scholarly journals Measurement of intrapleural pressure in patients with spontaneous pneumothorax: a pilot study

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Hiroyuki Kaneda ◽  
Takahito Nakano ◽  
Tomohiro Murakawa
Keyword(s):  
Clinical Study ◽  
Spontaneous Pneumothorax ◽  
Clinical Impact ◽  
Air Leak ◽  
Chest Drainage ◽  
Initial Management ◽  
Intrapleural Pressure ◽  
Mean Pressure ◽  
The Mean ◽  
Persistent Air Leak

Abstract Background The initial management of pneumothorax remains controversial, and we speculated that this might be because there is no method available for evaluation of air leak during initial management. We have developed a system for measurement of intrapleural pressure in pneumothorax to address air leak without the need for chest drainage. The aim of this clinical study was to confirm the ability of this measurement system and to determine the clinical impact of management of air leak. Methods Patients in whom need aspiration was indicated for spontaneous pneumothorax were enrolled in the study. The intrapleural pressure was measured during stable breathing and data recorded when patients were coughing were excluded. Results Eleven patients were enrolled in the study between December 2016 to July 2017. The patterns in change of intrapleural pressure varied widely depending on the state of the pneumothorax. The mean intrapleural pressure values on end-inspiration and end-expiration in patients with persistent air leak was significantly lower than those in patients without persistent air leak (p = 0.020). The number of negative mean pressure recordings in end-inspiration and end-expiration was significantly lower in patients with persistent air leak than in those without persistent air leak (p = 0.0060). Conclusions In this study, we demonstrated that intrapleural pressure could be successfully measured and visualized in patients with pneumothorax. Whether or not the pressure value is a predictor of persistent air leak needs to be confirmed in the future.

Management des Spontanpneumothorax: Die Therapieentscheidung mit digitaler pleuraler Manometrie beeinflussen

2020 ◽  
Vol 8 (3) ◽  
pp. 150-151
Author(s):  
Stefanie Keymel
Keyword(s):  
Clinical Study ◽  
Spontaneous Pneumothorax ◽  
Clinical Impact ◽  
Air Leak ◽  
Chest Drainage ◽  
Initial Management ◽  
Intrapleural Pressure ◽  
Mean Pressure ◽  
The Mean ◽  
Persistent Air Leak

Background: The initial management of pneumothorax remains controversial, and we speculated that this might be because there is no method available for evaluation of air leak during initial management. We have developed a system for measurement of intrapleural pressure in pneumothorax to address air leak without the need for chest drainage. The aim of this clinical study was to confirm the ability of this measurement system and to determine the clinical impact of management of air leak. Methods: Patients in whom need aspiration was indicated for spontaneous pneumothorax were enrolled in the study. The intrapleural pressure was measured during stable breathing and data recorded when patients were coughing were excluded. Results: Eleven patients were enrolled in the study between December 2016 to July 2017. The patterns in change of intrapleural pressure varied widely depending on the state of the pneumothorax. The mean intrapleural pressure values on end-inspiration and end-expiration in patients with persistent air leak was significantly lower than those in patients without persistent air leak (p = 0.020). The number of negative mean pressure recordings in endinspiration and end-expiration was significantly lower in patients with persistent air leak than in those without persistent air leak (p = 0.0060). Conclusions: In this study, we demonstrated that intrapleural pressure could be successfully measured and visualized in patients with pneumothorax. Whether or not the pressure value is a predictor of persistent air leak needs to be confirmed in the future.

