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Huh JY, Jeong BH, Yoon HI, Kim H, Cho YJ, Kim C, Lee SJ, Kim HH, Ra SW, Lee YJ, Kim BK, Kim SK, Seo KH, Lee SW. Endobronchial valves for emphysema and persistent air-leak: 10-year experience in an Asian country. BMC Pulm Med 2024; 24:162. [PMID: 38570737 PMCID: PMC10988911 DOI: 10.1186/s12890-024-02982-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 03/26/2024] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND Endobronchial valve (EBV) therapy, a validated method for bronchoscopic lung volume reduction (BLVR) in severe emphysema, has been explored for persistent air-leak (PAL) management. However, its effectiveness and safety in the Asian population require further real-world evaluation. In this study, we assessed the outcomes of treatment with EBV within this demographic. METHODS We conducted a retrospective analysis of medical records from 11 Korean centers. For the emphysema cohort, inclusion criteria were patients diagnosed with emphysema who underwent bronchoscopy intended for BLVR. We assessed these patients for clinical outcomes of chronic obstructive pulmonary disease. All patients with PAL who underwent treatment with EBV were included. We identified the underlying causes of PAL and evaluated clinical outcomes after the procedure. RESULTS The severe emphysema cohort comprised 192 patients with an average age of 70.3 years, and 95.8% of them were men. Ultimately, 137 underwent treatment with EBV. Three months after the procedure, the BLVR group demonstrated a significant improvement in forced expiratory volume in 1 s (+160 mL vs. +30 mL; P = 0.009). Radiographic evidence of lung volume reduction 6 months after BLVR was significantly associated with improved survival (adjusted hazard ratio 0.020; 95% confidence interval 0.038-0.650; P = 0.010). Although pneumothorax was more common in the BLVR group (18.9% vs. 3.8%; P = 0.018), death was higher in the no-BLVR group (38.5% vs. 54.5%, P = 0.001), whereas other adverse events were comparable between the groups. Within the subset of 18 patients with PAL, the predominant causes of air-leak included spontaneous secondary pneumothorax (44.0%), parapneumonic effusion/empyema (22.2%), and post-lung resection surgery (16.7%). Following the treatment, the majority (77.8%) successfully had their chest tubes removed. Post-procedural complications were minimal, with two incidences of hemoptysis and one of empyema, all of which were effectively managed. CONCLUSIONS Treatment with EBV provides substantial clinical benefits in the management of emphysema and PAL in the Asian population, suggesting a favorable outcome for this therapeutic approach.
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Affiliation(s)
- Jin-Young Huh
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong, South Korea
| | - Byeong-Ho Jeong
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Ho Il Yoon
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Hojoong Kim
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Young-Jae Cho
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Changhwan Kim
- Department of Internal Medicine, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, South Korea
- Department of Internal Medicine, Hallym University Dongtan Sacred Heart Hospital, Hwaseong-si, Gyeonggi-do, South Korea
| | - Seung Jun Lee
- Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Jinju, South Korea
| | - Hwan Hee Kim
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Seung Won Ra
- Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea
| | - Ye Jin Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Beong Ki Kim
- Division of Pulmonology, Allergy and Critical Care Medicine, Department of Internal Medicine, Korea University Ansan Hospital, Ansan, South Korea
| | - Sung Kyoung Kim
- Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, South Korea
| | - Ki Hyun Seo
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, South Korea
| | - Sei Won Lee
- Department of Pulmonary and Critical Care Medicine, and Clinical Research Center for Chronic Obstructive Airway Diseases, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, Republic of Korea.
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Maleki MH, Tashnizi MA, Shahri HMM, Emadi E, Alamdari DH, Sahebkar A. Persistent pneumothorax treatment following congenital cardiac surgery by platelet-fibrin glue. Updates Surg 2024; 76:647-652. [PMID: 38104302 DOI: 10.1007/s13304-023-01728-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 12/01/2023] [Indexed: 12/19/2023]
Abstract
Persistent pneumothorax is a life-threatening complication that can occur after congenital cardiac surgery. Traditional treatment such as chest tube drainage may not be effective in managing this condition. This study presents a new minimally invasive method for treating persistent pneumothorax using platelet-rich plasma-fibrin glue (PRP-FG). The method has been successful in treating postoperative chylothorax in previous studies, and its use has decreased morbidity, mortality, and hospital stay in chylothorax patients. Ten patients with persistent pneumothorax following cardiothoracic surgery (3 TAPVC, 2 d-TGA, 2 VSD + IAA,1 TRUNCUS + TAPVC, 1 VSD + COA, 1 GLENN), who did not respond to conservative management, underwent treatment with PRP-FG. Follow-up was done for a period of 1-4 years. The age and diagnoses of pneumothorax after surgery were 85.5 ± 36.0 days and 62.4 ± 34.3 h, respectively. Persistent pneumothorax of 8 patients (80%) was cured completely after PRP-FG injection. PRP-FG therapy was failed in two patients who died. All cured patients had a normal life without any complications during follow-up. After PRP-FG injection, 3 patients stopped bubbling at one-time injection, 3 patients stopped bubbling at two-time injection, and 2 patients stopped bubbling at three-time injection. Two patients died during treatment; in these cases, one-time injections were done which was not successful. Persistent pneumothorax after congenital-cardiac surgery can be treated successfully with PRP-FG. This bedside minimal-invasive procedure may significantly decrease the morbidity and mortality rate. Further research is needed to confirm the efficacy of this promising treatment through multicentre clinical trials.
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Affiliation(s)
- Mahmood Hossinzadeh Maleki
- Department of Cardiac Surgery, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohammad Abbasi Tashnizi
- Department of Cardiac Surgery, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Elaheh Emadi
- Vascular and Endovascular Surgery Research Centre, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Daryoush Hamidi Alamdari
- Vascular and Endovascular Surgery Research Centre, Mashhad University of Medical Sciences, Mashhad, Iran.
- Surgical Oncology Research Centre, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Amirhossein Sahebkar
- Biotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran
- Applied Biomedical Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
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Martinez AF, Tom Z, Hsia DW, Vintch J, Yee N. Novel Insights from Clinical Practice Autologous Blood Patch Pleurodesis and Endobronchial Valves for Management of Persistent Air Leaks in Two Cases of Tuberculosis. Respiration 2024; 103:289-294. [PMID: 38417419 DOI: 10.1159/000537992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 02/14/2024] [Indexed: 03/01/2024] Open
Abstract
INTRODUCTION Pulmonary infections, such as tuberculosis, can result in numerous pleural complications including empyemas, pneumothoraces with broncho-pleural fistulas, and persistent air leak (PAL). While definitive surgical interventions are often initially considered, management of these complications can be particularly challenging if a patient has an active infection and is not a surgical candidate. CASE PRESENTATION Autologous blood patch pleurodesis and endobronchial valve placement have both been described in remedying PALs effectively and safely. PALs due to broncho-pleural fistulas in active pulmonary disease are rare, and we present two such cases that were managed with autologous blood patch pleurodesis and endobronchial valves. CONCLUSION The two cases presented illustrate the complexities of PAL management and discuss the treatment options that can be applied to individual patients.
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Affiliation(s)
- Aida F Martinez
- Department of Internal Medicine, Harbor-UCLA Medical Center, Torrance, California, USA,
| | - Zachary Tom
- Division of Pulmonary Diseases and Critical Care Medicine, Department of Medicine, University of California Irvine, Irvine, California, USA
| | - David W Hsia
- Division of Respiratory and Critical Care Physiology and Medicine, Department of Internal Medicine, Harbor-UCLA Medical Center, Torrance, California, USA
- The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, California, USA
| | - Janine Vintch
- Division of Respiratory and Critical Care Physiology and Medicine, Department of Internal Medicine, Harbor-UCLA Medical Center, Torrance, California, USA
- The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, California, USA
| | - Nathan Yee
- Division of Respiratory and Critical Care Physiology and Medicine, Department of Internal Medicine, Harbor-UCLA Medical Center, Torrance, California, USA
- The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, California, USA
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Yamauchi Y, Adachi H, Takahashi N, Morohoshi T, Yamamoto T, Endo M, Ueno T, Woo T, Saito Y, Sawabata N. Suitable Patient Selection and Optimal Timing of Treatment for Persistent Air Leak after Lung Resection. J Clin Med 2024; 13:1166. [PMID: 38398477 PMCID: PMC10890009 DOI: 10.3390/jcm13041166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 02/12/2024] [Accepted: 02/14/2024] [Indexed: 02/25/2024] Open
Abstract
OBJECTIVES The choice of therapeutic intervention for postoperative air leak varies between institutions. We aimed to identify the optimal timing and patient criteria for therapeutic intervention in cases of postoperative air leaks after lung resection. METHODS This study utilized data from a prospective multicenter observational study conducted in 2019. Among the 2187 cases in the database, 420 cases with air leaks on postoperative day 1 were identified. The intervention group underwent therapeutic interventions, such as pleurodesis or surgery, while the observation group was monitored without intervention. A comparison between the intervention group and the observation group were analyzed using the cumulative distribution and hazard functions. RESULTS Forty-six patients (11.0%) were included in the intervention group. The multivariate analysis revealed that low body mass index (p = 0.019), partial resection (p = 0.010), intraoperative use of fibrin glue (p = 0.008), severe air leak on postoperative day 1 (p < 0.001), and high forced expiratory volume in 1 s (p = 0.021) were significant predictors of the requirement for intervention. The proportion of patients with persistent air leak in the observation group was 20% on postoperative day 5 and 94% on postoperative day 7. The hazard of air leak cessation peaked from postoperative day 3 to postoperative day 7. CONCLUSIONS This research contributes valuable insights into predicting therapeutic interventions for postoperative air leaks and identifies scenarios where spontaneous cessation is probable. A validation through prospective studies is warranted to affirm these findings.
