scholarly journals Successful use of endobronchial valve for persistent air leak in a patient with COVID-19 and bullous emphysema

2021 ◽  
Vol 14 (11) ◽  
pp. e246671
Author(s):  
Biplab K Saha ◽  
Alyssa Bonnier ◽  
Woon Hean Chong ◽  
Praveen Chenna
Keyword(s):  
Chest Pain ◽  
Lung Disease ◽  
Chest Tube ◽  
Complete Resolution ◽  
Shortness Of Breath ◽  
Air Leak ◽  
Management Guideline ◽  
Standard Management ◽  
Endobronchial Valve ◽  
Persistent Air Leak

Patients with SARS-CoV-2 pneumonia can suffer from pneumothorax and persistent air leak (PAL). The pneumothorax occurs with or without pre-existing lung disease. PAL refers to air leak lasting more than 5–7 days and arises due to bronchopleural or alveolopleural fistula. The management of PAL can be challenging as a standard management guideline is lacking. Here we present the case of a 42-year-old smoker with COVID-19 who presented to the hospital with fever, cough, acute left-sided chest pain and shortness of breath. He suffered from a large left-sided pneumothorax requiring immediate chest tube drainage. Unfortunately, the air leak persisted for 13 days before one-way endobronchial valve (EBV) was used with complete resolution of the air leak. We also review the literature regarding other cases of EBV utilisation for PAL in patients with COVID-19.

scholarly journals 1103: BRONCHOPLEURAL FISTULA WITH PERSISTENT AIR LEAK NECESSITATING ENDOBRONCHIAL VALVE PLACEMENT

2021 ◽  
Vol 50 (1) ◽  
pp. 550-550
Author(s):  
Zachary Estep ◽  
Farwa Ilyas ◽  
Raji Jasty ◽  
Frantz Hastrup
Keyword(s):  
Bronchopleural Fistula ◽  
Air Leak ◽  
Endobronchial Valve ◽  
Valve Placement ◽  
Persistent Air Leak

scholarly journals Determine the Clinical Presentation and Outcomes of Thoracostomy in Children with Complicated Pneumonia

2021 ◽  
Vol 15 (6) ◽  
pp. 1463-1465
Author(s):  
S. U. Rehman ◽  
S. Khan ◽  
M. Anwar ◽  
A. Rafique ◽  
Z. I. Bhatti ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Chest Pain ◽  
Chest Tube ◽  
Clinical Presentation ◽  
Causative Factor ◽  
Paediatric Surgery ◽  
Shortness Of Breath ◽  
Effective Treatment Modality ◽  
The Common ◽  
Complicated Pneumonia

Objective: To examine the clinical presentation and outcomes of thoracostomy in patients presented with complicated pneumonia. Study Design: Descriptive/Observational Place and Duration of Study: Department of Paediatric Surgery, DHQ Teaching Hospital Sahiwal from 1st January 2019 to 31st December 2020. Methodology: Fifty patients of both genders with ages 0 to 12 years presented with complicated pneumonia were included. All the patients received chest tube intubation. Outcomes of thoracostomy were examined. Radiological examination was done. Results: Thirty eight (76%) patients were males while 24% were females. Majority of patients 64% were ages less than 5 years. Fever, cough, shortness of breath and chest pain were the common symptoms. Staphylococcus aureus was the most common causative factor found in 56% cases followed by streptococcus in 24% cases. 84% cases were successfully removed chest tube. Recollection found in 8% cases, pneumothorax found in 4% patients and 4% patients had pneumatocele. Conclusion: Chest tube intubation was the safe and effective treatment modality for complicated pneumonia with fewer rates of complications. Keywords: Complicated pneumonia, Thoracostomy, Empyema, Pneumothorax, Outcomes

Endobronchial Valve Management of a Persistent Air Leak Complicating Bullous Emphysema

CHEST Journal ◽  
2012 ◽  
Vol 142 (4) ◽  
pp. 897A
Author(s):  
Philip Svigals ◽  
Luca Paoletti ◽  
Nicholas Pastis ◽  
John Huggins
Keyword(s):  
Air Leak ◽  
Endobronchial Valve ◽  
Persistent Air Leak

Digital Devices Improve Chest Tube Management: Results from a Prospective Randomized Trial

