Air Leak after Pulmonary Resection (Thoracic Surgery Clinics of North America, Vol 20, Issue 3 Aug10)

This issue of Thoracic Surgery Clinics is devoted to the prevention and management of air leak after pulmonary surgery. Despite recent progresses in surgical technique and improved perioperative care, prolonged air leak remains a frequent complication after pulmonary resection. Articles will address topics such as the physics and dynamics of the pleural space, risk factors of prolonged air leak, surgical techniques and interoperative measures, the use of sealants or buttressing material; postoperative rescue strategies and postoperative management of the chest tube, including the use of new digitalized systems and portable devices. Thoracic Surgery Clinics of NA, 20 (2010) 11. doi:10.1016/j.thorsurg.2010.04.005 Preface 0 Air Leak After Pulmonary Resection 0 Respiratory Mechanics and Fluid Dynamics After Lung Resection Surgery 0 Prologue: active and passive drainage of the pleural cavity 0 Mechanics 0 How Lung Expansion is Maintained in the Chest in Physiologic Conditions 0 How Lung Expansion is Altered by Thoracotomy and Lung Resection: the Emphysematous and the Fibrotic Lung 0 How the Work of Breathing is Modified After Lung Resection 0 Lung water balance 0 Lung Fluid Balance and Tissue Mechanics in Physiologic Conditions 0 How Lung Fluid Balance may be Altered by Lung Resection: the Idiopathic Lung Edema 0 Clinical considerations 0 The Postoperative Residual Pleural Space 0 The Management of the Chest Tube 0 The air leak 0 The hydrothorax 0 Preoperative Versus Postoperative Assessment: FEV1, Dlco, Vo2max 0 The Need for Early Postoperative Assessment 0 Suggestions: how to improve pre- to early postoperative evaluation 0 Summary 0 Respiratory Mechanics 0 Lung Fluid Balance 0 Clinical Considerations 0 Suggestions 0 References 0 Risk Factors for Prolonged Air Leak After Pulmonary Resection 0 Definition of PAL 0 Risk factors 0 PAL logistic risk model 0 Objective 0 Patients and Methods 0 Statistical Analysis 0 Results 0 PAL aggregate risk score 0 Objective 0 Patients and Methods 0 Statistical Analysis 0 Results 0 Digital PAL risk score 0 Objective 0 Population 0 Statistical Analysis 0 Results 0 Summary 0 References 0 Surgical Techniques to Avoid Parenchymal Injury During Lung Resection (Fissureless Lobectomy) 0 Basic principles 0 Right upper lobectomy 0 Left upper lobectomy 0 Left and right lower lobectomy 0 Advanced techniques 0 Outcomes 0 Fissureless lobectomy by thoracotomy 0 Summary 0 References 0 Intraoperative Measures for Preventing Residual Air Spaces 0 The parietal pleura 0 The visceral pleura 0 Chest wall muscles 0 The diaphragm 0 Osteotendinous chest wall 0 Omentum 0 Summary 0 References 0 Further readings 0 Use of Sealants and Buttressing Material in Pulmonary Surgery: An Evidence-Based Approach 0 Sealants 0 Biologic Sealants 0 Fibrin sealant 0 Experimental evidence 0 Clinical evidence 0 Lung volume reduction surgery 0 Pulmonary resection 0 Metastasectomy-precision cautery 0 Complications 0 Recommendations 0 Synthetic Sealant 0 Glutaraldehyde-albumin sealant 0 Experimental evidence 0 Clinical evidence 0 Pulmonary resection 0 Complications 0 Polyethylene glycol sealants 0 Experimental evidence 0 Clinical evidence 0 Pulmonary resection 0 Complications 0 Recommendations 0 Collagen fleece-bound fibrin sealants 0 Experimental evidence 0 Clinical evidence 0 Pulmonary resections 0 Complications 0 Recommendations 0 Staple-line buttressing 0 Experimental evidence 0 Clinical evidence 0 LVRS 0 Pulmonary Resection 0 Complications 0 Recommendations 0 Summary 0 References 0 Postoperative Strategies to Treat Permanent Air Leaks 0 Pleural drain management 0 Pleurodesis 0 Pneumoperitoneum 0 Endobronchial one-way valves 0 Reoperation 0 References 0 The Management of Chest Tubes After Pulmonary Resection 0 History of chest tubes 0 Definition of important terms 0 Active suction compared with passive suction 0 Initial evaluation of an air leak-is it real? 0 Evidence-based medicine for the management of chest tubes after pulmonary resection 0 Air leak management 0 Treatment of persistent air leaks 0 Outpatient management of chest tubes 0 High-volume drainage 0 The role of daily CXRs 0 References 0 The Cost of Air Leak: Physicians’ and Patients’ Perspectives 0 Financial costs 0 Impact on quality and delivery of care 0 Quality of life/patient satisfaction implications 0 Summary 0 References 0 Digital and Smart Chest Drainage Systems to Monitor Air Leaks: The Birth of a New Era? 0 Digital pleural drainage systems for the management of air leaks 0 Portable suction devices 0 Results of clinical experience using digital devices 0 Comment 0 References 0 Portable Chest Drainage Systems and Outpatient Chest Tube Management 0 Rationale for discharging patients undergoing pleural drainage 0 Discharge criteria and chest tube management 0 Available devices for outpatient pleural drainage management 0 Summary 0 References 0 Special Situations: Air Leak After Lung Volume Reduction Surgery and in Ventilated Patients 0 Prolonged air leak after LVRS 0 Incidence of prolonged air leak after LVRS 0 Early attempts to reduce leak 0 Why prolonged air leaks occur after LVRS 0 No-cut plication: durable reduction of prolonged air leak? 0 Recent efforts to reduce prolonged air leak in LVRS 0 Prolonged air leak in the mechanically ventilated patient 0 Causes of air leak in the mechanically ventilated patient 0 Management of prolonged air leaks in ventilated patients 0 Interventions to address prolonged air leak in ventilated patients 0 Summary 0 References 0 Evidence-Based Suggestions for Management of Air Leaks 0 The concept of prolonged air leak 0 Incidence, significance, and risk factors for air leaks 0 Incidence of Air Leak 0 Incidence of PAL 0 Significance of AL/PAL 0 Risk Factors for AL/PAL 0 Grading System for ALs 0 Intraoperative management of ALs 0 Buttressing Staple Lines in Patients Who are not Severely Emphysematous 0 Buttressing Staple Lines in Patients with Severe Emphysema 0 Use of Topical Sealants 0 Use of Pleural Tent 0 Use of Intraoperative Pneumoperitoneum 0 Postoperative management of routine ALs 0 Chest Drain Suction Management 0 Postoperative management of PALs 0 Acknowledgments 0 References 0 1.pdf 1 2.pdf 2 3.pdf 15 4.pdf 21 5.pdf 26 6.pdf 31 7.pdf 44 8.pdf 51 9.pdf 58 10.pdf 63 11.pdf 71 12.pdf 77 13.pdf 85 References......Page 0 1.pdf......Page 1 2.pdf......Page 2 3.pdf......Page 15 4.pdf......Page 21 5.pdf......Page 26 6.pdf......Page 31 7.pdf......Page 44 8.pdf......Page 51 9.pdf......Page 58 10.pdf......Page 63 11.pdf......Page 71 12.pdf......Page 77 13.pdf......Page 85