The pressure-dependent air leak after partial lung resection

Chopra, Amit; Doelken, Peter; Judson, Marc A.; Huggins, Terrill

doi:10.1136/thoraxjnl-2016-208884

Cited by 12 publications

(4 citation statements)

References 5 publications

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“…Subsequently, the drainage tube was removed after a clamping test, and intrapleural pressure manometry confirmed a pressure-dependent air leak. The patient was followed up for a year after discharge and repeated chest X-ray examinations showed stable localized pneumothorax [ 18 ]. Walker et al suggested that pressure-dependent air leaks with continuous chest drainage may be exacerbated by an increased pressure gradient between the site of air leak in lung tissue and the pleural cavity [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

Chest tube removal at different gas flows in prolonged air leak: a randomized non-inferiority trial

Li,

Yang,

Cai

et al. 2024

European Journal of Cardio-Thoracic Surgery

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OBJECTIVES To evaluate the safety and feasibility of removing drainage tubes at larger size of air leak in patients with prolonged air leak (PAL) after pulmonary surgery. METHODS Ninety-five patients who underwent pulmonary surgery with PAL in our center were enrolled in this randomized controlled, single-center, non-inferiority study. The drainage tube was clamped with a stable size of air leak observed over the last 6 hours, which was quantified by gas flow rate using the digital drainage system. The control group(n = 48) and the study group(n = 46) had their drainage tube clamped at 0-20ml/min and 60-80ml/min, respectively. We continuously monitored clinical symptoms, conducted imaging and laboratory examinations, and decided whether to reopen the drainage tube. RESULTS The reopening rate in the study group was not lower than that in the control group (2.08% vs 6.52%, p > 0.05). The absolute difference in reopening rate was 4.44% [95% confidence interval (95% CI) -0.038, 0.126], with an upper limit of 12.6% below the non-inferiority margin (15%). There were significant differences in the length of stay [16.5 (13, 24.75) vs 13.5 (12, 19.25), p = 0.017] and the duration of drainage [12 (9.25, 18.50) vs 10 (8, 12.25), p = 0.007] between the control and study groups. No notable differences were observed in chest X-ray results 14 days after discharge or in the readmission rate. CONCLUSIONS For patients with PAL, removing drainage tubes at larger size of air leak demonstrated similar safety compared to smaller size of air leak, and can shorten both length of stay and drainage duration.

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Section: Discussionmentioning

confidence: 99%

Chest tube removal at different gas flows in prolonged air leak: a randomized non-inferiority trial

Li,

Yang,

Cai

et al. 2024

European Journal of Cardio-Thoracic Surgery

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“…Both inspiratory and expiratory P pl were significantly lower in patients with complete pneumothorax resolution within 1 week of drainage than in patients who required longer treatment. A different study reported a potential role of pleural manometry for the identification of pressure-dependent pneumothorax after partial lung resection [47]. A similar diagnostic method for pneumothorax ex vacuo with the use of pleural manometry was proposed by Tan et al [48].…”

Section: Pleural Manometry In Pneumothoraxmentioning

confidence: 97%

Pleural Manometry—Basics for Clinical Practice

Faber

Krenke

2021

Curr Pulmonol Rep

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Purpose of Review The aim of this paper is to present basic data on pleural manometry and to outline the advances in its use as both a research tool enabling a better understanding of pleural pathophysiology and as a clinical tool useful in management strategy planning in patients with pleural diseases. To discuss updates and current trends in the development of pleural manometry, a search of the literature on pleural manometry published in recent years was performed. Recent Findings The technique of pleural manometry has significantly evolved over the last 40 years from simple water manometers to electronic or digital devices which enable the measurement and recording of instantaneous pleural pressure. Although to date it is mainly used as a research tool, pleural manometry has the potential to be applied in clinical practice. Recent studies demonstrated that monitoring of pleural pressure changes during therapeutic thoracentesis does not seem to be helpful in predicting re-expansion pulmonary edema and procedure-related chest discomfort. On the other hand, measurement of pleural elastance plays an important role in the diagnosis of unexpandable lung in patients with malignant pleural effusion facilitating determination of the optimal management strategy. Additionally, it allows for study of newly discovered phenomena, including pleural pressure pulse assessment and the impact of continuous positive airway pressure and cough on pleural pressure. Summary Pleural manometry is an established technique of pleural pressure measurement. Despite recent advances, its role in clinical practice remains undetermined.

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“…In 2017, Chopra et al described the concept of a pressure-dependent air leak after using pleural manometry to assess intra-pleural pressure during cough in a patient with PAL postlung resection. 16 Chopra et al found that even following spikes in intrapleural pressure with cough when the drain is clamped, the intrapleural pressure rapidly returned to baseline, suggesting the leak exists purely to equalize pleural and alveolar pressure. A subsequent observational study of 22 patients with PAL postlung resection found that 80% of these patients had a drainage-dependent air leak and all bar one were able to have their drains removed with resolution of their pneumothorax and without the need for further intervention.…”

Section: Controversies Of Etiology and Pathogenesismentioning

confidence: 99%

Expert Review on Spontaneous Pneumothorax: Advances, Controversies, and New Directions

Barton

Maskell

Walker

2023

Semin Respir Crit Care Med

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For decades, there has been scanty evidence, most of which is of poor quality, to guide clinicians in the assessment and management of pneumothorax. A recent surge in pneumothorax research has begun to address controversies surrounding the topic and change the face of pneumothorax management. In this article, we review controversies concerning the etiology, pathogenesis, and classification of pneumothorax, and discuss recent advances in its management, including conservative and ambulatory management. We review the evidence base for the challenges of managing pneumothorax, including persistent air leak, and suggest new directions for future research that can help provide patient-centered, evidence-based management for this challenging cohort of patients.

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The pressure-dependent air leak after partial lung resection

Cited by 12 publications

References 5 publications

Chest tube removal at different gas flows in prolonged air leak: a randomized non-inferiority trial

Chest tube removal at different gas flows in prolonged air leak: a randomized non-inferiority trial

Pleural Manometry—Basics for Clinical Practice

Expert Review on Spontaneous Pneumothorax: Advances, Controversies, and New Directions

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