Advancements in the Management of Postoperative Air Leak following Thoracic Surgery: From Traditional Practices to Innovative Therapies
Abstract
:1. Introduction
2. Materials and Methods
- Type of Publications: Peer-reviewed research articles, reviews, clinical guidelines, and meta-analyses.
- Language: Articles published in English.
- Relevance: Publications that specifically addressed the incidence, pathophysiology, diagnostic approaches, and management strategies for PAL.
- Innovative Treatments: Studies that detailed emerging therapies and techniques.
- Study Outcomes: Articles that provided clear outcomes of treatment efficacy, patient recovery timelines, and any complications associated with different management strategies.
3. Etiology and Risk Factors
3.1. Pathophysiology
3.2. Risk Factors
4. Diagnosis and Monitoring of Postoperative Air Leak
4.1. Clinical Assessment
4.2. Imaging Techniques
4.3. Intraoperative Detection
4.4. Monitoring Protocols
5. Intraoperative Prevention of Air Leaks
6. Conservative Management of Postoperative Air Leaks
6.1. Chest Tube Management
6.2. Application of External Suction
6.3. Optimizing Pulmonary Function
6.4. Pain Management
6.5. Observation and Digital Air Leak Monitoring
7. Pleurodesis
7.1. Chemical Pleurodesis
7.2. Autologous Blood Patch
8. Surgical Treatment of Postoperative Air Leaks
8.1. Mechanical Pleurodesis
8.2. Surgical Repair
8.3. Reinforcement Techniques
8.4. Bullectomy
8.5. Lobectomy
8.6. Thoracoplasty
8.7. Postoperative Care and Monitoring
9. Innovative Treatments of Postoperative Air Leaks
9.1. Autologous Plasma
9.2. Platelet Gel
9.3. Bioengineered Tissue Sealants
9.4. Endobronchial Valves
9.5. Stem Cell Therapy
10. Discussion
11. Future Directions
12. Conclusions
Author Contributions
Funding
Data Availability Statement
Conflicts of Interest
References
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Classification | Description |
---|---|
Grade 1 | Air leak observed only at forced expiration or cough |
Grade 2 | Air leak observed with normal expiration |
Grade 3 | Air leak observed with normal inspiration |
Grade 4 | Air leak observed throughout the respiratory cycle but ceases momentarily |
Grade 5 | Continuous air leak observed throughout the entire respiratory cycle without cessation |
Patient-Related Risk Factors | |
---|---|
Risk Factor | Description |
Chronic Lung Diseases | Conditions such as COPD, emphysema, or pulmonary fibrosis increase risk. |
Smoking History | Smoking adversely affects the integrity of lung parenchyma. |
Tumor Stage | Advanced stages often require more extensive surgical resections, potentially increasing the vulnerability of lung tissue. |
Age and Nutritional Status | Elderly patients and those with poor nutritional status may have reduced tissue repair capabilities. |
Obesity | Obesity can lead to increased surgical complications. |
Genetic Predisposition | Genetic factors may influence lung tissue integrity and the ability to heal. |
Preoperative Pulmonary Function | Lower preoperative lung function can indicate a higher risk of PAL. |
Immunosuppression | Patients with weakened immune systems may have delayed healing. |
Diabetes Mellitus | Diabetes can impair wound healing and lung recovery. |
Surgical and Perioperative Risk Factors | |
---|---|
Risk Factor | Description |
Type of Surgery | Certain procedures, like lung resections and lung volume reduction surgery for emphysema treatment, have a higher incidence of PAL. |
Upper Lobe Resections | Upper lobe resections carry a higher risk of air leak due to their greater elastic recoil, sparser anastomotic blood supply, prevalence of emphysematous changes in the upper lobes, and the technical challenges associated with their proximity to major airways and vessels. |
Pleural Adhesions | They complicate surgical dissection, potentially leading to inadvertent lung parenchyma injury and disruption of the lung surface integrity during surgery. |
Surgical Technique | Use of certain instruments and techniques can affect tissue integrity. |
Intraoperative Lung Manipulation | Excessive handling or manipulation of lung tissue can predispose to PAL. |
Extended Operative Time | Longer surgeries may increase the risk of PAL due to prolonged exposure. |