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Affiliation(s)
- Yoshikane Yamauchi
- Department of Surgery, Teikyo University School of Medicine, Tokyo 173-8502, Japan;
| | - Hiroyuki Adachi
- Department of Thoracic Surgery, Kanagawa Cardiovascular and Respiratory Center, Yokohama 236-0051, Japan;
| | - Nobumasa Takahashi
- Department of Thoracic Surgery, Saitama Cardiovascular and Respiratory Center, Kumagaya 360-0197, Japan
| | - Takao Morohoshi
- Department of General Thoracic Surgery, Yokosuka Kyosai Hospital, Yokosuka 238-8558, Japan
| | - Taketsugu Yamamoto
- Department of Thoracic Surgery, Yokohama Rosai Hospital, Yokohama 222-0036, Japan;
| | - Makoto Endo
- Department of Thoracic Surgery, Yamagata Prefectural Central Hospital, Yamagata 990-2292, Japan;
| | - Tsuyoshi Ueno
- Department of Thoracic Surgery, National Hospital Organization Shikoku Cancer Center, Matsuyama 791-0245, Japan;
| | - Tekkan Woo
- Department of Surgery, Yokohama City University, Yokohama 236-0004, Japan
| | - Yuichi Saito
- Department of Surgery, Teikyo University School of Medicine, Tokyo 173-8502, Japan;
| | - Noriyoshi Sawabata
- Department of Thoracic and Cardiovascular Surgery, Nara Medical University, Kashihara 634-8521, Japan
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Watanabe T, Yamauchi Y, Takeyama R, Kohmaru S, Dejima H, Saito Y, Sakao Y. A Comparison of the Efficacies of OK-432 and Talc Slurry for Pleurodesis in Patients with Prolonged Air Leak after Pulmonary Resection. Ann Thorac Cardiovasc Surg 2024; 30:n/a. [PMID: 37648484 PMCID: PMC10902650 DOI: 10.5761/atcs.oa.23-00115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023] Open
Abstract
PURPOSE A prolonged air leak (PAL) is one of the common postoperative complications of pulmonary resection. The aim of this study was to evaluate the efficacy and safety of pleurodesis with sterile talc or OK-432 for postoperative air leak. METHODS Patients with postoperative air leak who received chemical pleurodesis using sterile talc or OK-432 were retrospectively identified from medical records data. For pleurodesis with either agent, prior assessment and approval by the hospital safety department were carried out for each case, in addition to individual consent. RESULTS Between February 2016 and June 2022, 39 patients had PALs and underwent chemical pleurodesis. Among them, 24 patients received pleurodesis with talc (Talc group) and 15 with OK-432 (OK-432 group). The leak resolved after less than two pleurodesis treatments in 22 patients (91.7%) in the Talc group compared with 14 patients (93.3%) in the OK-432 group. Pleurodesis significantly increased white blood cell counts, C-reactive protein concentration, and body temperature in the OK-432 group compared with that in the Talc group (p <0.001, p = 0.003, and p <0.001, respectively). CONCLUSIONS Pleurodesis with talc may be an effective treatment option for postoperative air leak. Our findings suggest that talc was as effective as OK-432 and resulted in a milder systemic inflammatory response.
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Affiliation(s)
- Tomohiro Watanabe
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Yoshikane Yamauchi
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Ryo Takeyama
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Shinya Kohmaru
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Hitoshi Dejima
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Yuichi Saito
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Yukinori Sakao
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
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Shorthose M, Barton E, Walker S. The contemporary management of spontaneous pneumothorax in adults. Breathe (Sheff) 2023; 19:230135. [PMID: 38229681 PMCID: PMC10790175 DOI: 10.1183/20734735.0135-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 10/12/2023] [Indexed: 01/18/2024] Open
Abstract
Spontaneous pneumothorax is a common presentation, and there has been a recent surge of research into the condition. With the recent publication of the new British Thoracic Society guidelines and the upcoming European Respiratory Society guidelines, we provide a concise up-to-date summary of clinical learning points. In particular we focus on the role of conservative or ambulatory management, as well as treatment options for persistent air leak and guidance for when to refer to thoracic surgeons for the prevention of the recurrence of pneumothorax. Educational aims To give up-to-date guidance on the acute management of spontaneous pneumothorax, including the role of conservative or ambulatory managementTo discuss the different treatment options for persistent air leak.To guide physicians on when to refer patients to thoracic surgeons for the prevention of the recurrence of pneumothorax.
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Affiliation(s)
| | - Eleanor Barton
- Academic Respiratory Unit, North Bristol NHS Trust, Bristol, UK
| | - Steven Walker
- Academic Respiratory Unit, North Bristol NHS Trust, Bristol, UK
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Qsous G, Zamvar V. Persistent Air Leak Due to Chest Drain Malposition. Cureus 2023; 15:e49255. [PMID: 38143651 PMCID: PMC10745075 DOI: 10.7759/cureus.49255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2023] [Indexed: 12/26/2023] Open
Abstract
Persistent or prolonged air leak (PAL) is one of the common complications that may happen after many procedures in thoracic surgery. The treatment may change based on the cause, and accordingly, the understanding and awareness of the causes and the exclusion of the rare causes are very important in the treatment of this condition. Here, we present an unusual case with PAL due to chest drain malposition with intraparenchymal insertion in an elderly patient who presented initially with a secondary spontaneous pneumothorax (SSP).
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Affiliation(s)
- Ghaith Qsous
- Cardiothoracic Surgery, Royal Infirmary Hospital of Edinburgh, Edinburgh, GBR
| | - Vipin Zamvar
- Cardiothoracic Surgery, Royal Infirmary Hospital of Edinburgh, Edinburgh, GBR
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Williams J, Prey B, Francis A, Weykamp M, Liu B, Parsons M, Vu M, Franko J, Roedel E, Horton J, Bingham J, Mentzer S, Kuckelman J. Bioadhesive patch as a parenchymal sparing treatment of acute traumatic pulmonary air leaks. J Trauma Acute Care Surg 2023; 95:679-684. [PMID: 36973876 DOI: 10.1097/ta.0000000000003956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
INTRODUCTION Traumatic pulmonary injuries are common in chest trauma. Persistent air leaks occur in up to 46% of patients depending on injury severity. Prolonged leaks are associated with increased morbidity and cost. Prior work from our first-generation pectin patches successfully sealed pulmonary leaks in a cadaveric swine model. We now test the next-generation pectin patch against wedge resection in the management of air leaks in anesthetized swine. METHODS A continuous air leak of 10% to 20% percent was created to the anterior surface of the lung in intubated and sedated swine. Animals were treated with a two-ply pectin patch or stapled wedge resection (SW). Tidal volumes (TVs) were recorded preinjury and postinjury. Following repair, TVs were recorded, a chest tube was placed, and animals were observed for presence air leak at closure and for an additional 90 minutes while on positive pressure ventilation. Mann-Whitney U test and Fisher's exact test used to compare continuous and categorical data between groups. RESULTS Thirty-one animals underwent either SW (15) or pectin patch repair (PPR, 16). Baseline characteristics were similar between animals excepting baseline TV (SW, 10.3 mL/kg vs. PPR, 10.9 mL/kg; p = 0.03). There was no difference between groups for severity of injury based on percent of TV loss (SW, 15% vs. PPR, 14%; p = 0.5). There was no difference in TV between groups following repair (SW, 10.2 mL/kg vs. PPR, 10.2 mL/kg; p = 1) or at the end of observation (SW, 9.8 mL/kg vs. PPR, 10.2 mL/kg; p = 0.4). One-chamber intermittent air leaks were observed in three of the PPR animals, versus one in the SW group ( p = 0.6). CONCLUSION Pectin patches effectively sealed the lung following injury and were noninferior when compared with wedge resection for the management of acute traumatic air leaks. Pectin patches may offer a parenchymal sparing option for managing such injuries, although studies evaluating biodurability are needed.
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Affiliation(s)
- James Williams
- From the Madigan Army Medical Center (J.W., B.P., A.F., M.W., M.P., M.V., J.F., E.R., J.H., J.B., J.K.), Tacoma, Washington; and Laboratory of Adaptive and Regenerative Biology (B.L., S.M., J.K.), Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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Fiorelli A, Cannella L, Capasso F, Pizzolorusso A, Picozzi F, Messina G, Natale G, Mercadante E, Tafuto S. One-way endobronchial valves in the management of complex persistent air leaks in a soft tissue sarcoma patient. Thorac Cancer 2023; 14:2712-2714. [PMID: 37555456 PMCID: PMC10493475 DOI: 10.1111/1759-7714.15064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 07/25/2023] [Accepted: 07/26/2023] [Indexed: 08/10/2023] Open
Abstract
Complex persistent air leak (PAL) is a clinical condition which is difficult to treat. Herein, we report the clinical case of an 18-year-old woman with lung and bone metastases due an ultrarare sarcoma: "round cell sarcoma non-Ewing". She developed persistent air leaks due to an alveolopleural fistula which developed following two cycles of chemotherapy with doxorubicin. Chest drainage with suction failed to resolve the air leaks, while surgical treatment was unfeasible due to the poor clinical condition of the patient. Thus, she was reviewed for endoscopic treatment with one-way endobronchial valves. A small valve was sequentially inserted within each segment of the right upper bronchus to occlude the entire upper lobe. Two days after the procedure, resolution of the air leaks were obtained. Chest drainage was removed 5 days later and the patient was discharged. Chemotherapy was resumed. The patient died 7 months later because of disease progression.
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Affiliation(s)
- Alfonso Fiorelli
- Thoracic Surgery UnitUniversity of Campania Luigi VanvitelliCasertaItaly
| | - Lucia Cannella
- S.C. Sarcomi e Tumori Rari, Istituto Nazionale Tumori‐IRCCS‐Fondazione “G. Pascale”NaplesItaly
| | - Francesca Capasso
- Thoracic Surgery UnitUniversity of Campania Luigi VanvitelliCasertaItaly
| | - Antonio Pizzolorusso
- S.C. Sarcomi e Tumori Rari, Istituto Nazionale Tumori‐IRCCS‐Fondazione “G. Pascale”NaplesItaly
| | - Feranda Picozzi
- S.C. Sarcomi e Tumori Rari, Istituto Nazionale Tumori‐IRCCS‐Fondazione “G. Pascale”NaplesItaly
| | - Gaetana Messina
- Thoracic Surgery UnitUniversity of Campania Luigi VanvitelliCasertaItaly
| | - Giovanni Natale
- Thoracic Surgery UnitUniversity of Campania Luigi VanvitelliCasertaItaly
| | - Edoardo Mercadante
- Thoracic Surgery, Istituto Nazionale Tumori, “Fondazione G. Pascale”–IRCCSNaplesItaly
| | - Salvatore Tafuto
- S.C. Sarcomi e Tumori Rari, Istituto Nazionale Tumori‐IRCCS‐Fondazione “G. Pascale”NaplesItaly
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Duron G, Backer E, Feller-Kopman D. Evaluation and management of persistent air leak. Expert Rev Respir Med 2023; 17:865-872. [PMID: 37855445 DOI: 10.1080/17476348.2023.2272701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 10/16/2023] [Indexed: 10/20/2023]
Abstract
INTRODUCTION Persistent air leaks (PAL) represent a challenging clinical problem for which there is not a clear consensus to guide optimal management. PAL is associated with significant morbidity, mortality, and increased length of hospital stay. There are a variety of surgical and non-surgical management options available. AREAS COVERED This narrative review describes the current evidence for PAL management including surgical approach, autologous blood patch pleurodesis, chemical pleurodesis, endobronchial valves, and one-way valves. Additionally, emerging topics such as drainage-dependent air leak and intensive care unit management are described. EXPERT OPINION There has been considerable progress in understanding the pathophysiology of PAL and growing evidence to support the various non-surgical treatment modalities. Increased recognition of drainage-dependent persistent air leaks offers the opportunity to decrease the number of patients requiring additional invasive treatment. Randomized control trials are needed to guide optimal management.