2017 ◽  
Vol 66 (07) ◽  
pp. 595-602 ◽  
Author(s):  
Filippo Lococo ◽  
Dania Nachira ◽  
Leonardo Ciavarella ◽  
Maria Congedo ◽  
Venanzio Porziella ◽  
...  
Keyword(s):  
Randomized Trial ◽  
Roc Curve ◽  
Chest Tube ◽  
Prospective Randomized Trial ◽  
Chest Drain ◽  
Air Leak ◽  
Digital Devices ◽  
Prolonged Air Leak ◽  
Group D ◽  
Persistent Air Leak

Background Digital devices could help clinical practice measuring the air leak, but their role is still debated. Aim of this study is to test advantages using these devices. Methods From June 2012 to May 2015, we enrolled 95 patients undergoing lobectomy or wedge resection in a prospective randomized trial. Patients were divided into two groups: group D (digital, 50 patients) evaluated with digital device and group E (empirical, 45 patients) evaluated with water seal. Logistic regression analysis and receiver operating characteristic (ROC) curve analysis were used to select and assess predictors of persistent air leak. In group D, chest drain was removed if the air leak was absent or < 0.5 L/h for 12 consecutive hours and in group E if clinical signs of air leak were absent. Results Mean hospitalization and mean chest tube stay was 6.0 ± 3.3 and 4.4 ± 3.2 days, respectively, prolonged air leak occurred in nine (8%). Hospitalization was 5.8 ± 2.5 versus 6.2 ± 4.2 days (p = 0.5), while mean chest tube stay was 4.1 ± 2.0 versus 4.6 ± 3.5 days (p = 0.4) in group D and group E, respectively. Clamping test was needed in one patient in group D and in seven in group E (p = 0.019). At multivariate analysis, heart disease (p < 0.0001), lobectomy (p < 0.0001), fused fissure (p < 0.0001), and air leakage in first postoperative (p.o.) day were predictors of persistent air leak (AUC on the ROC curve of 69.7%, sensibility: 77.8%). In group D, an air leak value > 0.2 L/h with spikes over 0.5 L/h in third p.o. was predictive of persistent air leak, with chest tube duration of 7.73 ± 5.20 versus 4.32 ± 1.33 days (AUC: 83%, sensitivity: 80%, p < 0.0001). Conclusion In our experience, digital devices reduced observer variability and mistakes in chest tube management, thus identifying patients at risk for prolonged air leak.

scholarly journals Efficacy of Intraoperative Hypertonic Glucose Solution Administration on Persistent Air Leak After Extended Pleurectomy/Decortication for Malignant Pleural Mesothelioma: A Retrospective Case–Control Study

2021 ◽  
Vol 11 ◽  
Author(s):  
Alberto Testori ◽  
Gianluca Perroni ◽  
Marco Alloisio ◽  
Emanuele Voulaz ◽  
Veronica Maria Giudici ◽  
...  
Keyword(s):  
Hospital Discharge ◽  
Malignant Pleural Mesothelioma ◽  
Chest Tube ◽  
Glucose Solution ◽  
Control Group ◽  
Pleural Mesothelioma ◽  
Air Leak ◽  
Retrospective Case ◽  
Hypertonic Glucose ◽  
Persistent Air Leak

BackgroundPersistent air leak is a common complication occurring from 6% to 23% of cases after extended pleurectomy/decortication for malignant pleural mesothelioma. Treatment options for this complication after major lung resection are well documented in literature; nevertheless, lines of evidence in extended pleurectomy/decortication for malignant pleural mesothelioma are absent. The aim of the study is to evaluate the efficacy of intraoperative administration of 50% hypertonic glucose solution in reducing duration of air leak following extended pleurectomy/decortication for malignant pleural mesothelioma.Materials and MethodsIn this retrospective case–control study, we analyzed our electronic health record and selected those patients with a histological diagnosis of malignant pleural mesothelioma who underwent extended pleurectomy/decortication in the period 2013–2021. From 2018, we introduced a lavage with 500 ml of glucose solution at 50% concentration into the chest cavity at the end of the surgical procedure. Patients operated before 2018 were used as the control group. Postoperative glycemia was measured, and patients were followed after hospital discharge until the air leak resolved and the chest tube was removed. Statistical analysis was performed using R software.ResultsA total of 71 patients met our criteria. Treatment and control groups were similar for age, sex, smoking status, number of comorbidities, tumor histotype, and side of disease. Use of hypertonic glucose solution resulted in shorter chest tube maintenance after hospital discharge (p = 0.0028). A statistically significant difference (p = 0.02) was also found in postoperative glycemia between the treatment (103 g/dl ± 8.9) and control group (98.8 g/dl ± 8.6). Days of hospitalization and chest tube maintenance during hospitalization did not significantly differ between the groups.InterpretationIntraoperative administration of 50% hypertonic glucose solution reduced the duration of air leak after hospital discharge. An increase in postoperative glycemia was found in the treatment group, but with no clinical effect. Hypertonic glucose solution is an effective and safe method to manage persistent air leak after extended pleurectomy/decortication for malignant pleural mesothelioma.