Impact of Treatment on Cessation of Air Leakage and Recurrence of Spontaneous Pneumothorax: A Case Control Study

2021 ◽  
Author(s):  
Takahito Nakano ◽  
Hiroyuki Kaneda ◽  
Kento Fukumoto ◽  
Hiroshi Matsui ◽  
Yohei Taniguchi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Multivariate Analysis ◽  
Initial Treatment ◽  
Spontaneous Pneumothorax ◽  
Significant Risk ◽  
Lung Collapse ◽  
Air Leak ◽  
Initial Management ◽  
High Degree ◽  
Persistent Air Leak

Abstract Background: Conservative observation with/without oxygen supplementation, aspiration, or tube drainage is selected as an initial treatment for spontaneous pneumothorax. In this study, we have examined the efficacy of initial management for cessation of air leak and prevention of recurrence separately, with consideration of the degree of lung collapse.Methods: Spontaneous pneumothorax in patients who underwent initial management in our institute between January 2006 and December 2015 were included in this retrospective, single-institutional study. Multivariate analyses were conducted to identify risk factors related to the persistent air leak after initial treatment and those related to ipsilateral recurrence after last treatment.Results: In the multivariate analysis for predicting persistent air leak after first treatment, repeated episode of ipsilateral pneumothorax (p = 0.0022), high degree of lung collapse (p = 0.032), and bulla formation (p < 0.0001) were the statistically significant risk factors for treatment failure. Recurrence of ipsilateral pneumothorax was observed in 126 cases. In the multivariate analysis for predicting the recurrence, repeated episode of ipsilateral pneumothorax was the significant risk factor (p = 0.0032).Conclusions: Predicting factors for persistent air leak after initial treatment were recurrence of ipsilateral pneumothorax, high degree of lung collapse, and radiological evidence of bullae. The predictive factor for recurrence after the last treatment was recurrence of ipsilateral pneumothorax. Selection of either observational or interventional approach at initial management did not affect the outcomes evaluated. Therefore, because of treatment invasiveness, observation is recommended to be attempted first in cases sans risk factors.Trial Registration: retrospectively registeredDate of IRB approval: May 28, 2018Number of IRB approval: 2017320

scholarly journals Surgical experience in the management of Spontaneous Pneumothorax

2016 ◽  
Vol 10 (1) ◽  
Author(s):  
Aamir Bilal ◽  
Muhammad Shoaib Nabi ◽  
Muhammad Salim
Keyword(s):  
Spontaneous Pneumothorax ◽  
Wedge Resection ◽  
Pulmonary Function Tests ◽  
First Episode ◽  
Medical Institute ◽  
Air Leak ◽  
Female Ratio ◽  
Significant Impairment ◽  
The Mean ◽  
Persistent Air Leak

Objective: To determine the efficacy and evaluate the results in terms of recurrence of Bullectomy and parietal pleurectomy in patients with spontaneous pneumothorax. Design: A prospective observational study. Place and duration of study: This study was conducted at the department of cardiothoracic surgery, postgraduate Medical Institute Lady Reading Hospital Peshawar from March 1998 to April 2001. Patients and methods: This prospective study included 110 patients; 82 (75.5%) males and 28(25.4%) females. Male: female ratio was 2.5:1. The mean age of the patients was 38.5 years (range 10 to 50 years. Ninety percent of the patients complained of chest pain while 45% experienced dyspnea pain. (Best radiograph was obtained in all while CT thorax was obtained in 20(18.1%) patients. The magnitude of pneumothorax and associated pathology was determined radiologically. Thirty-nine (35.4%) patients presented with first episode; 99 (44.5%) had recurrent while 22(20%) had persistent pneumothorax. Tube thoracostomy was the initial line of management in 80 (72.7%) of patients who presented with first episode of pneumothorax. Indications for surgery included recurrent pneumothorax, persistent air leak (>7 days), non expansion of the lung, complicated pneumothorax and suspicion of bulls on CxR or C.T thorax. Out of 110 patients, 28(25.4%) required surgery. Result: The mean operative time was 45(+15) minutes. Surgical indications included recurrences 18(66.6%), persistent air leak 5(18.5%) non expansion of the lung 3(11.1 %) patients. Twenty-two (78.5%) patients under went bullectomy/wedge resection, over sewing and ligation was clone in 6 (21.4%) while pleurectomy was done in all these patients. There were no operative deaths. Over all 2(7.1%) patients had post operative air leak. The post operative hospital stay averaged 6.9 days. Our 18 months of follow up has show n no recurrence and no significant impairment of post operative pulmonary function tests. Conclusion: Pleurectomy with bullectomy or ligation of subpleural blebs is a safe and reliable procedure and gives excellent results.