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Affiliation(s)
- Garret Duron
- Department of Pulmonary and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Elliot Backer
- Dartmouth-Hitchcock Medical Center, Department of Pulmonary and Critical Care Medicine, 1 Medical Center Drive, Lebanon, NH, Lebanon
| | - David Feller-Kopman
- Dartmouth-Hitchcock Medical Center, Department of Pulmonary and Critical Care Medicine, 1 Medical Center Drive, Lebanon, NH, Lebanon
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Johnson BH, Johnston SS, Tewari P, Afolabi M, Danker III W. Clinical and Economic Burden Associated with Prolonged Air Leaks Among Patients Undergoing Thoracic Resection: A Retrospective Database Analysis. CLINICOECONOMICS AND OUTCOMES RESEARCH 2023; 15:269-280. [PMID: 37070065 PMCID: PMC10105567 DOI: 10.2147/ceor.s405270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 04/01/2023] [Indexed: 04/19/2023] Open
Abstract
Purpose Prophylactic use of lung sealants among patients undergoing thoracic resection has been reported for the management of intraoperative air leaks and is associated with a lower incidence of prolonged air leak (PAL) and a shorter length of stay (LOS). This study estimated the incremental economic and clinical burden of PAL among patients with lung sealants used during thoracic resection in the United States. Patients and Methods This retrospective analysis examined hospital data (Premier Healthcare Database) for adults (age ≥18 years) with inpatient thoracic resection between October 2015 - March 2021 (first admission=index) and lung sealant used during their procedure. Follow-up extended through 90 days post-discharge. Patients were grouped by presence/absence of PAL (ie, diagnosis of post-procedural air leak or post-procedural pneumothorax with associated LOS exceeding 5 days). Outcomes included intensive care unit (ICU) days, total index hospital costs, all-cause 30-, 60-, and 90-day readmission, discharge status, and in-hospital mortality. Generalized linear models quantified associations between PAL and outcomes, accounting for hospital-level clustering, and patient, procedure, and hospital/provider characteristics. Results Among the 9727 patients included for study (51.0% female, 83.9% white, mean age 66 years), 12.5% had PAL, which was associated with significant incremental increases in ICU days (0.93 days, p<0.001) and total hospital cost ($11,119, p<0.001). PAL also decreased the likelihood of discharge to home (from 91.3% to 88.1%, p<0.001) and increased the risk of readmission within 30, 60, and 90 days by up to 34.0% (from 9.3% to 12.6%;11.7% to 15.4%;13.6% to 17.2%, respectively), all p<0.01. Absolute risk of mortality was low, but two times higher in patients with PAL versus those without PAL (2.4% vs 1.1%, p=0.001). Conclusion This analysis demonstrates that despite the prophylactic use of lung sealants, PAL continues to put a burden on the healthcare system, highlighting an unmet need for improved sealant technology.
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Affiliation(s)
- Barbara H Johnson
- Epidemiology, Johnson & Johnson, New Brunswick, NJ, USA
- Correspondence: Barbara H Johnson, Real-World Data Analytics and Research, Epidemiology - MedTech, Johnson & Johnson, 410 George Street, New Brunswick, NJ, 08901, USA, Tel/Fax +1 603 616 6719, Email
| | | | | | | | - Walter Danker III
- Ethicon Franchise Health Economics and Market Access, Johnson & Johnson, Raritan, NJ, USA
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Singh H, Kurman JS, Jani C, Abdalla M, DePaul B, Benn BS. Off-label use of intrabronchial valves for persistent air leak is safe and effective: a retrospective case analysis. J Thorac Dis 2022; 14:4725-4732. [PMID: 36647468 PMCID: PMC9840033 DOI: 10.21037/jtd-22-824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 10/21/2022] [Indexed: 11/16/2022]
Abstract
Background Persistent air leak (PAL) is a challenging clinical problem associated with prolonged hospital stay and increased morbidity. Historically, treatment options were limited to thoracostomy tube drainage, pleurodesis, and surgical repair. The development of one-way airway valves has represented a paradigm shift in PAL management. We present our experience using intrabronchial valves (IBVs) for PAL management looking at both on-label (post-thoracic surgery) and off-label (all other) indications. Methods We performed a retrospective review of our single-center experience. Data collected included demographics, primary pathology leading to PAL, comorbidities, time to chest tube removal, complications, mortality, need for any additional procedure, and time to IBV removal. Results During the study period, 15 patients underwent IBV insertion for PAL. The on-label cohort contained three patients (post lobectomy or segmentectomy). The off-label cohort had 12 patients (6 empyema, 4 secondary spontaneous pneumothorax, 1 penetrating trauma, and 1 post percutaneous lung nodule biopsy). In the on-label cohort, chest tube was removed after a mean duration of 4.0±1.0 days for all patients. In the off-label cohort, 83.3% (10/12) had chest tube removal 16.2±5.7 days (P=0.396) after IBV placement. One patient developed hypoxic respiratory failure shortly after IBV insertion, necessitating removal of 2 out of 5 valves. Conclusions IBVs are a minimally invasive, well tolerated treatment modality for patients with PAL and a viable alternative to invasive surgical interventions. Procedure or valve-related complications are uncommon. Valves can be removed and do not preclude surgical intervention. Updated guidelines are necessary to formalize PAL management.
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Affiliation(s)
- Harpreet Singh
- Department of Pulmonary and Critical Care, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Jonathan S Kurman
- Department of Pulmonary and Critical Care, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Chinmay Jani
- Department of Medicine, Mount Auburn Hospital, Cambridge, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Mohammed Abdalla
- Department of Pulmonary and Critical Care, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Brandon DePaul
- Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Bryan S Benn
- Department of Pulmonary and Critical Care, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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13
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Juneja D, Kataria S, Singh O. Air leaks in COVID-19. World J Virol 2022; 11:176-185. [PMID: 36159609 PMCID: PMC9372787 DOI: 10.5501/wjv.v11.i4.176] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 04/11/2022] [Accepted: 06/27/2022] [Indexed: 02/06/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) continues to create havoc and may present with myriad complications involving many organ systems. However, the respiratory system bears the maximum brunt of the disease and continues to be most commonly affected. There is a high incidence of air leaks in patients with COVID-19, leading to acute worsening of clinical condition. The air leaks may develop independently of the severity of disease or positive pressure ventilation and even in the absence of any traditional risk factors like smoking and un-derlying lung disease. The exact pathophysiology of air leaks with COVID-19 remains unclear, but multiple factors may play a role in their development. A significant proportion of air leaks may be asymptomatic; hence, a high index of suspicion should be exercised for enabling early diagnosis to prevent further deterioration as it is associated with high morbidity and mortality. These air leaks may even develop weeks to months after the disease onset, leading to acute deterioration in the post-COVID period. Conservative management with close monitoring may suffice for many patients but most of the patients with pneumothorax may require intercostal drainage with only a few requiring surgical interventions for persistent air leaks.
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Affiliation(s)
- Deven Juneja
- Institute of Critical Care Medicine, Max Super Speciality Hospital, Saket, New Delhi 110017, India
| | - Sahil Kataria
- Institute of Critical Care Medicine, Max Super Speciality Hospital, Saket, New Delhi 110017, India
| | - Omender Singh
- Institute of Critical Care Medicine, Max Super Speciality Hospital, Saket, New Delhi 110017, India
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14
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Narenchandra V, Vishnukanth G, Dwivedi DP, Hemachandren M, Adithian S, Vinod Kumar S, Rajangam M, Mohapatra MM, Upadhya P. Comparison of efficacy of autologous blood patch pleurodesis versus doxycycline pleurodesis in the management of persistent air leak in patients with secondary spontaneous pneumothorax. A randomized control trial. Monaldi Arch Chest Dis 2022. [PMID: 35698824 DOI: 10.4081/monaldi.2022.2036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 03/03/2022] [Indexed: 11/23/2022] Open
Abstract
Secondary spontaneous pneumothorax (SSP) patients sometimes have a persistent air leak (PAL) that leads to increased morbidity and increased hospital stay. Further, these patients also need pleurodesis to prevent a recurrence. Autologous blood patch pleurodesis (ABPP) has been successfully tried in post lobectomy air leak cases. However, its utility in SSP patients with PAL has not been widely established. In this context, we performed a non-blinded randomized control study to compare the efficacy of ABPP vs doxycycline pleurodesis in the closure of air leak in SSP patients. This study was a non-blinded randomized control study done in 38 SSP patients with PAL. They were randomized into doxycycline arm and ABPP arm. Post pleurodesis air leak was assessed every 12 hours for cessation. Success was considered when there was a complete cessation of air leak. Post-procedural complications were noted and patients were followed up for 28 days to look for recurrence. The median time for closure was 24 hours [interquartile range (12.24)] for ABPP and 36 hours [interquartile range (24.72)] for doxycycline pleurodesis. Success rate of ABPP vs doxycycline pleurodesis is 94.7% vs 84.2% (p=0.6). Post-procedure pain was more in doxycycline group (15% vs 73%) (p<0.01). On visual analogue scale, ABPP had a lesser pain as compared to doxycycline pleurodesis (average visual analogue scale value of 2 vs scale of 7). The recurrence rate was equal in both groups (5%). Though ABPP and doxycycline have similar success rates, ABPP has an early closure of air leak and greater patient tolerability. ABPP can be tried as an alternative to doxycycline pleurodesis in SSP patients with persistent air leaks.
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Affiliation(s)
- Vijayarangam Narenchandra
- Department of Pulmonary Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry.
| | - Govindaraj Vishnukanth
- Department of Pulmonary Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry.
| | - Dharm Prakash Dwivedi
- Department of Pulmonary Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry.
| | - Munuswamy Hemachandren
- Department of Cardiothoracic and Vascular Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry.
| | - Subathra Adithian
- Department of Radiodiagnosis, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry.
| | - Saka Vinod Kumar
- Department of Pulmonary Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry.
| | - Manju Rajangam
- Department of Pulmonary Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry.
| | - Madhusmita Mohanty Mohapatra
- Department of Pulmonary Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry.
| | - Pratap Upadhya
- Department of Pulmonary Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry.
