Management of Air Leaks

AbstractLung air leaks (LALs) due to visceral pleura injury during surgery are a difficult-to-avoid complication in thoracic surgery (TS). Reliable LAL closure is an important patient management issue after TS. We demonstrated both safeties of transplantation of a cultured human autologous dermal fibroblast sheet (DFS) to LALs. From May 2016 to March 2018, five patients who underwent thoracoscopic lung resection met all the inclusion criteria. Skin biopsies were acquired from each patient to source autologous dermal cells for DFS fabrication. During the primary culture, fibroblasts migrated from the dermal tissue pieces and proliferated to form cell monolayers. These fibroblasts were subcultured to confluence. Transplantable DFSs were fabricated from these subcultured fibroblasts that were trypsinized and seeded onto temperature-responsive culture dishes. After 10 days of fabrication culture, intact patient-specific DFS were harvested. DFSs were analyzed for fibroblast cell content and tissue contaminants prior to application. For closing intraoperative LAL, mean number of transplanted autologous DFS per patient was 6 ± 2 sheets. Mean chest drainage duration was 5.0 ± 4.8 days. The two patients with major LAL had a drainage duration of more than 7 days. All patients currently have no LAL recurrence after discharge. DFSs effectively maintain LAL closure via remodeling of the deposited extracellular matrix. The use of autologous DFSs to permanently close air leaks using a patient-derived source is expected to reduce surgical complications during high-risk lung resections.

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Management of Persistent Air Leaks with Intrabronchial Valves

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0037-1603622 ◽

2017 ◽

Vol 66 (07) ◽

pp. 603-606

Author(s):

Andreas Hecker ◽

Konstantin Mayer ◽

Biruta Witte ◽

Matthias Hecker

Keyword(s):

Thoracic Surgery ◽

Minimal Invasive ◽

Therapeutic Approaches ◽

Air Leak ◽

Frequent Complication ◽

Less Invasive ◽

Air Leaks ◽

Prolonged Hospitalization ◽

Highly Effective ◽

Endoscopic Placement

AbstractPersistent air leaks (PALs) are regarded as a frequent complication after thoracic surgery resulting in prolonged hospitalization and increased morbidity. Several more or less invasive therapeutic approaches are available for treatment of PAL with varying degrees of success. The endoscopic placement of one-way intrabronchial valves in the segment(s) in which the air leak has been located offers a highly effective and well-tolerated minimal invasive option for patients with PAL.

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Intrabronchial Valve Treatment for Prolonged Air Leak: Can We Justify the Cost?

Canadian Respiratory Journal ◽

10.1155/2016/2867547 ◽

2016 ◽

Vol 2016 ◽

pp. 1-6 ◽

Cited By ~ 2

Author(s):

Eitan Podgaetz ◽

Felix Zamora ◽

Heidi Gibson ◽

Rafael S. Andrade ◽

Eric Hall ◽

...

Keyword(s):

Individual Patient Data ◽

Cost Effective ◽

Air Leak ◽

Levels Of Care ◽

Air Leaks ◽

Limited Experience ◽

Tube Removal ◽

Prolonged Air Leak ◽

Chest Tube Removal ◽

The Cost

Background.Prolonged air leak is defined as an ongoing air leak for more than 5 days. Intrabronchial valve (IBV) treatment is approved for the treatment of air leaks.Objective.To analyze our experience with IBV and valuate its cost-effectiveness.Methods.Retrospective analysis of IBV from June 2013 to October 2014. We analyzed direct costs based on hospital and operating room charges. We used average costs in US dollars for the analysis not individual patient data.Results.We treated 13 patients (9 M/4 F), median age of 60 years (38 to 90). Median time from diagnosis to IBV placement was 9.8 days, time from IBV placement to chest tube removal was 3 days, and time from IBV placement to hospital discharge was 4 days. Average room and board costs were $14,605 including all levels of care. IBV cost is $2750 per valve. The average number of valves used was 4. Total cost of procedure, valves, and hospital stay until discharge was $13,900.Conclusion.In our limited experience, the use of IBV to treat prolonged air leaks is safe and appears cost-effective. In pure financial terms, the cost seems justified for any air leak predicted to last greater than 8 days.

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Pneumomediastinum in the Neonate

Neonatal Network The Journal of Neonatal Nursing ◽

10.1891/0730-0832.33.5.275 ◽

2014 ◽

Vol 33 (5) ◽

pp. 275-282 ◽

Cited By ~ 1

Author(s):

Kristi J. Cagle ◽

Carol Trotter

Keyword(s):

Air Leak ◽

Air Leaks ◽

Radiologic Findings ◽

Free Air

A pneumomediastinum is an air leak in which the free air is concentrated in the mediastinum. Although most neonatal pneumomediastinums do not require intervention, complications such as subsequent air leaks can arise. Proper radiologic identification, as well as an understanding of the anatomy and pathophysiology associated with a pneumomediastinum, are necessary for an accurate understanding and diagnosis. This article will review the interpretation of radiologic findings in a neonate with a pneumomediastinum.

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