Predictors and treatment of persistent air leaks.
BACKGROUND
Air leaks prolong hospital stay.


METHODS
A prospective algorithm was applied to patients. If patients were ready for discharge but still had an air leak, a Heimlich valve was placed and they were discharged. If the leak was still present after 2 weeks, the tube was clamped for a day and removed.


RESULTS
There were 669 patients. Factors that predicted a persistent air leak were FEV1% of less than 79% (p = 0.006), history of steroid use (p = 0.002), male gender (p = 0.05), and having a lobectomy (p = 0.01). Types of air leaks on day 1 that eventually required a Heimlich valve were expiratory leaks (p = 0.02), leaks that were an expiratory 4 or more (p < 0.0001), and the presence of a pneumothorax concomitant with an air leak (p < 0.0001). Thirty-three patients were placed on a Heimlich valve, and 6 patients had a pneumothorax or subcutaneous emphysema develop; all patients had an expiratory 5 leak or larger (p < 0.0001). Thirty-three patients went home on a valve. Seventeen patients had leaks that resolved by 1 week, 6 by 2 weeks, and the remaining 9 had their tubes removed without problems.


CONCLUSIONS
Steroid use, male gender, a large leak, a leak with a pneumothorax, and having a lobectomy are all risk factors for a persistent leak. Discharge on a Heimlich valve is safe and effective for patients with a persistent leak unless the leak is an expiratory 5 or more. Once home on a valve, most air leaks will seal in 2 weeks; if not, chest tubes can be safely removed regardless of the size of the leak or the presence of a pneumothorax.
Cerfolio
Robert J
RJ
Department of Biostatistics, University of Alabama at Birmingham, 35294, USA. Robert.cerfolio@ccc.uab.edu
Bass
Cynthia Sale
CS
Pask
Amanda Harrison
AH
Katholi
Charles R
CR
D000388:Air; D000465:Algorithms; D005260:Female; D006801:Humans; D008297:Male; D011013:Pneumonectomy / Q000009:adverse effects*; D011030:Pneumothorax / Q000453:epidemiology / Q000628:therapy*; D011379:Prognosis; D011446:Prospective Studies