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15
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Baden W, Hofbeck M, Warmann SW, Schaefer JF, Sieverding L. Interventional closure of a bronchopleural fistula in a 2 year old child with detachable coils. BMC Pediatr 2022; 22:250. [PMID: 35513808 PMCID: PMC9074316 DOI: 10.1186/s12887-022-03298-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 04/21/2022] [Indexed: 11/30/2022] Open
Abstract
Background Bronchopleural fistula (BPF) is a severe complication following pneumonia or pulmonary surgery, resulting in persistent air leakage (PAL) and pneumothorax. Surgical options include resection, coverage of the fistula by video-assisted thoracoscopic surgery (VATS), or pleurodesis. Interventional bronchoscopy is preferred in complex cases and involves the use of sclerosants, sealants and occlusive valve devices. Case presentation A 2.5-year-old girl was admitted to our hospital with persistent fever, cough and dyspnoea. Clinical and radiological examination revealed right-sided pneumonia and pleural effusion. The child was started on antibiotics, and the effusion was drained by pleural drainage. Following removal of the chest tube, the child developed tension pneumothorax. Despite insertion of a new drain, the air leak persisted. Thoracoscopic debridement with placement of another new drain was performed after 4 weeks, without abolishment of the air leak. Bronchoscopy with bronchography revealed a BPF in right lung segment 3 (right upper-lobe anterior bronchus). We opted for an interventional approach that was performed under general anaesthesia during repeat bronchoscopy. Following bronchographic visualisation of the fistula, a 2.7 French microcatheter was placed in right lung segment 3 (upper lobe), allowing occlusion of the fistula by successive implantation of 4 detachable high-density packing volume coils, which were placed into the fistula. Subsequent bronchography revealed no evidence of residual leakage, and the chest tube was removed 2 days later. The chest X-ray findings normalized, and follow-up over 4 years was uneventful. Conclusions Bronchoscopic superselective occlusion of BPF using detachable high-density packing large-volume coils was a successful minimally invasive therapeutic intervention performed with minimal trauma in this child and has not been reported thus far. In our small patient, the short interventional time, localized intervention and minimal damage in the lung seemed superior to the corresponding outcomes of surgical lobectomy or pleurodesis in a young growing lung, enabling normal development of the surrounding tissue. Follow-up over 4 years did not show any side effects and was uneventful, with normal lung-function test results to date. Supplementary Information The online version contains supplementary material available at 10.1186/s12887-022-03298-y.
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Affiliation(s)
- Winfried Baden
- Department Paediatrics 2, Pulmonology, Cardiology, Intensive Care, Children's Hospital, University of Tuebingen, Hoppe-Seyler-Strasse 1, 72076, Tuebingen, Germany.
| | - Michael Hofbeck
- Department Paediatrics 2, Pulmonology, Cardiology, Intensive Care, Children's Hospital, University of Tuebingen, Hoppe-Seyler-Strasse 1, 72076, Tuebingen, Germany
| | - Steven W Warmann
- Department Paediatric Surgery and Paediatric Urology, Children's Hospital, University of Tuebingen, Tuebingen, Germany
| | - Juergen F Schaefer
- Department Radiology, Division of Paediatric Radiology, University Hospital, Tuebingen, Germany
| | - Ludger Sieverding
- Department Paediatrics 2, Pulmonology, Cardiology, Intensive Care, Children's Hospital, University of Tuebingen, Hoppe-Seyler-Strasse 1, 72076, Tuebingen, Germany
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16
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Aliaga F, Grosu HB, Vial MR. Overview of Bronchopleural Fistula Management, with a Focus on Bronchoscopic Treatment. CURRENT PULMONOLOGY REPORTS 2022. [DOI: 10.1007/s13665-022-00289-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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17
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Tension Pneumothorax With Persistent Air Leak in Critical COVID-19 Pneumonia With Acute Respiratory Distress Syndrome Treated With Intrabronchial Valves. J Bronchology Interv Pulmonol 2022; 29:e20-e23. [DOI: 10.1097/lbr.0000000000000792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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18
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The validation of chest tube management after lung resection surgery using a random forest classifier. INTERNATIONAL JOURNAL OF DATA SCIENCE AND ANALYTICS 2022. [DOI: 10.1007/s41060-021-00296-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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19
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Dezube AR, Dolan DP, Mazzola E, Kucukak S, De Leon LE, Bueno R, Marshall MB, Jaklitsch MT, Rochefort MM. Risk factors for prolonged air leak and need for intervention following lung resection. Interact Cardiovasc Thorac Surg 2022; 34:212-218. [PMID: 34536000 PMCID: PMC8766207 DOI: 10.1093/icvts/ivab243] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 07/14/2021] [Accepted: 08/02/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Prolonged air leak (PAL; >5 days) following lung resection is associated with postoperative morbidity. We investigated factors associated with PAL and PAL requiring intervention. METHODS Retrospective review of all patients undergoing lobectomy, segmentectomy or wedge resection from 2016 to 2019 at our institution. Bronchoplastic reconstructions and lung-volume reduction surgeries were excluded. Incidence and risk factors for PAL and PAL requiring intervention were evaluated. RESULTS In total, 2384 patients were included. PAL incidence was 5.4% (129/2384); 22.5% (29/129) required intervention. PAL patients were more commonly male (56.6% vs 39.7%), older (mean age 69 vs 65 years) and underwent lobectomy or thoracotomy (all P < 0.001). Patients with PAL had longer length of stay (9 vs 3 days), more discharge needs and increased odds of complication (all P < 0.050).Twenty-nine patients required intervention (9 chest tubes; 4 percutaneous drains; 16 operations). In 50% of operative interventions, an air leak source was identified; however, the median time from intervention to resolution was 13 days. Patients requiring intervention had increased steroid use, lower diffusion capacity for carbon monoxide and twice the length of stay versus PAL patients (all P < 0.050).On univariable analysis, forced expiratory volume in 1 s (FEV1) <40%, diffusion capacity for carbon monoxide <50%, steroid use and albumin <3 had increased odds of intervention (P < 0.050). CONCLUSIONS Age, gender and operative technique were related to PAL development. Patients with worse forced expiratory volume in 1 s or diffusion capacity for carbon monoxide, steroid use or poor nutrition were less likely to heal on their own, indicating a population that could benefit from earlier intervention.
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Affiliation(s)
- Aaron R Dezube
- Division of Thoracic and Cardiac Surgery, Brigham and Women’s Hospital, Boston, MA, USA
| | - Daniel P Dolan
- Division of Thoracic and Cardiac Surgery, Brigham and Women’s Hospital, Boston, MA, USA
| | - Emanuele Mazzola
- Department of Data Sciences, Dana Farber Cancer Institute, Boston, MA, USA
| | - Suden Kucukak
- Division of Thoracic and Cardiac Surgery, Brigham and Women’s Hospital, Boston, MA, USA
| | - Luis E De Leon
- Division of Thoracic and Cardiac Surgery, Brigham and Women’s Hospital, Boston, MA, USA
| | - Raphael Bueno
- Division of Thoracic and Cardiac Surgery, Brigham and Women’s Hospital, Boston, MA, USA
| | - M Blair Marshall
- Division of Thoracic and Cardiac Surgery, Brigham and Women’s Hospital, Boston, MA, USA
| | - Michael T Jaklitsch
- Division of Thoracic and Cardiac Surgery, Brigham and Women’s Hospital, Boston, MA, USA
| | - Matthew M Rochefort
- Division of Thoracic and Cardiac Surgery, Brigham and Women’s Hospital, Boston, MA, USA
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20
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Schütz K, Happel CM, Keil O, Dingemann J, Carlens J, Wetzke M, Müller C, Köditz H, Griese M, Reiter K, Schweiger-Kabesch A, Backendorf A, Scharff A, Bertram H, Schwerk N. Interventional Bronchus Occlusion Using Amplatzer Devices - A Promising Treatment Option for Children with Persistent Air Leak. KLINISCHE PADIATRIE 2022; 234:293-300. [PMID: 34979579 DOI: 10.1055/a-1697-5624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Persistent air leak (PAL) is a severe complication of secondary spontaneous pneumothorax (SSP). Surgical interventions are usually successful when medical treatment fails, but can be associated with significant complications and loss of potentially recoverable lung parenchyma. METHODS Retrospective analysis of efficacy and safety of interventional bronchus occlusions (IBO) using Amplatzer devices (ADs) in children with PAL secondary to SSP. RESULTS Six patients (four males, 4-15 years of age) underwent IBO using ADs as treatment for PAL. Necrotizing pneumonia (NP) was the most common cause (n=4) of PAL. Three patients were previously healthy and three suffered from chronic lung disease. All patients required at least two chest tubes prior to the intervention for a duration of 15-43 days and all required oxygen or higher level of ventilatory support. In three cases, previous surgical interventions had been performed without success. All children improved after endobronchial intervention and we observed no associated complications. All chest tubes were removed within 5-25 days post IBO. In patients with PAL related to NP (n=4), occluders were removed bronchoscopically without re-occurrence of pneumothorax after a mean of 70 days (IQR: 46.5-94). CONCLUSION IBO using ADs is a safe and valuable treatment option in children with PAL independent of disease severity and underlying cause. A major advantage of this procedure is its less invasiveness compared to surgery and the parenchyma- preserving approach.
