title: Improved application technique of albumin-glutaraldehyde glue for repair of superficial lung defects.
abstract: BACKGROUND
  Albumin-glutaraldehyde glue has gained widespread acceptance for treatment of alveolar air leaks (AAL) in thoracic surgery. As liquid run-off during application is detrimental to its sealing efficacy, we developed a modified technique and assessed it in vitro.
  
  
  METHODS
  Caudal lobes of freshly excised swine lungs (n = 20) were intubated and ventilated. A standardized focal superficial parenchymal defect (40 × 25 mm) was created on the inflated lung. AAL was assessed under exposure to increasing inspired tidal volume (TVi). Lung lobes were randomly selected and subjected to either a standard sealing suggested by the manufacturer (control group) or a modified technique relying on placement of a square silicone frame around the lesion site (study group). AAL was subsequently assessed until burst failure occurred and the occuring lesions length was recorded on the inflated lung to evaluate elasticity of underlying tissue.
  
  
  RESULTS
  Superficial parenchymal defects resulted in AAL increasing with ascending TVi. AAL prior to sealant application was comparable in both groups. An application error occurred once in our control group. At TVi = 400, 500, 600 and 700 ml, the albumin-glutaraldehyde glue achieved complete sealing in 10, 10, 9 and 8 lungs respectively in our study group, as opposed to 9, 7, 6 and 4 lobes in the control group. The required mean burst pressure was significantly higher in our study group (41.0 ± 1.0 vs. 37.5 ± 4.2 cmH2O, p = 0.0195), but there was no difference in expansion of covered defect between both groups (1.0 ± 0.4 vs. 1.5 ± 1.7 mm, p = 0.3772).
  
  
  CONCLUSIONS
  Our tests suggest that frame-assisted sealant application might prevent glue run-off and thus improves its sealing efficacy. We encourage further investigation of this technique in well-designed, controlled clinical trials.
authors: Department of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany.
authors: Maximilian
authors: M
authors: Bures
authors: Department of Cardiac and Thoracic Surgery, Otto-von-Guericke University Magdeburg, Magdeburg, Germany.
authors: Patrick
authors: P
authors: Zardo
authors: Department of Pathology, Hannover Medical School, Carl-Neuberg Str. 1, 30625, Hannover, Germany.
authors: Florian
authors: F
authors: Länger
authors: Department of Thoracic Surgery, Center for Pneumology and Thoracic Surgery, Chest Hospital Schillerhoehe, Teaching hospital of the University of Tuebingen, Gerlingen, Germany. zhang.ruoyu@yahoo.com.|Department of Thoracic Surgery, Center for Pneumology and Thoracic Surgery, Schillerhoehe Hospital, Solitudestr. 18, Gerlingen, Germany. zhang.ruoyu@yahoo.com.
authors: Ruoyu
authors: R
authors: Zhang
mesh_terms: D000287:Administration, Topical; D000388:Air; D000418:Albumins / Q000008:administration & dosage; D000818:Animals; D004195:Disease Models, Animal; D005976:Glutaral / Q000008:administration & dosage; D008168:Lung / Q000473:pathology; D055370:Lung Injury / Q000209:etiology / Q000628:therapy*; D011312:Pressure; D011506:Proteins / Q000008:administration & dosage*; D013510:Pulmonary Surgical Procedures / Q000009:adverse effects*; D013552:Swine; D014014:Tissue Adhesives / Q000008:administration & dosage*; D014945:Wound Healing
chemical_list: D000418:Albumins; C472676:Bio-glue; D011506:Proteins; D014014:Tissue Adhesives; D005976:Glutaral
keywords: Air leaks; Application; BioGlue; Lung; Sealant