Percutaneous Technique for Management of Persistent Airspace With Prolonged Air Leak Using Fibrin Glue

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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A Prolonged Air Leak Score for Lung Cancer Resection: An Analysis of The Society of Thoracic Surgeons General Thoracic Surgery Database

The Annals of Thoracic Surgery ◽

10.1016/j.athoracsur.2019.05.069 ◽

2019 ◽

Vol 108 (5) ◽

pp. 1478-1483 ◽

Cited By ~ 7

Author(s):

Christopher W. Seder ◽

Sanjib Basu ◽

Timothy Ramsay ◽

Gaetano Rocco ◽

Shanda Blackmon ◽

...

Keyword(s):

Lung Cancer ◽

Thoracic Surgery ◽

Air Leak ◽

Cancer Resection ◽

Prolonged Air Leak ◽

General Thoracic Surgery

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Intraoperative ventilatory leak predicts prolonged air leak after lung resection: A retrospective observational study

PLoS ONE ◽

10.1371/journal.pone.0187598 ◽

2017 ◽

Vol 12 (11) ◽

pp. e0187598 ◽

Cited By ~ 2

Author(s):

Won Ho Kim ◽

Hyung-Chul Lee ◽

Ho-Geol Ryu ◽

Hyun-Kyu Yoon ◽

Chul-Woo Jung

Keyword(s):

Observational Study ◽

Lung Resection ◽

Retrospective Observational Study ◽

Air Leak ◽

Prolonged Air Leak

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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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Autologous Blood Pleurodesis: What Is the Optimal Time Interval and Amount of Blood?

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0041-1727129 ◽

2021 ◽

Author(s):

Alessio Campisi ◽

Andrea Dell'Amore ◽

Yonghui Zhang ◽

Zhitao Gu ◽

Angelo Paolo Ciarrocchi ◽

...

Keyword(s):

Chest Tube ◽

Autologous Blood ◽

Optimal Time ◽

Time Interval ◽

Air Leak ◽

Increased Risk ◽

Tube Removal ◽

Blood Patch ◽

Prolonged Air Leak ◽

Chest Tube Removal

Abstract Background Air leak is the most common complication after lung resection and leads to increased length of hospital (LOH) stay or patient discharge with a chest tube. Management by autologous blood patch pleurodesis (ABPP) is controversial because few studies exist, and the technique has yet to be standardized. Methods We retrospectively reviewed patients undergoing ABPP for prolonged air leak (PAL) following lobectomy in three centers, between January 2014 and December 2019. They were divided into two groups: Group A, 120 mL of blood infused; Group B, 60 mL. Propensity score-matched (PSM) analysis was performed, and 23 patients were included in each group. Numbers and success rates of blood patch, time to cessation of air leak, time to chest tube removal, reoperation, LOH, and complications were examined. Univariate and multivariate analysis of variables associated with an increased risk of air leak was performed. Results After the PSM, 120 mL of blood is statistically significant in reducing the number of days before chest tube removal after ABPP (2.78 vs. 4.35), LOH after ABPP (3.78 vs. 10.00), and LOH (8.78 vs. 15.17). Complications (0 vs. 4) and hours until air leak cessation (6.83 vs. 3.91, range 1–13) after ABPP were also statistically different (p < 0.05). Air leaks that persisted for up to 13 hours required another ABPP. No patient had re-operation or long-term complications related to pleurodesis. Conclusion In our experience, 120 mL is the optimal amount of blood and the procedure can be repeated every 24 hours with the chest tube clamped.

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Ambulant treatment with a digital chest tube for prolonged air leak is safe and effective

Journal of Thoracic Disease ◽

10.21037/jtd-21-1196 ◽

2021 ◽

Vol 0 (0) ◽

pp. 0-0

Author(s):

Lars Dinjens ◽

Wytze S. de Boer ◽

Jos A. Stigt

Keyword(s):

Chest Tube ◽

Air Leak ◽

Prolonged Air Leak ◽

Digital Chest

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Prolonged air leak following lobectomy can be predicted in lung cancer patients

Surgery Today ◽

10.1007/s00595-016-1467-5 ◽

2017 ◽

Vol 47 (8) ◽

pp. 973-979 ◽

Cited By ~ 7

Author(s):

Satoru Okada ◽

Junichi Shimada ◽

Daishiro Kato ◽

Hiroaki Tsunezuka ◽

Masayoshi Inoue

Keyword(s):

Lung Cancer ◽

Cancer Patients ◽

Air Leak ◽

Lung Cancer Patients ◽

Prolonged Air Leak

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Safety of early discharge with a chest tube after pulmonary segmentectomy

European Journal of Cardio-Thoracic Surgery ◽

10.1093/ejcts/ezaa097 ◽

2020 ◽

Vol 58 (3) ◽

pp. 613-618

Author(s):

Feichao Bao ◽

Natasha Toleska Dimitrovska ◽

Shoujun Hu ◽

Xiao Chu ◽

Wentao Li

Keyword(s):

Chest Tube ◽

Enhanced Recovery ◽

Enhanced Recovery After Surgery ◽

Early Discharge ◽

Air Leak ◽

Tube Removal ◽

Prolonged Air Leak ◽

Life Threatening ◽

Chest Tube Removal ◽

Hospital Days

Abstract OBJECTIVES Early removal of chest tube is an important step in enhanced recovery after surgery protocols. However, after pulmonary resection with a wide dissection plane, such as pulmonary segmentectomy, prolonged air leak, a large volume of pleural drainage and the risk of developing empyema in patients can delay chest tube removal and result in a low rate of completion of the enhanced recovery after surgery protocol. In this study, we aimed to assess the safety of discharging patients with a chest tube after pulmonary segmentectomy. METHODS We retrospectively reviewed a single surgeon’s experience of pulmonary segmentectomy from May 2019 to September 2019. Patients who fulfilled the criteria for discharging with a chest tube were discharged and provided written instructions. They returned for chest tube removal after satisfactory resolution of air leak or fluid drainage. RESULTS In total, 126 patients underwent pulmonary segmentectomy. Ninety-five (75%) patients were discharged with a chest tube postoperatively. The mean time to chest tube removal after discharge was 5.6 (range 2–32) days, potentially saving 532 inpatient hospital days. Overall, 90 (95%) patients experienced uneventful and successful outpatient chest tube management. No life-threatening complications were observed. No patient experienced complications resulting from chest tube malfunction. Five (5%) patients experienced minor complications. Overall, all patients reported good-to-excellent mobility with a chest tube. CONCLUSIONS Successful postoperative outpatient chest tube management after pulmonary segmentectomy can be accomplished in selected patients without a major increase in morbidity or mortality.

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