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Affiliation(s)
- Katharina Schütz
- Department of Paediatric Pulmonology, Allergology and Neonatology, Hannover Medical School Centre for Paediatrics and Adolescent Medicine, Hannover, Deutschland.,Excellence Cluster RESIST - Resolving Infection Susceptibility, Hannover Medical School, Hannover, Deutschland
| | - Christoph M Happel
- Pediatric Cardiology and Pediatric Intensive Care, Hanover Medical Specialists, Hanover, Deutschland
| | - Oliver Keil
- Department of Anesthesiology and Intensive Care Medicine, Hannover Medical School, Hannover, Deutschland
| | - Jens Dingemann
- Department of Paediatric Surgery, Hannover Medical School Centre for Paediatrics and Adolescent Medicine, Hannover, Deutschland
| | - Julia Carlens
- Department of Paediatric Pulmonology, Allergology and Neonatology, Hannover Medical School Centre for Paediatrics and Adolescent Medicine, Hannover, Deutschland
| | - Martin Wetzke
- Department of Paediatric Pulmonology, Allergology and Neonatology, Hannover Medical School Centre for Paediatrics and Adolescent Medicine, Hannover, Deutschland
| | - Carsten Müller
- Department of Paediatric Pulmonology, Allergology and Neonatology, Hannover Medical School Centre for Paediatrics and Adolescent Medicine, Hannover, Deutschland
| | - Harald Köditz
- Department of Paediatric Cardiology and Intensive Care Medicine, Hannover Medical School Centre for Paediatrics and Adolescent Medicine, Hannover, Deutschland
| | - Matthias Griese
- Department of Paediatric Pneumology, Dr. von Haunersches Kinderspital, German Center for Lung Research, University of Munich, Munich, Deutschland
| | - Karl Reiter
- Department of Paediatric Pneumology and Allergy, University Children's Hospital Regensburg (KUNO) at the Hospital St. Hedwig of the Order of St. John, University of Regensburg, Regensburg, Deutschland
| | - Andrea Schweiger-Kabesch
- Department of Paediatric Pneumology and Allergy, University Children's Hospital Regensburg (KUNO) at the Hospital St. Hedwig of the Order of St. John, University of Regensburg, Regensburg, Deutschland
| | - Alexander Backendorf
- Department of Neonatology and Paediatric Intensive Care, Vestische Childrenhospital Datteln, University of Witten/Herdecke, Datteln, Deutschland
| | - AnnaZychlinsky Scharff
- Department of Paediatric Haematology and Oncology, Hannover Medical School Centre for Paediatrics and Adolescent Medicine, Hannover, Deutschland
| | - Harald Bertram
- Department of Paediatric Pneumology, Dr. von Haunersches Kinderspital, German Center for Lung Research, University of Munich, Munich, Deutschland
| | - Nicolaus Schwerk
- Department of Paediatric Pulmonology, Allergology and Neonatology, Hannover Medical School Centre for Paediatrics and Adolescent Medicine, Hannover, Deutschland.,BREATH (Biomedical Research in End-stage and obstructive Lung Disease Hannover), German Center for Lung Research (DZL), Hannover, Deutschland
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21
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Thoracic hydatid cysts: an analysis of surgical management in a tertiary care centre in India. Indian J Thorac Cardiovasc Surg 2022; 38:17-27. [PMID: 34924702 PMCID: PMC8630355 DOI: 10.1007/s12055-021-01294-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 10/17/2021] [Accepted: 10/18/2021] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION AND PURPOSE Though hydatidosis is a ubiquitous zoonosis endemic to India, there is a dearth of literature regarding the management of thoracic hydatid disease (THD) in India. There are no surgical guidelines available. The aim of this study is to analyse the details of THD operated upon in a tertiary care hospital in India and propose a protocol for its management. METHODS The case files of all adult patients operated upon for THD in our institution between 2009 and 2019 were retrieved and a retrospective study done. RESULTS A total of 186 patients, 103 (55.4%) males and 83 (44.6%) females, with a mean age of 34.2 years were studied. The commonest symptom was cough as in 83 (44.6%) patients. Complications were seen in 22 (11.8%) patients. Computerized tomogram (CT) was confirmatory in most patients. Isolated pulmonary disease was seen in 135 (72.6%) patients with 153 (82.3%) uni-lobar involvement. Right lower lobe was most frequently involved as in 56 (30.1%). Extra-pulmonary, intra-thoracic involvement was seen in 6 (3.2%) and synchronous extra-thoracic disease in 45 (24.2%) patients. All patients were initiated on anthelmintics. Postero-lateral thoracotomy was the commonest surgical approach. Twenty (10.7%) patients required lung resections. The mean hospital stay was 5.9 days. Air leak, seen in 10 (5.4%) patients, was the commonest post-operative complication. There was single in-hospital mortality. Age, diabetes mellitus, secondary bacterial infection of the cyst and cyst characteristics were found to significantly affect the surgical outcomes. CONCLUSION Surgery, the treatment of choice for THD, can be done with negligible morbidity and mortality and should be expedited to prevent complications. Risk factors should be identified pre-operatively for better decision-making. Adequate concurrent medical therapy may prevent recurrences. Prolonged follow-up is mandatory to detect late recurrences.
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22
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Ramadurai D, DiBardino DM, Hong G. Endobronchial valve placement in secondary pneumothorax related to allergic bronchopulmonary aspergillosis. Respir Med Case Rep 2021; 34:101554. [PMID: 34820259 PMCID: PMC8602042 DOI: 10.1016/j.rmcr.2021.101554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 10/05/2021] [Accepted: 11/08/2021] [Indexed: 11/06/2022] Open
Abstract
Secondary pneumothorax is a rare but serious complication of allergic bronchopulmonary aspergillosis (ABPA) and bronchiectasis [1,2]. Persistent air leak (PAL) after secondary pneumothorax is an ongoing abnormal communication between bronchi or alveoli and the pleural space, despite drainage. Ongoing PAL for 5 days after initial chest tube insertion necessitates prolonged ambulatory drainage or aggressive management with video-assisted thoracoscopic surgery (VATS) or pleurodesis [3,4]. There are no randomized trials examining the efficacy of endobronchial valves (EBVs) for PAL with underlying inflammatory pulmonary disease. We describe the successful use of an EBV for PAL in a man with ABPA on high dose steroids, with a large bronchopleural fistula (BPF).
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Affiliation(s)
- Deepa Ramadurai
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - David M DiBardino
- Section of Interventional Pulmonology and Thoracic Oncology, Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Gina Hong
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pennsylvania, Philadelphia, PA, USA
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23
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Havaldar AA, Fazal AR, Chennabasappa A. A rare case of persistent air leak: beware of all the tubes. Int J Emerg Med 2021; 14:58. [PMID: 34551716 PMCID: PMC8459542 DOI: 10.1186/s12245-021-00381-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 09/03/2021] [Indexed: 11/29/2022] Open
Abstract
Background Patients with acute respiratory failure, impaired consciousness, and impaired airway reflexes will require invasive mechanical ventilation. Monitoring of such patients is important. The use of ventilator scalars and loops help in monitoring, diagnosing the abnormality, and treating the patients effectively. We report a rare cause one should suspect in a case of persistent and fixed air leak in a patient requiring mechanical ventilation. Case presentation We describe a 28-year-old young patient requiring ventilator support due to neuromuscular weakness. His neuromuscular weakness was rapidly progressing involving the respiratory muscles. The patient was intubated and put on mechanical ventilator support. He was transferred from another health care center to our hospital. On evaluation, the patient was intubated with ETT no 8. The patient had persistent air leak as observed on the ventilator graphics. We checked for ETT cuff malfunction, ventilator circuit, catheter mount, and HME for any disconnection causing the leak. The air leak which we observed in our patient was due to the malpositioned Ryle’s tube. Conclusions Vigilant monitoring of patients requiring mechanical ventilation is necessary. For the evaluation of the cause of air leak, algorithmic approach will help in correctly identifying the abnormality.
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Affiliation(s)
| | - Abdul Rahim Fazal
- Department of Critical Care, St. John's Medical College, Bangalore, 560034, India
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24
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Ahmed H, Badran A, Tamburrini A, Kattach H, Veres L, Alzetani A. Endobronchial Valves in the Management of Persistent Air Leak in Coronavirus Disease 2019. Ann Thorac Surg 2021; 113:e1-e3. [PMID: 34492216 PMCID: PMC8418015 DOI: 10.1016/j.athoracsur.2021.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 07/28/2021] [Accepted: 08/03/2021] [Indexed: 11/27/2022]
Abstract
Pneumothorax and persistent air leak are documented complications of severe acute respiratory syndrome coronavirus 2 infection. Patients who fall into this category are often poor candidates for invasive thoracic surgical intervention. Endobronchial valves offer an effective and less invasive treatment option and can successfully treat persistent air leak and support the weaning of patients with severe acute respiratory syndrome coronavirus 2 pneumonia off ventilation.
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Affiliation(s)
- Hanad Ahmed
- Department of Thoracic Surgery, University Hospital Southampton, Southampton, United Kingdom
| | - Abdul Badran
- Department of Thoracic Surgery, University Hospital Southampton, Southampton, United Kingdom
| | - Alessandro Tamburrini
- Department of Thoracic Surgery, University Hospital Southampton, Southampton, United Kingdom
| | - Hassan Kattach
- Department of Thoracic Surgery, University Hospital Southampton, Southampton, United Kingdom
| | - Lukacs Veres
- Department of Thoracic Surgery, University Hospital Southampton, Southampton, United Kingdom
| | - Aiman Alzetani
- Department of Thoracic Surgery, University Hospital Southampton, Southampton, United Kingdom.
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25
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Abstract
OBJECTIVE To describe the physiology of air leak in bronchopleural fistula in mechanically ventilated patients and how understanding of its physiology drives management of positive-pressure ventilation. To provide guidance of lung isolation, mechanical ventilator, pleural catheter, and endobronchial strategies for the management of bronchopleural fistula on mechanical ventilation. DATA SOURCES Online search of PubMed and manual review of articles (laboratory and patient studies) was performed. STUDY SELECTION Articles relevant to bronchopleural fistula, mechanical ventilation in patients with bronchopleural fistula, independent lung ventilation, high-flow ventilatory modes, physiology of persistent air leak, extracorporeal membrane oxygenation, fluid dynamics of bronchopleural fistula airflow, and intrapleural catheter management were selected. Randomized trials, observational studies, case reports, and physiologic studies were included. DATA EXTRACTION Data from selected studies were qualitatively evaluated for this review. We included data illustrating the physiology of driving pressure across a bronchopleural fistula as well as data, largely from case reports, demonstrating management and outcomes with various ventilator modes, intrapleural catheter techniques, endoscopic placement of occlusion and valve devices, and extracorporeal membrane oxygenation. Themes related to managing persistent air leak with mechanical ventilation were reviewed and extracted. DATA SYNTHESIS In case reports that demonstrate different approaches to managing patients with bronchopleural fistula requiring mechanical ventilation, common themes emerge. Strategies aimed at decreasing peak inspiratory pressure, using lower tidal volumes, lowering positive end-expiratory pressure, decreasing the inspiratory time, and decreasing the respiratory rate, while minimizing negative intrapleural pressure decreases airflow across the bronchopleural fistula. CONCLUSIONS Mechanical ventilation and intrapleural catheter management must be individualized and aimed at reducing air leak. Clinicians should emphasize reducing peak inspiratory pressures, reducing positive end-expiratory pressure, and limiting negative intrapleural pressure. In refractory cases, clinicians can consider lung isolation, independent lung ventilation, or extracorporeal membrane oxygenation in appropriate patients as well as definitive management with advanced bronchoscopic placement of valves or occlusion devices.
