Special Situations: Air Leak After Lung Volume Reduction Surgery and in Ventilated Patients

Nicotera, Saila P.; DeCamp, Malcom McAvoy

doi:10.1016/j.thorsurg.2010.04.003

Cited by 2 publications

(1 citation statement)

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“…[30][31][32]. This choice could be an attractive option for ventilated patients in intensive care and for patients with severe secondary SP [33].…”

Section: Classification and Treatmentmentioning

confidence: 99%

Controversies in Pneumothorax Treatment

Amer¹

2019

Pneumothorax

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Surgical intervention either by video-assisted thoracoscopic surgery (VATS) or open procedure proved its worth in reducing the incidence of recurrence in pneumothorax. However, many controversies surround the management of this common medical condition. Despite advances in knowledge and technology, chest physicians and surgeons could not be more divisive about the management of pneumothorax. There are no two thoracic surgical centres and possibly no two surgeons within the same hospital that agree on the management of the different aspects of pneumothorax. The variability in reported outcomes and the paucity of published multicentre randomised controlled trials (RCT) highlight the need for further studies investigating the best options for pneumostasis and pleurodesis. This chapter aims at discussing some of these controversies and reviews the literature at its current state of evidence.2 their statement that "although thoracic surgeons are the best trained physicians to manage chest tubes and pleural problems, they often do not speak the same language or recommend similar treatment algorithms even to each other" [5]. The physiology of respiration and pneumothoraxThe pressure in the pleural space is determined by the difference between the lung elastic recoil and volume changes of the semi-rigid chest wall. The rib cage moves in three dimensions; the girdle handle movement of the ribs increases the anteroposterior and the lateral dimensions of the chest, whereas the piston-pump movement of the diaphragm leads to an increase in the vertical dimension of the chest cavity. The chest and diaphragm movements create a physiological negative pressure within the pleural space that forces the lung to change shape and volume with the respiratory cycle, resulting in inflation and deflation. Neutralising this negative pressure in the pleural space leads to lung collapse, as the elastic structure of the lung favours its collapse (recoil). Pneumothorax or air in the pleural space invariably leads to lung collapse. A thin film of fluid exists between the parietal and visceral pleurae to lubricate the sliding of these two structures, roughly 15 mls in a 70 kg adult person. The fluid is a microvascular filtrate produced by the parietal pleura and is cleared also by the parietal pleural lymphatics, a process similar to that in any other body organ.

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“…[30][31][32]. This choice could be an attractive option for ventilated patients in intensive care and for patients with severe secondary SP [33].…”

Section: Classification and Treatmentmentioning

confidence: 99%