Anesthesia Type | Specific types of anesthesia may affect lung function. |
Postoperative Pain Management | Inadequate pain management can prevent effective coughing and deep breathing. |
Mechanical Ventilation Use | Use of mechanical ventilation can affect lung mechanics. |
Experience of Surgical Team | Less experienced surgical teams may cause higher rates of PAL due to technique variability. |
Grade | Description |
---|---|
0 | No leak |
1 | Countable bubbles |
2 | Stream of bubbles |
3 | Coalesced bubbles |
Ref. | Authors | Year | Study Focus | Key Findings | Relevance to PAL Management |
---|---|---|---|---|---|
[1] | Geraci TC, et al. | 2021 | Postoperative air leaks in lung surgery | Identified predictors, intraoperative techniques, and management strategies. | Insights into comprehensive management of PAL. |
[2] | Aprile V, et al. | 2023 | Conservative management of PAL | Reviewed intraoperative prevention and conservative management strategies. | Highlights the importance of non-surgical management. |
[3] | Cerfolio RJ, et al. | 1998 | Management algorithm for air leaks post-pulmonary resection | Developed a prospective management algorithm. | Basis for many current protocols; emphasizes early management. |
[4] | Brunelli A, et al. | 2004 | Predictors of prolonged air leak after lobectomy | Investigated patient and surgical factors influencing air leak duration. | Identifies risk factors to inform surgical planning. |
[6] | Sridhar P, et al. | 2020 | Prevention of postoperative prolonged air leaks | Explored preventive measures for PAL after pulmonary resection. | Offers insights into effective preventive strategies. |
[10] | Brunelli A, et al. | 2010 | Scoring system to predict risk of prolonged air leaks | Introduced a scoring system based on patient-specific factors. | Helps in preoperative planning and risk assessment. |
[13] | Orsini B, et al. | 2015 | Validation of prolonged air leaks score in VATS | Validated a scoring system for predicting PAL risk in VATS procedures. | Assists in assessing risk and planning VATS procedures. |
[15] | French DG, et al. | 2018 | Management of parenchymal air leaks | Discussed optimal management techniques for parenchymal air leaks. | Provides guidelines for effective postoperative care. |
[19] | Yang HC, et al. | 2018 | Novel air leak test using surfactant for lung surgery | Introduced a novel test for detecting air leaks during surgery. | Enhances intraoperative detection and management. |
[20] | Kang DY | 2020 | Intraoperative air leak detection via CO2 insufflation | Demonstrated safe and practical air leak site detection during surgery. | Improves intraoperative detection and potential outcomes. |
[21] | Okusanya OT, et al. | 2018 | Infrared intraoperative fluorescence imaging | Explored the use of indocyanine green for intraoperative leak detection. | Offers advanced technique for enhancing leak detection. |
[24] | Lequaglie C, et al. | 2012 | Use of sealant to prevent prolonged air leaks | Evaluated the effectiveness of sealants in preventing prolonged air leaks. | Supports the use of biological sealants in surgery. |
[27] | Li SJ, et al. | 2017 | Fissureless technique for decreasing PAL | Reviewed the efficacy of avoiding pulmonary fissure dissection. | Suggests techniques that minimize surgical air leaks. |
[33] | Brunelli A, et al. | 2013 | Tailored suction in chest drains | Compared tailored suction strategies for managing air leaks. | Influences chest drain management to reduce PAL duration. |
[34] | Alphonso N, et al. | 2005 | Suction vs. non-suction to underwater seal drains | Evaluated the impact of suction on underwater seal drains post-lung resection. | Questions the necessity of suction in drain management. |
[35] | Holbek BL, et al. | 2019 | Effects of low suction on digital drainage devices | Investigated the impact of low suction settings on digital drainage devices. | Supports refined suction strategies in postoperative care. |
[48] | Marshall K, et al. | 2020 | Pain management in thoracic surgery | Reviewed methods for effective pain management in thoracic surgeries. | Emphasizes the importance of pain management in PAL recovery. |
