Management of residual pleural space and air leaks after major pulmonary resection

Abstract

Abstract Postoperative air leaks associated with residual pleural space is a well known complication contributing to prolong hospitalization. Many techniques have been proposed for the treatment of this complication. Between 1999 and 2009, 39 patients with air leaks associated with residual pleural space ()3 cm at chest X-ray) persisting over three days after major lung resection were enrolled in this study. All patients were treated with combined pneumoperitoneum and autologus blood patch. Pneumoperitoneum is obtained by the injection of 30 mlykg of air under the diaphragm, using a Verres needle through the periumbilical area. The blood patch is obtained by instillating 100 ml of autologus blood through the chest tubes. No patients experienced complications related to the procedure. Obliteration of pleural space was obtained in all the patients at a maximum of 96 h postoperatively. Air leaks stopped in all the cases at a maximum of 144 h from surgery. Chest tube was removed 24 h after the air leakage disappearance. Our 10-year experience supports the early, combined use of pneumoperitoneum and blood patch whenever pleural space and air leaks present after major pulmonary resection. This approach may be recommended because of its easiness, safety, effectiveness, and the low costs. 2010 Published by European Association for Cardio-Thoracic Surgery. All rights reserved. Keywords: Pleural space; Air leaks; Pneumoperitoneum; Blood patch 1. Introduction The occurrence of residual pleural space associated with air leaks after major lung resection is a well known complication experienced by all surgeons in the thoracic community. Improvements in surgical techniques and instrumentation have contributed to reduce the incidence of this complication over the last decades. Conservative approaches include prolonged period of drainage, physiotherapy, pleurodesis with various agents (tetracycline, quanacrine, talcum, silver nitrate), and the use of Heimlich valve w1– 6x. The persistence of parenchymal air leaks and of residual pleural space may promote the occurrence of further serious complications, and especially of pleural infections. This determines longer hospitalization and increased patients’ discomfort w7x; furthermore, in patients with lung cancer, it may have a detrimental effect on the oncologic treatment, delaying adjuvant chemotherapy andyor radiotherapy. This report describes our experience with the sequential application of pneumoperitoneum w8, 9x and blood patch w10–13x in 39 patients with residual pleural space associated with air leaks persisting over three days after major pulmonary resections for lung cancer