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Kalverkamp S, Mantas A, Spillner J, Hima F, Kanzler SS, Stopinski T, Tolba RH, Zayat R. Efficacy of a Novel Medical Adhesive for Sealing Lung Parenchyma: An in vitro Study in Rabbit Lungs. Eur Surg Res 2021; 62:255-261. [PMID: 34289469 DOI: 10.1159/000517173] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 05/12/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION During thoracic resection procedures, complete hemostasis and aerostasis are priorities. A persistent alveolar air leak is associated with increased morbidity and mortality rates. This study aimed to evaluate whether the novel medical adhesive VIVO (Adhesys Medical GmbH Aachen, Germany) is a reliable alternative sealing technique to routine surgical procedures. METHODS We conducted an in vitro animal study by analyzing 21 lungs of New Zealand (n = 19) and Chinchilla Bastard (n = 2) rabbits (age, 11-18 weeks; weight, 2,400-3,600 g). Three groups, each comprising 7 animals, were evaluated. VIVO (VIVO-group) was compared with standard surgical lung parenchymal lesion closure with a polypropylene suture (Suture-group) and TachoSil® (TachoSil-group). We adopted a stable, pressure-controlled ventilation protocol. After explantation, a surgical incision 0.5-cm deep and 1.5-cm wide was made in the lungs using a customized template. Air leak was measured quantitatively (mL/min) using a respirator and visualized qualitatively by 2 observers who made independent judgments. Next, the leak was closed using VIVO, suture, or TachoSil® as specified by the manufacturer. Subsequently, positive end-expiratory pressure (PEEP) and inspiratory pressure were gradually increased until a maximum of 15 and 30 mbar were attained, respectively. RESULTS At PEEPs of 8, 10, and 15 mbar, VIVO achieved complete sealing of the profound parenchymal defect in all (n = 7) lungs. After closure of the incision, we observed an air leak variation of 127 ± 114 mL/min (Suture-group), 31 ± 49 mL/min (VIVO-group), and 114 ± 134 mL/min (TachoSil-group). VIVO showed a significantly lower air leak than surgical sutures (p = 0.031) and TachoSil® (p = 0.046). CONCLUSION VIVO offers sufficient closure of the lung parenchymal lesions. The novel adhesive enabled significantly better sealing with lower persistent air leakage than TachoSil® or surgical sutures. Further investigation using in vivo models is strongly encouraged to confirm our findings.
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Affiliation(s)
- Sebastian Kalverkamp
- Department of Thoracic and Cardiovascular Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Anna Mantas
- Department of Thoracic and Cardiovascular Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Jan Spillner
- Department of Thoracic and Cardiovascular Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Flutura Hima
- Department of Thoracic and Cardiovascular Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | | | - Thaddäus Stopinski
- Institute for Laboratory Animal Science & Experimental Surgery, RWTH Aachen, University Hospital RWTH Aachen, Aachen, Germany
| | - René H Tolba
- Institute for Laboratory Animal Science & Experimental Surgery, RWTH Aachen, University Hospital RWTH Aachen, Aachen, Germany
| | - Rashad Zayat
- Department of Thoracic and Cardiovascular Surgery, University Hospital RWTH Aachen, Aachen, Germany
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Ahuja J, de Groot PM, Shroff GS, Strange CD, Vlahos I, Rajaram R, Truong MT, Wu CC. The postoperative chest in lung cancer. Clin Radiol 2021; 77:6-18. [PMID: 34154835 DOI: 10.1016/j.crad.2021.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 05/05/2021] [Indexed: 12/17/2022]
Abstract
Most of the complications following lung cancer surgery occur in the early postoperative period and can result in significant morbidity and mortality. Delayed complications can also occur. Diagnosing these complications can be challenging because clinical manifestations are non-specific. Imaging plays an important role in detecting these complications in a timely manner and facilitates prompt interventions. Hence, it is important to have knowledge of the expected anatomical alterations following lung cancer surgeries, and the spectrum of post-surgical complications and their respective imaging findings to avoid misinterpretations or delay in diagnosis.
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Affiliation(s)
- J Ahuja
- Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - P M de Groot
- Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - G S Shroff
- Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - C D Strange
- Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - I Vlahos
- Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - R Rajaram
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - M T Truong
- Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - C C Wu
- Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Hugen N, Hekma EJ, Claessens NJM, Smit HJM, Reijnen MMPJ. Efficacy of an autologous blood patch for prolonged air leak, a systematic review. Ann Thorac Surg 2021; 114:1064-1071. [PMID: 34115999 DOI: 10.1016/j.athoracsur.2021.05.047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 03/21/2021] [Accepted: 05/12/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND Prolonged air leak (PAL) following pulmonary surgery remains a clinical challenge and sometimes needs surgical reintervention. An autologous blood patch (ABP) may provide a noninvasive method to cease air leak. Its value, however, is debatable. The aim of this systematic review is to synthesize evidence regarding the efficacy of ABP in patients with PAL. METHODS A comprehensive search for published studies was performed in the Medline database, Embase and the Cochrane library. Randomized controlled trials, case-control studies and case series in which a postoperative ABP was performed were included. Findings from these studies were tabulated and data was synthesized graphically. PROSPERO registration number CRD42020157591. RESULTS A total of 8 studies was included in the analysis, comprising 151 patients. Studies demonstrated heterogeneity in ABP timing and practice and an intermediate to high risk of bias was scored. The majority of studies demonstrated a beneficial effect of the ABP, with a high rate of success of over 89%. One randomized trial did not find a difference in time to cease of air leak following ABP compared with conservative tube thoracostomy. The overall complication rate was 10%. CONCLUSIONS Quality of included studies is limited due to lack of comparison groups. Synthesized data in this review demonstrates a high rate of successful procedures and acceptable complication rates, which seems to be encouraging to justify a large randomized clinical trial on the use of ABP for patients who suffer from PAL following thoracic surgery.
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Affiliation(s)
- Niek Hugen
- Department of Thoracic Surgery, Rijnstate Hospital, Arnhem, the Netherlands; Department of Surgery, Radboud university medical center, the Netherlands.
| | - Edo J Hekma
- Department of Thoracic Surgery, Rijnstate Hospital, Arnhem, the Netherlands
| | - Niels J M Claessens
- Department of Respiratory Medicine, Rijnstate Hospital, Arnhem, the Netherlands
| | - Hans J M Smit
- Department of Respiratory Medicine, Rijnstate Hospital, Arnhem, the Netherlands
| | - Michel M P J Reijnen
- Department of Thoracic Surgery, Rijnstate Hospital, Arnhem, the Netherlands; Multi-Modality Medical Imaging Group, TechMed Centre, University of Twente, Enschede, The Netherlands
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Kanitra JJ, Thampy CA, Cullen ML. A decade's experience of pediatric lung abscess and empyema at a community hospital. Pediatr Pulmonol 2021; 56:1245-1251. [PMID: 33386780 DOI: 10.1002/ppul.25254] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 12/24/2020] [Accepted: 12/27/2020] [Indexed: 11/08/2022]
Abstract
BACKGROUND Discussions on the diagnostic and management of acquired pediatric lung pathology are usually published by large tertiary children's hospitals. It is likely that much of this pathology is actually seen and managed in nonacademic practices. METHODS A 10-year retrospective review of patients under 18-years of age, treated for lung abscesses or empyema was performed. RESULTS Nineteen empyema and four lung abscesses were included. Presenting symptoms, workup, and management are reviewed. A unique subset (n = 4) of atypical pulmonary pathology is described. A 14-year-old with a vaping history and a lung abscess misdiagnosed as an empyema. A 15-year-old with primary pulmonary Hodgkin's lymphoma presenting as a lung abscess and empyema. A 5-year-old with an empyema complicated by a bronchopleural fistula and a 21-year-old with autism and an acquired lung cyst. CONCLUSION Our dilemmas, experiences, and strategies in managing complex lung disease are generalized to community-based practice.
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Affiliation(s)
- John J Kanitra
- Department of Surgery, Ascension St. John Hospital, Detroit, Michigan, USA
| | - Chelsea A Thampy
- Department of Surgery, Ascension St. John Hospital, Detroit, Michigan, USA
| | - Marc L Cullen
- Division of Pediatric Surgery, Department of Surgery, Ascension St. John Hospital, Detroit, Michigan, USA
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Benjamin SR, Panakkada RK, Andugala SS, Gnanamuthu BR, Rao VM, Narayanan D, Mohammad A, Sameer M. Surgical management of empyema thoracis - experience of a decade in a tertiary care centre in India. Indian J Thorac Cardiovasc Surg 2021; 37:274-284. [PMID: 33967415 DOI: 10.1007/s12055-020-01085-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 10/21/2020] [Accepted: 10/27/2020] [Indexed: 11/29/2022] Open
Abstract
Introduction and purpose Empyema thoracis (ET) is defined as the accumulation of pus in the pleural cavity. Early stages of ET are treated medically and the late stages surgically. Decortication, thoracoplasty, window procedure (Eloesser flap procedure) and rib resections are the open surgical procedures executed. There are no strict guidelines available in developing nations to guide surgical decision-making, as to which procedure is to be followed. Methods Details of all adult patients treated surgically for ET, between the years 2009 and 2019, and maintained in a live database in our institute, were retrieved and analysed. Medically managed patients were excluded. Results There were 437 patients in the study. The average age was 38 years. There was right side preponderance with a male:female ratio of 5:1. Tuberculosis was the commonest aetiology identified in 248 (57%) patients and diabetes was the commonest co-morbidity present in 97 (22%) patients. There was a higher incidence of a window procedure (WP) in tubercular patients 145 (59%). Only 26 (14%) of the non-tubercular patients underwent a WP. Post-operative complications were persistent air leak in 12 (6%) patients and premature closure of a window in 7 (4%) patients. There were 4 (0.9%) post-operative mortalities. Conclusion Surgical management of late stages of ET provides good results with minimal morbidity and mortality. In developing nations like India, the high incidence of tuberculosis and late presentations make the surgical management difficult and the strategies different from those in developed nations. No clear guidelines exist for the surgical management of ET in developing nations. There is a need for a consensus on the surgical management of empyema in such countries.
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Affiliation(s)
- Santhosh Regini Benjamin
- The Department of Cardiothoracic Surgery, The Christian Medical College Hospital, Vellore, Tamil Nadu 632004 India
| | - Rijoy Kolakkada Panakkada
- The Department of Cardiothoracic Surgery, The Christian Medical College Hospital, Vellore, Tamil Nadu 632004 India
| | - Shalom Sylvester Andugala
- The Department of Cardiothoracic Surgery, The Christian Medical College Hospital, Vellore, Tamil Nadu 632004 India
| | - Birla Roy Gnanamuthu
- The Department of Cardiothoracic Surgery, The Christian Medical College Hospital, Vellore, Tamil Nadu 632004 India
| | - Vinay Murahari Rao
- The Department of Cardiothoracic Surgery, The Christian Medical College Hospital, Vellore, Tamil Nadu 632004 India
| | - Deepak Narayanan
- The Department of Cardiothoracic Surgery, The Christian Medical College Hospital, Vellore, Tamil Nadu 632004 India
| | - Aamir Mohammad
- The Department of Cardiothoracic Surgery, The Christian Medical College Hospital, Vellore, Tamil Nadu 632004 India
| | - Mallampati Sameer
- The Department of Cardiothoracic Surgery, The Christian Medical College Hospital, Vellore, Tamil Nadu 632004 India
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Flora AS, Aragaki-Nakahodo A, Benzaquen S. Endobronchial Valve Placement for Persistent Air Leaks Secondary to Pulmonary Infections. J Bronchology Interv Pulmonol 2021; 28:47-52. [PMID: 32452981 DOI: 10.1097/lbr.0000000000000689] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 04/27/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Pneumothoraces associated with infectious diseases have a higher rate of treatment failure and longer length of hospital stay than those associated with obstructive lung diseases and malignancy. Little is mentioned in the medical literature concerning the use of endobronchial 1-way valves in treating alveolar-pleural fistulae (APF) caused by pulmonary infections. METHODS A 7-year, single-center, retrospective analysis of patients consented for exempted off-label use of the Olympus Spiration Implantable Endobronchial Valve system to control prolonged air leaks at the University of Cincinnati Medical Center. RESULTS Nineteen consecutive patients had 22 separate APF events from pulmonary infections during which a total of 101 valves were placed over 23 procedures (average 4.4±2.8 valves per procedure). The average time from the first chest tube placement to valve placement was 23.4±20.8 days (range, 2 to 84 d). Chest tubes were successfully removed in 19 (86.4%) of 22 APF events without further intervention. In events not including chest tubes remaining solely for empyema treatment after cessation of air leak (n=14), the average time from valve placement to the removal of all chest tubes was 12.8±20.2 days (1 to 81 d). Thirty and ninety day all-cause mortality was 15.8%. On average, valves were removed 64.1±27.1 days (range, 38 to 135 d) after placement. CONCLUSION Based on our institutional experience, endobronchial valves may be a treatment option for select patients with persistent air leaks caused by pulmonary infections. Further standardized and comparative studies are required to fully understand the risks and benefits of this treatment.
