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Touchet TJ, Brinson B, Jones M, Byju A, Fletcher G, Hasan SM, Nash LD, Maitland DJ. Development of Biopsy Tract Sealants Based on Shape Memory Polymer Foams. Biomed Mater Devices 2023; 1:853-860. [PMID: 38130883 PMCID: PMC10732340 DOI: 10.1007/s44174-023-00064-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 01/24/2023] [Indexed: 12/23/2023]
Abstract
Lung biopsies are often used to aid in the diagnosis of cancers. However, the procedure carries the dual risk of air (pneumothorax) or blood (hemothorax) filling the pleural cavity, increasing the risk of a collapsed lung and chest intubation. This work demonstrates the effectiveness of a polyurethane-based shape memory polymer foam as a biopsy tract sealant. The impact of diameter, length, pore size, and shape memory effect was evaluated to determine the ideal device design for tract sealing. Characterization in an in vitro benchtop lung model identified that diameter had the largest influence on sealing efficacy, while the length of the device had little to no impact. Finally, evaluation of deployment force demonstrated that devices fabricated from the shape memory polymer foams were easier to deploy than elastic foams. Following characterization, down-selected device designs were combined with radiopaque markers for use in image-guided based procedures. Furthermore, the introduction of the markers or sterilization did not impact the ability of the devices to seal the biopsy tract and led to a decrease in the deployment force. Overall, these results demonstrate the potential for polyurethane-based shape memory foam devices to serve as biopsy tract sealant devices that aim to reduce complications, such as pneumothorax, from occurring.
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Affiliation(s)
- Tyler J. Touchet
- Department of Biomedical Engineering, Texas A&M University, College Station, TX 77843
| | - Braeden Brinson
- Department of Biomedical Engineering, Texas A&M University, College Station, TX 77843
| | - McKenzie Jones
- Department of Biomedical Engineering, Texas A&M University, College Station, TX 77843
| | - Achu Byju
- Department of Biomedical Engineering, Texas A&M University, College Station, TX 77843
| | - Grace Fletcher
- Department of Biomedical Engineering, Texas A&M University, College Station, TX 77843
| | | | | | - Duncan J. Maitland
- Department of Biomedical Engineering, Texas A&M University, College Station, TX 77843
- Shape Memory Medical, Inc., Santa Clara, CA 95054, USA
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Jungmann M, Recalde Phillips S, Touchet TJ, Brinson B, Parish K, Petersen C, Hasan SM, Nash LD, Maitland DJ, Alge DL. Swellable and Thermally Responsive Hydrogel/Shape Memory Polymer Foam Composites for Sealing Lung Biopsy Tracts. ACS Biomater Sci Eng 2023; 9:642-650. [PMID: 36729490 PMCID: PMC10726527 DOI: 10.1021/acsbiomaterials.2c01369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 01/19/2023] [Indexed: 02/03/2023]
Abstract
Lung tissue biopsies can result in a leakage of blood (hemothorax) and air (pneumothorax) from the biopsy tract, which threatens the patient with a collapsed lung and other complications. We have developed a lung biopsy tract sealant based on a thiol-ene-crosslinked PEG hydrogel and polyurethane shape memory polymer (SMP) foam composite. After insertion into biopsy tracts, the PEG hydrogel component contributes to sealing through water-driven swelling, whereas the SMP foam contributes to sealing via thermal actuation. The gelation kinetics, swelling properties, and rheological properties of various hydrogel formulations were studied to determine the optimal formulation for composite fabrication. Composites were then fabricated via vacuum infiltration of the PEG hydrogel precursors into the SMP foam followed by thermal curing. After drying, the composites were crimped to enable insertion into biopsy tracts. Characterization revealed that the composites exhibited a slight delay in shape recovery compared to control SMP foams. However, the composites were still able to recover their shape in a matter of minutes. Cytocompatibility testing showed that leachable byproducts can be easily removed by washing and washed composites were not cytotoxic to mouse lung fibroblasts (L929s). Benchtop testing demonstrated that the composites can be easily deployed through a cannula, and the working time for deployment after exposure to water was 2 min. Furthermore, testing in an in vitro lung model demonstrated that the composites were able to effectively seal a lung biopsy tract and prevent air leakage. Collectively, these results show that the PEG hydrogel/SMP foam composites have the potential to be used as lung biopsy tract sealants to prevent pneumothorax post-lung biopsy.
