Management of Patients with Prolonged Air Leak after Pulmonary Resection with Heimlich Valve

Abstract

Prolonged air leak (PAL) after pulmonary resection is defined as air leak persisting for five or more days. Majority can be managed conservatively using one-way device Heimlich valve (HV) while few may require surgical intervention. Objective: To evaluate safe discharge policy for Prolonged air leak and role of Heimlich valve in its management. Methods: A retrospective study was conducted in the Department of Thoracic surgery at Jinnah Postgraduate Medical Center, Karachi, including patients with PAL following pulmonary resection between the years 2019-2021. Cerfolio Grade IV air leaks were excluded. Results: File records of 467 patients were reviewed; seventy (15%) had PAL. Most common indication for resection was bronchiectasis (n=24; 34.3%); Lobectomy was the most common procedure (31/70; 44.3%) associated with PAL. Grade II (n=38) air leak was most commonly encountered. All grade III patients developed complications (p=0.02), followed by grade II (p=0.07) whereas Grade I had least complications (8/19; p<0.001). Lobectomy patients showed improvement of air leak on HV (p=0.008). Grade I PAL (n=19) discharged on HV had the least frequency of lung collapse (LC) and residual space (RS) (n=8; p=0.006 and n=1; p<0.001) respectively, whereas Grade III (n=13) discharged with HV developed significant number of complications; LC (n=12;92.8%; p=0.03) and RS (n=11; 84.6%; p<0.001). Conclusions: PAL is an important factor complicating resections. Effective preoperative preparation and meticulous resection technique can decrease complications. Nonetheless, not all patients can be discharged on HV. Patients with smaller leaks can be safely sent home on HV whereas larger leaks require management in hospital with some form of intervention.