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Affiliation(s)
- Arjan S Flora
- Interventional Pulmonology Service, Division of Pulmonary, Critical Care, and Sleep Medicine, University of Cincinnati Medical Center, Cincinnati, OH
| | - Alejandro Aragaki-Nakahodo
- Interventional Pulmonology Service, Division of Pulmonary, Critical Care, and Sleep Medicine, University of Cincinnati Medical Center, Cincinnati, OH
| | - Sadia Benzaquen
- Division of Pulmonary, Critical Care, and Sleep Medicine, Einstein Medical Center, Philadelphia, PA
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Improved outcomes utilizing a novel pectin-based pleural sealant following acute lung injury. J Trauma Acute Care Surg 2020; 89:915-919. [PMID: 33108138 DOI: 10.1097/ta.0000000000002754] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Persistent air leaks after thoracic trauma are associated with significant morbidity. To evaluate a novel pectin sealant in a swine model of traumatic air leaks, we compared a pectin biopolymer with standard surgical and fibrin-based interventions. METHODS A standardized lung injury was created in male Yorkshire swine. Interventions were randomized to stapled wedge resection (n = 5), topical fibrin glue (n = 5), fibrin patch (n = 5), and a pectin sealant (n = 6). Baseline, preintervention and postintervention tidal volumes (TV) were recorded. Early success was defined as the return to near-normal TV (>95% of baseline). Late success was defined as no detectable air leak in the chest tube after chest closure. RESULTS There were no differences in injury severity between groups (mean TV loss, 62 ± 17 mL, p = 0.2). Early success was appreciated in 100% (n = 6) of the pectin interventions which was significantly better than the fibrin sealant (20%, n = 1), fibrin patch (20%, n = 1), and stapled groups (80%, n = 4, p = 0.01). The percent of return to baseline TV after sealant intervention was significantly increased in the pectin (98%) and staple arms (97%) compared with the fibrin sealant (91%) and fibrin patch arms (90%) (p = 0.02; p = 0.03). Late success was also improved with the pectin sealant: no air leak was detected in 83% of the pectin group compared with 40% in the stapled group (p = 0.008)-90% of the fibrin-based interventions resulted in continuous air leaks (p = 0.001). CONCLUSION Pectin-based bioadhesives effectively seal traumatic air leaks upon application in a porcine model. Further testing is warranted as they may provide a superior parenchymal-sparing treatment option for traumatic air leaks.
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Creden SP, Ripley RT. Commentary: A tool in the arsenal for persistent air leaks. JTCVS Tech 2020; 4:341-342. [PMID: 34318068 PMCID: PMC8307458 DOI: 10.1016/j.xjtc.2020.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 10/01/2020] [Accepted: 10/09/2020] [Indexed: 10/28/2022] Open
Affiliation(s)
- Samuel P Creden
- Division of General Thoracic Surgery, The Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex
| | - R Taylor Ripley
- Division of General Thoracic Surgery, The Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex
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Abstract
Malignant pleural effusion frequently complicates both solid and hematologic malignancies and is associated with high morbidity, mortality, and health care costs. Although no pleura-specific therapy is known to impact survival, both pleurodesis and indwelling pleural catheter (IPC) placement can significantly alleviate symptoms and improve quality of life. The optimal choice of therapy in terms of efficacy and particularly cost-effectiveness depends on patient preferences and individual characteristics, including lung expansion and life expectancy. Attempting chemical pleurodesis through an IPC in the outpatient setting appears to be a particularly promising approach in the absence of a nonexpandable lung.
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Affiliation(s)
- Majid Shafiq
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA
| | - David Feller-Kopman
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, 1800 Orleans Street, Suite 7-125, Baltimore, MD 21287, USA.
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Botwin AL, Niedzwiecki GA, Botwin KP. Persistent air leak treated by autologous blood patch pleurodesis: the role of CT-guided small-bore chest tube insertion. Clin Imaging 2020; 60:75-78. [DOI: 10.1016/j.clinimag.2019.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Revised: 09/28/2019] [Accepted: 12/02/2019] [Indexed: 11/24/2022]
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Cossu A, Martin Rother MD, Kusmirek JE, Meyer CA, Kanne JP. Imaging Early Postoperative Complications of Cardiothoracic Surgery. Radiol Clin North Am 2020; 58:133-150. [DOI: 10.1016/j.rcl.2019.08.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Marwah V, Katoch CDS, Kumar K, Pathak K, Bhattacharjee S, Jindamwar P. Bronchoscopic device closure of postoperative bronchopleural fistulae: Novel devices and innovative techniques. Lung India 2020; 37:107-113. [PMID: 32108593 PMCID: PMC7065536 DOI: 10.4103/lungindia.lungindia_179_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background Bronchoscopic device closure plays a significant role in the nonsurgical management of bronchopleural fistulae (BPF). Herein, we describe our 10-year experience in the management of postoperative BPF using various device closure modalities. This is the largest series of bronchoscopic device closure of BPF being reported from India. Materials and Methods This was a retrospective analysis of data of patients who underwent bronchoscopic device closure with various techniques for the management of postoperative BPF. In total, 11 patients (six males and five females) with a mean age (±standard deviation) of 42.72 ± 14.40 years with BPFs were treated with various bronchoscopic interventions for BPF closure. We used various devices such as endobronchial coils, occluder devices, and covered tracheobronchial self-expandable stents for BPF closure depending on the size of air leaks. We describe the various devices used, technique, and outcome of bronchoscopic management of BPF. Results All our patients had developed BPFs postoperatively. Pulmonary tuberculosis was the most common etiology seen in nine of our patients. All the devices were placed using a fiberoptic bronchoscope, and all patients were followed up for a minimum duration of 6 months. We successfully localized and closed BPFs in nine (81.81%) of our patients. Conclusions Bronchoscopic device closure can be a successful strategy to manage postoperative BPF with minimal complications.
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Affiliation(s)
- Vikas Marwah
- Department of Pulmonary, Critical Care and Sleep Medicine, Military Hospital (CTC), Pune, Maharashtra, India
| | - C D S Katoch
- Department of Pulmonary, Critical Care and Sleep Medicine, Military Hospital (CTC), Pune, Maharashtra, India
| | - Kunal Kumar
- Department of Pulmonary, Critical Care and Sleep Medicine, Military Hospital (CTC), Pune, Maharashtra, India
| | - Kamal Pathak
- Department of Interventional Radiology, Excelcare Hospitals, Guwahati, Assam, India
| | | | - Prashant Jindamwar
- Department of Microbiology, Military Hospital (CTC), Pune, Maharashtra, India
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Abu-Hijleh M, Styrvoky K, Anand V, Woll F, Yarmus L, Machuzak MS, Nader DA, Mullett TW, Hogarth DK, Toth JW, Acash G, Casal RF, Hazelrigg S, Wood DE. Intrabronchial Valves for Air Leaks After Lobectomy, Segmentectomy, and Lung Volume Reduction Surgery. Lung 2019; 197:627-633. [PMID: 31463549 DOI: 10.1007/s00408-019-00268-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 08/21/2019] [Indexed: 11/24/2022]
Abstract
PURPOSE Air leaks are common after lobectomy, segmentectomy, and lung volume reduction surgery (LVRS). This can increase post-operative morbidity, cost, and hospital length of stay. The management of post-pulmonary resection air leaks remains challenging. Minimally invasive effective interventions are necessary. The Spiration Valve System (SVS, Olympus/Spiration Inc., Redmond, WA, US) is approved by the FDA under humanitarian use exemption for management of prolonged air leaks. METHODS This is a prospective multicenter registry of 39 patients with air leaks after lobectomy, segmentectomy, and LVRS managed with an intention to use bronchoscopic SVS to resolve air leaks. RESULTS Bronchoscopic SVS placement was feasible in 82.1% of patients (32/39 patients) and 90 valves were placed with a median of 2 valves per patient (mean of 2.7 ± 1.5 valves, range of 1 to 7 valves). Positive response to SVS placement was documented in 76.9% of all patients (30/39 patients) and in 93.8% of patients when SVS placement was feasible (30/32 patients). Air leaks ultimately resolved when SVS placement was feasible in 87.5% of patients (28/32 patients), after a median of 2.5 days (mean ± SD of 8.9 ± 12.4 days). Considering all patients with an intention to treat analysis, bronchoscopic SVS procedure likely contributed to resolution of air leaks in 71.8% of patients (28/39 patients). The post-procedure median hospital stay was 4 days (mean 6.0 ± 6.1 days). CONCLUSIONS This prospective registry adds to the growing body of literature supporting feasible and effective management of air leaks utilizing one-way valves.
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Affiliation(s)
- Muhanned Abu-Hijleh
- Division of Pulmonary and Critical Care Medicine, Interventional Pulmonology, Department of Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA.
