Air Leak After Pulmonary Resection [Thoracic Surg. Clinics, 20] (Elsevier, 2010) WW

98 Pages·2010·3.8 MB·English

Preface
Air Leak After
Pulmonary Resection

Alessandro Brunelli, MD
Guest Editor

Despite recent progress in surgical technique and
improved perioperative care, prolonged air leak
remains a frequent complication after pulmonary
resection. Several studies have shown that air leak
andingeneralchesttubemanagementarethemajor
factors influencing duration of hospital stay and
postoperative costs.
This issue of Thoracic Surgery Clinics is devoted
to the prevention and management of air leak after
pulmonary surgery. A preliminary overview of the
physics and dynamics of the pleural space is
provided in the first article to put in context all
the preventative measures or treatments dis-
cussed in the following articles. In particular, the
relationships between intrapleural pressure, intra-
pulmonary and pleural fluid filtration, and lung re-
expansion are discussed in detail. The concept
of passive suction versus active suction applied
to chest tubes is also introduced to explain the
negative pressure exerted by gravity in contrast
to the one applied by external pumps.
The next article focuses on risk factors of pro-
longed air leak. Different risk scores are provided
that can assist clinicians and researchers to stratify
the risk of prolonged air leak in lung resection candi-
dates. The subsequent articles discuss different
measures that can be used to prevent or treat this
complication: surgical techniques, such as the fis-
sureless lobectomy; intraoperative measures, such
as pleural tent or pneumoperitoneum; use of

sealants or buttressing material; and postoperative
rescue strategies, such as blood patching, chemical
pleurodesis, or use of endobronchial valves.
The second part of the volume is dedicated to
the postoperative management of chest tube,
with a particular emphasis on the use of new digi-
talized systems and portable devices that have the
potential to streamline and standardize postopera-
tive practice and facilitate fast-track policies. One
article
is
dedicated
to
the
occurrence
and
management of air leak in special situations,
such as patients with end-stage emphysema
submitted to lung volume reduction surgery or
those mechanically ventilated. The final article
appropriately wraps up this issue of Thoracic
Surgery Clinics summarizing in an evidence-based
format the different treatment options in the
management of air leak.
I hope the outstanding contributions collected in
this issue will be valuable information that can be
used in daily clinical practice and form the basis
of future investigations.

Alessandro Brunelli, MD
Division of Thoracic Surgery
Umberto I Regional Hospital, Ospedali Riuniti
Ancona 60020, Italy

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