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Affiliation(s)
- Matthew
A. Jungmann
- Department
of Biomedical Engineering, Texas A&M
University, College
Station, Texas 77843, United States
| | - Sarea Recalde Phillips
- Department
of Biomedical Engineering, Texas A&M
University, College
Station, Texas 77843, United States
| | - Tyler J. Touchet
- Department
of Biomedical Engineering, Texas A&M
University, College
Station, Texas 77843, United States
| | - Braeden Brinson
- Department
of Biomedical Engineering, Texas A&M
University, College
Station, Texas 77843, United States
| | - Katherine Parish
- Department
of Chemical Engineering, Texas A&M University, College Station, Texas 77843, United States
| | - Corinne Petersen
- Department
of Biomedical Engineering, Texas A&M
University, College
Station, Texas 77843, United States
| | | | - Landon D. Nash
- Shape
Memory Medical, Inc., Santa Clara, California 95054, United States
| | - Duncan J. Maitland
- Department
of Biomedical Engineering, Texas A&M
University, College
Station, Texas 77843, United States
- Shape
Memory Medical, Inc., Santa Clara, California 95054, United States
| | - Daniel L. Alge
- Department
of Biomedical Engineering, Texas A&M
University, College
Station, Texas 77843, United States
- Department
of Materials Science & Engineering, Texas A&M University, College Station, Texas 77843, United States
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Klement W, Gilbert S, Resende VF, Maziak DE, Seely AJE, Shamji FM, Sundaresan SR, Villeneuve PJ, Japkowicz N. The validation of chest tube management after lung resection surgery using a random forest classifier. Int J Data Sci Anal. [DOI: 10.1007/s41060-021-00296-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Jin R, Zheng Y, Gao T, Zhang Y, Wang B, Hang J, Li H. A nomogram for preoperative prediction of prolonged air leak after pulmonary malignancy resection. Transl Lung Cancer Res 2021; 10:3616-3626. [PMID: 34584861 PMCID: PMC8435390 DOI: 10.21037/tlcr-21-186] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 07/23/2021] [Indexed: 11/28/2022]
Abstract
Background Prolonged air leak (PAL) is one of the most common postoperative complications after lung surgery. This study aimed to identify risk factors of PAL after lung resection and develop a preoperative predictive model to estimate its risk for individual patients. Methods Patients with pulmonary malignancies or metastasis who underwent pulmonary resection between January 2014 and January 2018 were included. PAL was defined as an air leak more than 5 days after surgery, risk factors were analyzed. Forward stepwise multivariable logistic regression analysis was performed to identify independent risk factors, and a derived nomogram was built. Data from February 2018 to September 2018 were collected for internal validation. Results A total of 1,511 patients who met study criteria were enrolled in this study. The overall incidence of PAL was 9.07% (137/1,511). Age, percent forced expiratory volume in 1 second, surgical type, surgical approach and smoking history were included in the final model. A nomogram was developed according to the multivariable logistic regression results. The C-index of the predictive model was 0.70, and the internal validation value was 0.77. The goodness-of-fit test was non-significant for model development and internal validation. Conclusions The predictive model and derived nomogram achieved satisfied preoperative prediction of PAL. Using this nomogram, the risk for an individual patient can be estimated, and preventive measures can be applied to high-risk patients.