scholarly journals Time course of resolution of persistent air leak in spontaneous pneumothorax

1995 ◽  
Vol 89 (2) ◽  
pp. 129-132 ◽  
Author(s):  
R. Mathur ◽  
J. Cullen ◽  
W.J.M. Kinnear ◽  
I.D.A. Johnston
Keyword(s):  
Spontaneous Pneumothorax ◽  
Time Course ◽  
Air Leak ◽  
Persistent Air Leak

scholarly journals Novel imaging detailing the origins of a pneumothorax

Thorax ◽  
2017 ◽  
Vol 73 (1) ◽  
pp. 85-87 ◽  
Author(s):  
Kozo Nakanishi ◽  
Hidenori Goto ◽  
Tomokazu Ito ◽  
Yasuhito Nagata ◽  
Shinichi Hayashi ◽  
...  
Keyword(s):  
Clinical Study ◽  
Chest Tube ◽  
Spontaneous Pneumothorax ◽  
Pleural Cavity ◽  
Three Dimensional ◽  
Prospective Clinical Study ◽  
Air Leak ◽  
Air Stream ◽  
Cine Ct

This is a prospective clinical study aimed at introducing a method to visualise the location of an air leak and to identify the bulla responsible on three-dimensional (3-D) cine CT. In 10 patients with spontaneous pneumothorax, dynamic 320-detector row CT was performed with injection of 0.9% saline into the affected pleural cavity via a preplaced chest tube. In eight cases, 3-D cine CT thoracography revealed the location of the air leak and the bulla responsible (7 cases: air stream sign; 1 case: repeated collapse and expansion of a bulla with the patient's breathing).

scholarly journals Intrapleural instillation of autologous blood for persistent air leak in spontaneous pneumothorax- is it as effective as it is safe?

2010 ◽  
Vol 5 (1) ◽  
Author(s):  
Dimos Karangelis ◽  
Georgios I Tagarakis ◽  
Marios Daskalopoulos ◽  
Georgios Skoumis ◽  
Nicholaos Desimonas ◽  
...  
Keyword(s):  
Spontaneous Pneumothorax ◽  
Autologous Blood ◽  
Air Leak ◽  
Persistent Air Leak

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.

Applying Fibrin Glue under Pleurography for Intractable Secondary Spontaneous Pneumothorax

2019 ◽  
Author(s):  
Jeong Cho ◽  
Yeong Kim ◽  
Hoseok I. ◽  
Jung Eom ◽  
Hyo Ahn
Keyword(s):  
Fibrin Glue ◽  
Spontaneous Pneumothorax ◽  
Air Leakage ◽  
Air Leak ◽  
Short Term ◽  
Secondary Spontaneous Pneumothorax ◽  
Prolonged Air Leak ◽  
Postoperative Drainage ◽  
The Mean

Background Prolonged air leakage is a problem that can frequently develop in patients with a secondary spontaneous pneumothorax (SSP) or in those who undergo thoracic surgery. However, the management of an air leak is difficult and reoperation might be avoided due to several reasons including adhesions. Herein, we introduce a fibrin glue application under pleurography (FGAP) and short-term outcomes in patients who underwent this procedure. Methods FGAP was performed in 20 patients with an intractable persistent air leakage who had poor lung function, comorbidities to undergo general anesthesia and were expected severe adhesions due to previous surgery. All medical records were retrospectively reviewed. Results Eighteen cases sealed soon after dropping the glue. One patient had a prolonged air leak for 12 days and another patient required an operation to control air leakage 16 days after the procedure. The mean duration of postoperative drainage was 4.17 ± 2.11 days (range: 3–14 days). No postprocedural complications were recorded. The mean duration of follow-up was 12.01 ± 5.02 months (range: 4–22 months). Conclusion FGAP could be a treatment option to seal air leaks, especially in cases with intractable air leakage.

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