Predictors of alveolar air leaks.
Persistent air leaks are caused by the failure of the postoperative lung to achieve a configuration that is physiologically amenable to healing. The raw pulmonary surface caused by the dissection of the fissure often is separated from the pleura, and the air leak fails to close. Additionally, higher air flow thorough an alveolar-pleural fistula seems to keep the fistula open. Other factors that interfere with wound healing, such as steroid use, diabetes, or malnutrition, can result in persistence of the leak. A thoracic surgeon can minimize the incidence of air leak through meticulous surgical technique and can identify patients in whom the balance of risks (Table 1) and benefits warrant operative intervention based on an understanding of the underlying pathophysiology.
Loran
David B
DB
Division of Cardiothoracic Surgery, Department of Surgery, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX 77555-0528, USA.
Woodside
Kenneth J
KJ
Cerfolio
Robert J
RJ
Zwischenberger
Joseph B
JB
D000388:Air; D005260:Female; D006801:Humans; D008297:Male; D011013:Pneumonectomy / Q000009:adverse effects* / Q000379:methods; D011030:Pneumothorax / Q000453:epidemiology* / Q000209:etiology; D011183:Postoperative Complications / Q000453:epidemiology*; D011237:Predictive Value of Tests; D015995:Prevalence; D011379:Prognosis; D018570:Risk Assessment; D013908:Thoracotomy / Q000009:adverse effects / Q000379:methods