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Affiliation(s)
- Runsen Jin
- Department of Thoracic Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuyan Zheng
- Department of Thoracic Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Taotao Gao
- Department of Thoracic Surgery, Huainan Eastern Hospital Group, Huainan, China
| | - Yajie Zhang
- Department of Thoracic Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bingshun Wang
- Department of Biostatistics, Clinical Research Institute, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Junbiao Hang
- Department of Thoracic Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hecheng Li
- Department of Thoracic Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Okada S, Shimada J, Kato D, Tsunezuka H, Inoue M. Prolonged air leak following lobectomy can be predicted in lung cancer patients. Surg Today 2017; 47:973-979. [PMID: 28091813 DOI: 10.1007/s00595-016-1467-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 12/05/2016] [Indexed: 12/01/2022]
Abstract
PURPOSE The purpose of this study was to identify the factors associated with prolonged air leak (PAL) following pulmonary lobectomy for lung cancer. METHODS The data of 146 patients who underwent pulmonary lobectomy for lung cancer between August 2010 and July 2015 were retrospectively reviewed. Air leaks were assessed daily by a visual evaluation and were categorized as follows: forced expiratory only (Grade 1), expiratory only (Grade 2), or continuous (Grade 3). Logistic regression analyses were performed to identify the predictors of PAL (>5 days). RESULTS PAL occurred in 23 patients (16%). An air leak at rest (Grade ≥ 2) was detected on postoperative day (POD) 1 in 48% of the patients with PAL and 7% of the patients without PAL. A univariate analysis demonstrated that PAL was significantly associated with male sex, a smoking history of ≥ 40 pack years, a serum albumin level of ≤4.0 mg/dL, and an air leak on POD1 (Grade ≥ 2). A multivariate analysis demonstrated that a serum albumin level of ≤4.0 mg/dL (p = 0.027) and an air leak on POD1 (p = 0.006) were independent predictors of PAL. PAL occurred in 75% of the patients with these two risk factors. CONCLUSIONS The preoperative serum albumin level and the presence of a visually evaluated air leak on POD1 may be useful indicators for the perioperative management of air leaks.
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Affiliation(s)
- Satoru Okada
- Division of Thoracic Surgery, Department of Surgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajiicho, Kawaramachidori-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Junichi Shimada
- Division of Thoracic Surgery, Department of Surgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajiicho, Kawaramachidori-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Daishiro Kato
- Division of Thoracic Surgery, Department of Surgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajiicho, Kawaramachidori-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Hiroaki Tsunezuka
- Division of Thoracic Surgery, Department of Surgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajiicho, Kawaramachidori-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Masayoshi Inoue
- Division of Thoracic Surgery, Department of Surgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajiicho, Kawaramachidori-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan.
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Abstract
Protocols for the management of air leaks are critical aspects in the postoperative course of patients following lung resections. Many investigations in the last decade are focusing on the chest tube modalities or preventative measures, however, little is known about the pathophysiology of air leak and the patient perception of this common complication. This review concentrates on understanding the reasons why a pulmonary parenchyma may start to leak or an air leak may be longer than others. Experimental works support the notion that lung overdistension may favor air leak. These studies may represent the basis of future investigations. Furthermore, the standardization of nomenclature in the field of pleural space management and the creation of novel air leak scoring systems have contributed to improve the knowledge among thoracic surgeons and facilitate the organization of trials on this matter. We tried to summarize available evidences about the patient perception of a prolonged air leak and about what would be useful for them in order to prevent worsening of their quality of life. Future investigations are warranted to better understand the pathophysiologic mechanisms responsible of prolonged air leak in order to define tailored treatments and protocols. Improving the care at home with web-based telemonitoring or real time connected chest drainage may in a future improve the quality of life of the patients experience this complication and also enhance hospital finances.
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Affiliation(s)
- Cecilia Pompili
- 1 Division of Thoracic Surgery, St James' University Hospital, Leeds, UK ; 2 Department of Health Sciences, University of Milano-Bicocca, Milano, Italy
| | - Giuseppe Miserocchi
- 1 Division of Thoracic Surgery, St James' University Hospital, Leeds, UK ; 2 Department of Health Sciences, University of Milano-Bicocca, Milano, Italy
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