Prospective randomized trial compares suction versus water seal for air leaks

Cerfolio, Robert J.; Bass, Cyndi; Katholi, Charles R.

doi:10.1016/s0003-4975(01)02474-2

Cited by 243 publications

(142 citation statements)

References 5 publications

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Section: Air Leakmentioning

confidence: 99%

“…Prolonged air leak is defined as a leak lasted more than 7 days after pulmonary resection. Cerfolio et al reported an incidence of 25% on postoperative day 1 and 20% on postoperative day 2 [5,6]. There are many techniques available to reduce parenchymal air leaks post-operatively and a variety of factors that influence any given patients propensity for developing an air leak.…”

Section: Air Leakmentioning

confidence: 99%

“…Cerfolio et al [19] published a randomized study in which chest tubes were continued on suction or placed to water seal on postoperative day 2. By postoperative day 3 the leak had resolved in 67% of those on water seal, and only 7% on suction.…”

Section: Non-operative Managementmentioning

confidence: 99%

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Postlobectomy Early Complications

Ziarnik

Grogan

2015

Thoracic Surgery Clinics

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INTRODUCTIONThe most effective management of postoperative crises is prevention. This starts with preoperative preparation and patient screening. There are many factors that can be controlled and improved by the patient, including but not limited to, smoking cessation, cardiopulmonary rehab and teaching/setting peri-operative expectations. Equally as important is patient selection, which is influenced by pulmonary function tests, cardiopulmonary reserve, and pre-existing comorbidities. After the operation, the care team can also greatly improve outcomes with aggressive cardiopulmonary therapies, ambulation, vigilant monitoring and frequent assessments of the patient. Even when all of these guidelines are followed not all early complications can be avoided.A recent review of the National Cancer Database by Rosen et al found a 2.6% mortality from lobectomy [1]. Morbidity associated with lobectomy is 10% to 50%, and increases in the elderly [2]. The population being treated by thoracic surgeons continues to age and the complexity of the operations is increasing as neoadjuvant therapies become more prevalent. Early postoperative crises after lobectomy will occur, necessitating prompt and effective management strategies. The most common complications after pulmonary resection are listed below in Table 1, in this chapter we will focus on the early complications after lobectomy [3].For the purposes of this chapter we will define early post-operative crisis as those that develop within 48 hours of the operation. AIR LEAKProlonged air leak is the most common complication after pulmonary resection, with a reported incidence of 15-18% [4]. Prolonged air leak is defined as a leak lasted more than 7 days after pulmonary resection. Cerfolio et al reported an incidence of 25% on postoperative day 1 and 20% on postoperative day 2 [5,6] U.S. Department of Veterans AffairsPublic Access Author manuscript VA Author ManuscriptVA Author Manuscript VA Author Manuscript parenchymal air leaks post-operatively and a variety of factors that influence any given patients propensity for developing an air leak. Patient factors that increase risk of developing an air leak include emphysematous lungs, larger parenchymal resection and therefore less parenchymal apposition to chest wall, and inadequate drainage of air by thoracostomy tube(s). PREVENTION STRATEGIES1. Bronchial stump buttressing with a muscle flap. In patients with an infected pleural space or who are on chronic immunosuppression, coverage of the stump with vascularized muscle may prevent bronchial stump breakdown [7]. The intercostal muscle is an excellent coverage option and is harvested from the intercostal space upon entry into the chest at the level of the thoracotomy. It is important to plan ahead, as this muscle needs to be harvested prior to placing the rib spreader in an open operation to prevent crushing the vascular supply. Dissection is begun on the inferior rib and the muscle is mobilized using a periosteal elevator posteriorly to the paraspinous muscle. Attention is...

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Section: Air Leakmentioning

confidence: 99%

Section: Air Leakmentioning

confidence: 99%

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Postlobectomy Early Complications

Ziarnik

Grogan

2015

Thoracic Surgery Clinics

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“…Further, the use of suction has also historically, been associated with reduced patient mobilization, particularly if wall suction is used. On the other hand, the so called "no suction" or "alternate suction" approaches have been shown to be effective in some circumstances to reduce the duration of air leak (2,3,4), presumably by decreasing the air flow, whilst also favoring mobilization (since the patient is not attached to the wall suction). Nonetheless, the absence of suction makes this approach ineffective in case of medium to large air leaks (particularly in the presence of a large pneumothorax) (2) and to be associated with an increased risk of other complications (particularly pneumonia and arrhythmia) (5).…”