scholarly journals Suction Versus Nonsuction Drainage After Uniportal Video-Assisted Thoracoscopic Surgery: A Propensity Score-Matched Study

2021 ◽  
Vol 11 ◽  
Author(s):  
Jian Zhou ◽  
Chuan Li ◽  
Quan Zheng ◽  
Chenglin Guo ◽  
Mengyuan Lyu ◽  
...  
Keyword(s):  
Propensity Score ◽  
Chest Tube ◽  
Thoracoscopic Surgery ◽  
Air Leak ◽  
Chest Drainage ◽  
Video Assisted ◽  
Matched Study ◽  
Water Seal ◽  
Persistent Air Leak ◽  
Video Assisted Thoracoscopic Surgery

BackgroundUniportal video-assisted thoracoscopic surgery (UniVATS) was utilized with a rapid growth. The evidence is sparse, however, on whether to add external suction to water-seal drainage for chest drainage after UniVATS. This retrospective propensity score-matched study aimed to identify the necessity of adding external suction to chest drainage after UniVATS.MethodsPatients with lung cancer who underwent UniVATS were included from our prospectively maintained database. Patients were divided into two cohorts based on the addition of external suction to postoperative water-seal drainage or not. Propensity score-matched analysis was performed to identify the impact of suction on chest tube duration, incidence of persistent air leak, hospital stay, and hospitalization cost. Multivariable model with interaction terms was constructed to identify impact of covariables on effect of suction.ResultsThe two cohorts matched well on baseline characteristics (nonsuction: 173; suction: 96). Compared with nonsuction group, suction group showed longer median chest tube duration (3 vs. 2 days, p = 0.003), higher incidences of persistent air leak (9.4% vs. 1.2%, p = 0.003), persistent drainage (16.8% vs. 5.8%, p = 0.007), and reduced drainage volume within first 3 postoperative days (386.90 vs. 504.78 ml, p = 0.011). Resection extent was identified to mediate the relationship between suction and chest tube drainage.ConclusionsThese findings discouraged adding external suction to water-seal drainage after UniVATS regarding longer chest tube duration and more persistent air leak. Patients undergoing lobectomy would benefit more from water-seal drainage without external suction compared with those doing sublobectomy.

scholarly journals Bronchopleural Fistula as a Complication in a COVID-19 Patient Managed With Endobronchial Valves

2021 ◽  
Vol 9 ◽  
pp. 232470962110132
Author(s):  
Andrew Talon ◽  
Muhammad Zohab Arif ◽  
Hesham Mohamed ◽  
Abid Khokar ◽  
Ali Imran Saeed
Keyword(s):  
Severe Acute Respiratory Syndrome ◽  
Medical Literature ◽  
Bronchopleural Fistula ◽  
Middle Lobe ◽  
High Morbidity ◽  
Air Leak ◽  
Endobronchial Valve ◽  
Right Middle Lobe ◽  
The Right ◽  
Persistent Air Leak

Bronchopleural fistula (BPF) is associated with high morbidity if left untreated. Although rare, the frequency of BPF in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is becoming recognized in medical literature. We present a case of a 64-year-old male with BPF with persistent air leak due to SARS-CoV-2 pneumonia treated with Spiration Valve System endobronchial valve (EBV). An EBV was placed in the right middle lobe with successful cessation of air leak. In conclusion, the use of EBVs for BPF with persistent air leaks in SARS-CoV-2 patients who are poor surgical candidates is effective and safe.

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