- University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, POB Building II, Dallas, TX, 75390, USA.
| | - Kim Styrvoky
- Division of Pulmonary and Critical Care Medicine, Interventional Pulmonology, Department of Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Vikram Anand
- Division of Pulmonary and Critical Care Medicine, Interventional Pulmonology, Department of Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Fernando Woll
- Division of Pulmonary and Critical Care Medicine, Interventional Pulmonology, Department of Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Lonny Yarmus
- Division of Pulmonary and Critical Care, Section of Interventional Pulmonology, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Michael S Machuzak
- Department of Pulmonary, Allergy, Critical Care Medicine and Transplant Center, Interventional Pulmonology, Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Daniel A Nader
- Department of Medicine, Pulmonary and Critical Care Medicine, Interventional Pulmonology, Cancer Treatment Centers of America, Tulsa, OK, USA
| | - Timothy W Mullett
- Division of Cardiothoracic Surgery, Department of Surgery, University of Kentucky, Lexington, KY, USA
| | - D Kyle Hogarth
- Section of Pulmonary and Critical Care Medicine, Interventional Pulmonology, Department of Medicine, University of Chicago Medical Center, Chicago, IL, USA
| | - Jennifer W Toth
- Division of Pulmonary, Allergy, and Critical Care, Department of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Ghazwan Acash
- Department of Pulmonary and Critical Care Medicine, Interventional Pulmonology, Lahey Hospital and Medical Center, Tufts University School of Medicine, Burlington, MA, USA
| | - Roberto F Casal
- Department of Pulmonary Medicine, Interventional Pulmonology, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA
| | - Stephen Hazelrigg
- Department of Surgery, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Douglas E Wood
- Division of Cardiothoracic Surgery, Department of Surgery, University of Washington, Seattle, WA, USA
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Bronstein ME, Koo DC, Weigel TL. Management of air leaks post-surgical lung resection. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:361. [PMID: 31516907 DOI: 10.21037/atm.2019.04.30] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Airleaks are one of the most common complications associated with elective lung resection. There have been many techniques and modern advancements in thoracic surgery, however airleaks persist. This review article will discuss several interventions ranging from conservative noninvasive to surgical management of the persistent airleak. These techniques include stopping of suction on the plueravac, fibrin patches, pleurodesis, use of endobronchial valves (EBVs), return to OR for operative intervention, and lastly to send patients home with mini pleuravacs.
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Affiliation(s)
| | | | - Tracey L Weigel
- Division of Thoracic Surgery, Westchester Medical Center, Valhalla, NY, USA
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Intrabronchial valves for persistent pulmonary air leaks in children. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2019. [DOI: 10.1016/j.epsc.2019.101201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Zhang HT, Xie YH, Gu X, Li WP, Zeng YM, Li SY, Liu ZG, Wang HW, Bai C, Jin FG. Management of Persistent Air Leaks Using Endobronchial Autologous Blood Patch and Spigot Occlusion: A Multicentre Randomized Controlled Trial in China. Respiration 2019; 97:436-443. [PMID: 30904909 DOI: 10.1159/000495298] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 11/09/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Optimal management of persistent air leaks (PALs) in patients with secondary spontaneous pneumothorax (SSP) remains controversial. OBJECTIVE To evaluate the efficacy and safety of endobronchial autologous blood plus thrombin patch (ABP) and bronchial occlusion using silicone spigots (BOS) in patients with SSP accompanied by alveolar-pleural fistula (APF) and PALs. METHODS This prospective multicentre randomized controlled trial compared chest tube-attached water-seal drainage (CTD), ABP, and BOS that were performed between February 2015 and June 2017 in one of six tertiary care hospitals in China. Patients diagnosed with APF experiencing PALs (despite 7 days of CTD) and inoperable patients were included. Outcome measures included success rate of pneumothorax resolution at the end of the observation period (further 14 days), duration of air leak stop, lung expansion, hospital stay, and complications. RESULTS In total, 150 subjects were analysed in three groups (CTD, ABP, BOS) of 50 each. At 14 days, 60, 82, and 84% of CTD, ABP, and BOS subjects, respectively, experienced full resolution of pneumothorax (p = 0.008). All duration outcome measures were significantly better in the ABP and BOS groups than in the CTD group (p < 0.016 for all). The incidence of adverse events, including chest pain, cough, and fever, was not significantly different. All subjects in the ABP and BOS groups experienced temporary haemoptysis. Spigot displacement occurred in 8% of BOS subjects. CONCLUSION ABP and BOS resulted in clinically meaningful outcomes, including higher success rate, duration of air leak stop, lung expansion, and hospital stay, with an acceptable safety profile.
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Affiliation(s)
- Hai-Tao Zhang
- Department of Respiration, Tangdu Hospital, Air Force Military Medical University, Xi'an, China
| | - Yong-Hong Xie
- Department of Respiration, Tangdu Hospital, Air Force Military Medical University, Xi'an, China
| | - Xing Gu
- Department of Respiration, Tangdu Hospital, Air Force Military Medical University, Xi'an, China
| | - Wang-Ping Li
- Department of Respiration, Tangdu Hospital, Air Force Military Medical University, Xi'an, China
| | - Yi-Ming Zeng
- Department of Pulmonary and Critical Care Medicine, Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Shi-Yue Li
- Department of Respiratory, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Zhi-Guang Liu
- Department of Respiratory Medicine, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, China
| | - Hong-Wu Wang
- Department of Medical Oncology, Meitan General Hospital, Beijing, China
| | - Chong Bai
- Department of Respiratory Medicine, Changhai Hospital, Navy Military Medical University, Shanghai, China
| | - Fa-Guang Jin
- Department of Respiration, Tangdu Hospital, Air Force Military Medical University, Xi'an, China,
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Majid A, Kheir F, Sierra-Ruiz M, Ghattas C, Parikh M, Channick C, Keyes C, Chee A, Fernandez-Bussy S, Gangadharan S, Folch E. Assessment of Fissure Integrity in Patients With Intrabronchial Valves for Treatment of Prolonged Air Leak. Ann Thorac Surg 2018; 107:407-411. [PMID: 30315804 DOI: 10.1016/j.athoracsur.2018.08.046] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 08/15/2018] [Accepted: 08/20/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Intrabronchial valves (IBVs) are a treatment alternative for persistent air leak (PAL). However, there is a paucity of evidence regarding whether the absence of collateral ventilation (CV) can predict successful treatment of PAL with IBV placement. We assessed whether absence of CV measured by fissure integrity could predict successful resolution of PAL with IBV placement. METHODS A multicenter, retrospective study was performed. Patients who underwent IBV placement for PAL were identified. Chest computed tomography analysis via VIDA Diagnostics was used to assess CV. CV was present if the treated lobe was adjacent to a fissure that was <90% complete. RESULTS A total of 81 valves were placed in 26 patients (median, 3 per patient). A total of 16 patients without CV underwent IBV placement: 14 patients had complete resolution of PAL with a median time from IBV placement to air leak resolution of 4.5 days and 2 patients required subsequent procedures to manage the PAL. In a subset of patients without CV who underwent complete lobar occlusion with IBV (n = 8), median time to PAL resolution was 3 days, whereas in patients without CV who underwent incomplete lobar occlusion with IBV (n = 6), median time PAL resolution was 6.5 days (p = 0.045). All 10 patients with CV underwent IBV placement and complete lobar occlusion: 4 patients had complete PAL resolution with a median time from IBV placement to PAL resolution of 17.5 days and 6 patients required subsequent procedures to manage their PAL. CONCLUSIONS PAL treatment with IBV is more successful in patients without CV, especially when complete lobar occlusion with IBV is achieved.
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Affiliation(s)
- Adnan Majid
- Department of Interventional Pulmonology, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
| | - Fayez Kheir
- Department of Pulmonary Critical Care and Environmental Health, Tulane University, New Orleans, Louisiana
| | - Melibea Sierra-Ruiz
- Department of Interventional Pulmonology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Christian Ghattas
- Department of Interventional Pulmonology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Mihir Parikh
- Department of Interventional Pulmonology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Colleen Channick
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Colleen Keyes
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Alex Chee
- Department of Interventional Pulmonology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | | | - Sidhu Gangadharan
- Department of Interventional Pulmonology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Erik Folch
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, Massachusetts
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Bronchocutaneous Fistula without Pneumothorax Localized with Methylene Blue and Managed with Endobronchial Valves. Ann Am Thorac Soc 2018; 15:992-994. [PMID: 30067094 DOI: 10.1513/annalsats.201802-081cc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Revelo A, Keshishyan S, Epelbaum O, Yaghoubian S, DeLorenzo L, Chandy D, Carroll F, Paul L, Harris K. Diagnostic and therapeutic challenges in managing persistent air leaks. J Thorac Dis 2018; 10:522-528. [PMID: 29600087 DOI: 10.21037/jtd.2018.01.43] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Persistent air leak (PAL) is a common and challenging condition associated with increased morbidity and mortality, intensive care unit admission, and prolonged hospital stay. Multiple medical and surgical approaches have been developed to manage PAL. Depending on the etiology of PAL, surgical management may be effective and usually performed using video-assisted thoracoscopic surgery (VATS). Medical management is less invasive and consists of pleural or bronchoscopic methods. The non-surgical techniques for the management of PAL have not been investigated in large prospective studies, and so their use is mostly guided by observational data. Specifically, the role of intrabronchial valve (IBV) placement for PAL has been the subject of an ever-increasing number of case reports and series documenting successful deployment of IBVs for both surgical and medical PAL. In this case-based discussion, we describe three patients with non-surgical PAL who were managed using multiple modalities, including both surgical and medical approaches. These cases illustrate the challenges in identifying the location of the air leak and in the application of various therapeutic options.
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Affiliation(s)
- Alberto Revelo
- Department of Medicine, Interventional Pulmonology Section, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Sevak Keshishyan
- Department of Medicine, Pulmonary, Critical Care and Sleep Medicine, Critical Care and Sleep Medicine, Interventional Pulmonology Section, Westchester Medical Center, New York, USA
| | - Oleg Epelbaum
- Department of Medicine, Pulmonary, Critical Care and Sleep Medicine, Critical Care and Sleep Medicine, Interventional Pulmonology Section, Westchester Medical Center, New York, USA
| | - Saman Yaghoubian
- Department of Anesthesia, Critical Care and Sleep Medicine, Interventional Pulmonology Section, Westchester Medical Center, New York, USA
| | - Lawrence DeLorenzo
- Department of Medicine, Pulmonary, Critical Care and Sleep Medicine, Critical Care and Sleep Medicine, Interventional Pulmonology Section, Westchester Medical Center, New York, USA
| | - Dipak Chandy
- Department of Medicine, Pulmonary, Critical Care and Sleep Medicine, Critical Care and Sleep Medicine, Interventional Pulmonology Section, Westchester Medical Center, New York, USA
| | - Francis Carroll
- Department of Thoracic Surgery, Critical Care and Sleep Medicine, Interventional Pulmonology Section, Westchester Medical Center, New York, USA
| | - Lisa Paul
- Department of Medicine, Pulmonary, Critical Care and Sleep Medicine, Critical Care and Sleep Medicine, Interventional Pulmonology Section, Westchester Medical Center, New York, USA
| | - Kassem Harris
- Department of Medicine, Pulmonary, Critical Care and Sleep Medicine, Interventional Pulmonology Section, Westchester Medical Center, New York, USA
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