Section: Management Of Chest Tubes After Lung Resection a Suction Vsmentioning

confidence: 99%

Chest Tube Management after Surgery for Pneumothorax

Pompili

Salati

Brunelli

2017

Thoracic Surgery Clinics

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Key Points: management of chest tubes after lung resection; Suction vs. no suction; regulated suction; management of chest tube after surgery for pneumothorax; regulated suction and recurrence 2 Synopsis:There is scant evidence on the management of chest tubes after surgery for pneumothorax. Most of the current knowledge is extrapolated from studies performed on lung cancer patients.We reviewed the existing literature on this subject with particular focus on the effect of suction and no suction on the duration of air leak after lung resection and surgery for pneumothorax.Moreover, we discussed the role of regulated suction, which seems to provide some benefit in reducing pneumothorax recurrence after bullectomy and pleurodesis.Finally we provided a personal view on the management of chest tubes after surgery for pneumothorax. 3 Management of chest tubes after lung resection A. Suction vs. no suctionThere are relative pros and cons in using suction versus no suction.Theoretically, suction promotes pleura-pleural apposition favoring the sealing of air leak and certainly favoring the drainage of large air leaks. However, suction has also been shown to increase the flow through the chest tube proportional to the level of suction applied (1) and it is assumed that this increased airflow increases the duration of drainage. Further, the use of suction has also historically, been associated with reduced patient mobilization, particularly if wall suction is used. On the other hand, the so called "no suction" or "alternate suction" approaches have been shown to be effective in some circumstances to reduce the duration of air leak (2,3,4), presumably by decreasing the air flow, whilst also favoring mobilization (since the patient is not attached to the wall suction). Nonetheless, the absence of suction makes this approach ineffective in case of medium to large air leaks (particularly in the presence of a large pneumothorax) (2) and to be associated with an increased risk of other complications (particularly pneumonia and arrhythmia) (5). Table 1 summary of the findings of the randomized trials published on suction versus no suction in lung resection patients.As evident from the table, these trials yielded mixed results. Some authors found a benefit by using "water seal" (2,3,7), others did not find any difference between the two modalities (5,6). 4The lack of objective data for more sensitive measurement of air leak severity has prevented the standardization of studies, and even test and control groups within studies, resulting in a lack of accurate quantification and reproducibility. B. Regulated SuctionSome new electronic chest drainage systems are now able to measure the pleural pressure. There is scant evidence on the role of pleural pressure on the healing of the lung parenchyma after surgery and duration of air leak.A recent paper has shown that the difference between minimum pressure and maximum pressure calculated from measurements taken during the 6 th postoperative hour following lobectomy was associated with the...

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“…Treatment and outcome depend on the cause, the quality of the lung and the clinical status of the patients. Standard management involves prolonged chest tube drainage, placement of a Heimlich valve and sometimes pleurodesis [2][3][4]. Some intractable cases require surgical repair or pleural decortication [5].…”

Section: Introductionmentioning

confidence: 99%

Successful treatment of persistent postoperative air leaks following the placement of an endobronchial one-way valve

Conforti

Torre

Fieschi

et al. 2016

Monaldi Arch Chest Dis

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resection in pathological conditions of the lung involve a very large spectrum of available methods, from chest drainage and placement of Heimlich valves to surgical repair or pleural decortication. However, in some of these patients surgery may be contraindicated. This report describes an endobronchial approach to the control of marked and prolonged air leaks in four patients using a newly designed one-way airway valve (Pulmonx Corporation; Redwood City, Ca.USA) placed into the segmental bronchus that is the source of air leakage. As the device is a one-way inspiratory airway blocker, it can be used to control persistent air leaks while maintaining the drainage of mucus. This approach potentially provides an effective nonsurgical and minimally invasive alternative addition to the armamentarium of treatments for patients who suffer with persistent post-operative air leaks where other methods have failed or in frail patients who are categorised as a high surgical risk.

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Prospective randomized trial compares suction versus water seal for air leaks

Cited by 243 publications

References 5 publications

Postlobectomy Early Complications

Postlobectomy Early Complications

Chest Tube Management after Surgery for Pneumothorax

Successful treatment of persistent postoperative air leaks following the placement of an endobronchial one-way valve

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