Evidence-based suggestions for management of air leaks.
The management of postoperative alveolar air leaks (AALs) continues to challenge thoracic surgeons. AALs increase length of stay and health care costs, and likely lead to other postoperative complications. Staple line buttresses, topical sealants, pleural tents, pneumoperitoneum, and modifications of traditional chest tube management (ie, reduced suction) have all been proposed to help reduce AAL. However, the cost of some of the commercial products being marketed may outweigh their relative effectiveness, and some of these techniques and products have not been adequately studied to date. This article provides a review of the available evidence-based literature that addresses the efficacy of the options currently available to prevent and manage AALs. Management suggestions based on this literature are presented.
Merritt
Robert E
RE
Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford Medical Center, 2nd floor Falk Building, 300 Pasteur Drive, Stanford, CA 94305, USA. rmerritt@stanford.edu
Singhal
Sunil
S
Shrager
Joseph B
JB
D001804:Blood Transfusion, Autologous / Q000379:methods; D006801:Humans; D010996:Pleural Effusion / Q000628:therapy*; D011030:Pneumothorax / Q000628:therapy*; D011182:Postoperative Care; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology; D012307:Risk Factors; D017792:Surgical Stapling