[50] | Filosso PL, et al. | 2010 | Digital air leak monitoring | Reviewed the impact of digital monitoring systems on managing air leaks. | Highlights advancements in monitoring technologies. |
[54] | Arai H, et al. | 2018 | Evaluation of digital drainage systems | Compared outcomes with digital vs. traditional drainage systems. | Demonstrates benefits of digital systems in clinical practice. |
[56] | Yagi S, et al. | 2022 | Clinical utility of digital vs. analog drainage systems | Digital systems reduced the duration of chest drainage compared to analog. | Shows efficacy of digital systems in managing PAL. |
[62] | Lee SA, et al. | 2021 | Digital thoracic drainage systems | Evaluated clinical application of digital systems for air leak management. | Highlights precision and quantification advantages of digital systems. |
[64] | Joshi JM | 2009 | Ambulatory chest drainage | Discussed the efficacy and safety of ambulatory systems for managing PAL. | Advocates for patient mobility and comfort during recovery. |
[68] | Liberman M, et al. | 2010 | Persistent air leak management with chemical pleurodesis | Reviewed incidence and risk factors for persistent air leaks and pleurodesis use. | Highlights chemical pleurodesis as a valuable management option. |
[70] | Park EH, et al. | 2019 | Doxycycline vs. talc for chemical pleurodesis | Compared the efficacy and safety of doxycycline and talc in pleurodesis. | Offers insights into safer pleurodesis options. |
[77] | Talebzadeh H, et al. | 2023 | Glucose solution for pleurodesis | Compared 50% glucose solution to bleomycin for pleurodesis efficacy. | Suggests less common but effective pleurodesis agents. |
[81] | Hugen N, et al. | 2022 | Autologous blood patch for prolonged air leaks | Systematic review on the efficacy of autologous blood patch for PAL. | Validates the effectiveness and safety of the blood patch method. |
[93] | Skevis K, et al. | 2022 | Plasma pleurodesis | Explored fresh frozen plasma as an alternative pleurodesis method. | Introduces novel applications of plasma in pleurodesis. |
[97] | Andreetti C, et al. | 2010 | Autologous platelet gel for persistent air leaks | Investigated the efficacy of platelet gel in sealing air leaks post-lung resection. | Suggests a novel and less invasive option for managing PAL. |
[99] | Pinezich MR, et al. | 2024 | Lung-mimetic hydrofoam sealant | Developed a biodegradable sealant that mimics lung tissue for treating air leaks. | Represents innovative bioengineering approach to PAL management. |
[101] | Mahajan AK, et al. | 2013 | Use of endobronchial valves for persistent air leaks | Demonstrated the effectiveness of endobronchial valves in managing persistent air leaks post-thoracic surgery. | Introduces a minimally invasive method to control PAL, enhancing recovery and reducing the need for further surgical intervention. |
[105] | Chen X, et al. | 2021 | Stem cell therapy for pulmonary disorders | Reviewed potential of mesenchymal stem cells in treating pulmonary disorders including PAL. | Emerging research into regenerative options for PAL treatment. |
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Leivaditis, V.; Skevis, K.; Mulita, F.; Tsalikidis, C.; Mitsala, A.; Dahm, M.; Grapatsas, K.; Papatriantafyllou, A.; Markakis, K.; Kefaloyannis, E.; et al. Advancements in the Management of Postoperative Air Leak following Thoracic Surgery: From Traditional Practices to Innovative Therapies. Medicina 2024, 60, 802. https://doi.org/10.3390/medicina60050802
Leivaditis V, Skevis K, Mulita F, Tsalikidis C, Mitsala A, Dahm M, Grapatsas K, Papatriantafyllou A, Markakis K, Kefaloyannis E, et al. Advancements in the Management of Postoperative Air Leak following Thoracic Surgery: From Traditional Practices to Innovative Therapies. Medicina. 2024; 60(5):802. https://doi.org/10.3390/medicina60050802
Chicago/Turabian StyleLeivaditis, Vasileios, Konstantinos Skevis, Francesk Mulita, Christos Tsalikidis, Athanasia Mitsala, Manfred Dahm, Konstantinos Grapatsas, Athanasios Papatriantafyllou, Konstantinos Markakis, Emmanuel Kefaloyannis, and et al. 2024. "Advancements in the Management of Postoperative Air Leak following Thoracic Surgery: From Traditional Practices to Innovative Therapies" Medicina 60, no. 5: 802. https://doi.org/10.3390/medicina60050802