Management of Prolonged Air-Leak

Abstract

Prolonged air leak (PAL), which refers to air leakage that lasts longer than normal after thoracostomy tube drainage, is a common complication in thoracic surgery. It can occur in patients who undergo pulmonary lobectomy, lung volume reduction surgery (LVRS), or surgery for primary spontaneous pneumothorax (PSP). PAL is caused by impaired healing of disrupted alveoli, resulting in alveolapleural fistula. Risk factors for PAL include male sex, chronic obstructive pulmonary disease (COPD), lower forced expiratory volume in 1 second (FEV1), history of smoking, chronic steroid use, diabetes mellitus, right upper lobectomy (RUL), pleural adhesions, and incomplete fissures. Lower diffusing capacity of lung for carbon monoxide and lower FEV1, marked pleural adhesions, and upper lobe/diffuse emphysema are risk factors for PAL in LVRS patients. Air leakage delays healing and inhibits lung expansion, leading to worsening of pneumothorax. Underweight patients with lower body mass index (BMI) are more likely to experience PAL, possibly due to lower nutritional status and poor wound healing. A scoring system based on risk factors can help predict PAL. Overall, PAL management is an important aspect of thoracic surgery and requires careful attention to prevent complications and ensure successful outcomes. © 2021 Akademisyen Kitabevi A.Ş. All rights reserved.