associated with various adverse outcomes. However, studies on intraoperative risk factors for PAL are not sufficient. We investigated whether the intraoperative ventilatory leak (VL) can predict PAL. A retrospective study of 1060 patients with chest tubes after lung resection was conducted. Tidal volume data were retrieved from the electronic anesthesia records. Ventilatory leak (%) was calculated as [(inspiratory tidal volume—expiratory tidal volume)/ inspiratory tidal volume × 100] and was measured after restart of two-lung ventilation. Cox proportional hazards regression analysis was performed using VL as a predictor, and PAL as the dependent outcome. The odds ratio of the VL was then adjusted by adding possible risk factors including patient characteristics, pulmonary function and surgical factors. The incidence of PAL was 18.7%. VL >9.5% was a significant predictor of PAL in univariable analysis. VL remained significant as a predictor of PAL (1.59, 95% CI, 1.37–1.85, P <0.001) after adjusting for 7 additional risk factors including male gender, age >60 years, body mass index <21.5 kg/m2, forced expiratory volume in 1 sec <80%, thoracotomy, major lung resection, and one-lung ventilation time >2.1 hours. C-statistic of the prediction model was 0.80 (95% CI, 0.77–0.82). In conclusion, VL was a quantitative measure of intraoperative air leakage and an independent predictor of postoperative PAL. Monitoring VL during lung resection may be uselful in recommending additional surgical repair or use of adjuncts and thus, help reduce postoperative PAL.

Risk factors associated with prolonged air leak after video-assisted thoracic surgery pulmonary resection: a predictive model and meta-analysis

“…Prolonged air leak (PAL) is a condition where air escapes from the lung parenchyma into the pleural space for more than 5 days after lung surgery (1). PALs are considered to be the most common postoperative complication of the lung surgery with an incidence of 6-26% (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17). Previous studies have found that PAL is associated with other pulmonary complications such as atelectasis and pneumonia, which often translate into longer hospital stays and more hospitalization costs (18,19).…”

Intraoperative ventilatory leak: Real‐time guidance for management of air leak in lung cancer patients undergoing VATS lobectomy

“…5,[19][20][21][22][23] However, redistribution from the suture lines has also been hypothesized to cause tears in the visceral pleura in areas distant from the suture. Surgical adjuncts have been employed for PAL prevention, such as suture line reinforcement, pleural tenting, mechanical pleurodesis, pneumoperitoneum, [23][24][25][26][27][28] and biological and synthetic sealants are increasingly common methods for PAL prevention. 29,30 Our method for accurately quantifying air leaks intraoperatively uses the flowmeter attached to modern anesthesia machines without interrupting mechanical ventilation.…”

Evaluating and developing sealants for the prevention of pulmonary air leakage: A systematic review of animal models

“…54 In other studies, intraoperative PAL >500 ml/min or >9.5% of the inspiratory tidal volume have been found to be predictive of pPAL. 55,56 Similar classification might also apply to larger animals such as sheep and pigs. Classifications of air leakage that are specified or validated for animal species are not available and should be developed further.…”