Optimal management of postoperative parenchymal air leaks

Abstract

Post-lung resection air leaks remain one of the most common complications resulting in delay of hospital discharge (1). They result from an alveolar-pleural fistula, and in most instances, will heal spontaneously. Prolonged air leaks (PAL) have been defined as lasting more than 5 days after surgery (2). Despite multiple advances in lung resection, including the use of stapling devices, sealants and approaches without fissure dissection, thoracic surgeons continue to be plagued by air leaks. Over 50% of patients undergoing lung resection will have an air leak within the first 24 hours after surgery (2-4) and up to 15% of patients will have a PAL (5). Enhanced recovery after surgery (ERAS) programs must be designed to deal with air leaks in a systemic, evidencebased manner. Management of air leaks spans from the preoperative assessment to predict patients at high risk of PAL, intraoperative maneuvers to prevent parenchymal air leaks and postoperative management to reduce the duration of an air leak. This manuscript will focus on the two components of postoperative management of PAL: (I) accurate assessment of the air leak, and (II) management of a true alveolar-pleural fistula. Air leak assessment The accurate measurement of an air leak following lung resection has come to the forefront of ERAS programs. Traditional analogue devices only allow for a subjective static assessment of air leaks. Digital devices have allowed more objective measurements of air leaks by measuring

Allogenic blood patch pleurodesis for continuous pneumothorax in three cats

“…BPP has been described in humans 6 – 10 , 18 , 19 , 24 and dogs, 12 , 13 with some investigative research in rats and rabbits. 22 , 25 Human indications for BPP include continuous pneumothorax secondary to lung resection and in primary and secondary spontaneous pneumothorax.…”

“…6 – 8 , 10 , 11 , 14 , 15 , 17 , 19 Continuous pneumothorax is defined in human medicine as extending beyond 5–7 days. 17 , 18 , 27 A cut-off point of 5 days has been widely advocated in the past but is identified as arbitrary. 27 In veterinary medicine, BPP has been reported for traumatic, primary and secondary spontaneous pneumothorax in eight dogs whose continuous pneumothorax did not respond to two or more days of conservative management.…”

“…More recently, the use of blood patch pleurodesis (BPP) for continuous pneumothorax has been reported in humans and dogs. [6][7][8][9][10][11][12][13][14][15][16][17][18][19] Pleurodesis involves inciting adhesions between the parietal and visceral pulmonary pleura. Several methods of pleurodesis, including mechanical abrasion and intrathoracic delivery of pleurodesing agents such as talc and tetracyclines, have been attempted in dogs and experimental animals with disappointing results.…”

“…More recently, the use of blood patch pleurodesis (BPP) for continuous pneumothorax has been reported in humans and dogs. 6 – 19 …”

“…BPP is an alternative method to previously reported pleurodesis techniques and involves delivery of fresh whole blood into the pleural space. It is a simple, painless and inexpensive treatment, with reported success in humans 6 – 11 , 14 , 17 – 19 , 24 and dogs, 12 , 13 that warrants investigation in cats.…”