title: Management of Persistent Air Leaks.
abstract: Alveolar-pleural fistulas causing persistent air leaks (PALs) are associated with prolonged hospital stays and high morbidity. Prior guidelines recommend surgical repair as the gold standard for treatment, albeit it is a solution with limited success. In patients who have recently undergone thoracic surgery or in whom surgery would be contraindicated based on the severity of illness, there has been a lack of treatment options. This review describes a brief history of treatment guidelines for PALs. In the past 20 years, newer and less invasive treatment options have been developed. Aside from supportive care, the literature includes anecdotal successful reports using fibrin sealants, ethanol injection, metal coils, and Watanabe spigots. More recently, larger studies have demonstrated success with chemical pleurodesis, autologous blood patch pleurodesis, and endobronchial valves. This manuscript describes these treatment options in detail, including postprocedural adverse events. Further research, including randomized controlled trials with comparison of these options, are needed, as is long-term follow-up for these interventions.
authors.affiliation: Department of Medicine, Section of Pulmonary and Critical Care, University of Chicago, Chicago, IL.
authors.forename: Karen C
authors.initials: KC
authors.lastname: Dugan
authors.affiliation: Department of Medicine, Section of Pulmonary and Critical Care, University of Chicago, Chicago, IL.
authors.forename: Balaji
authors.initials: B
authors.lastname: Laxmanan
authors.affiliation: Department of Medicine, Section of Pulmonary and Critical Care, University of Chicago, Chicago, IL.
authors.forename: Septimiu
authors.initials: S
authors.lastname: Murgu
authors.affiliation: Department of Medicine, Section of Pulmonary and Critical Care, University of Chicago, Chicago, IL. Electronic address: dhogarth@uchicago.edu.
authors.forename: D Kyle
authors.initials: DK
authors.lastname: Hogarth
mesh_terms: D000388:Air; D015505:Chest Tubes; D002908:Chronic Disease; D005260:Female; D006801:Humans; D008171:Lung Diseases / Q000150:complications / Q000628:therapy*; D008297:Male; D010995:Pleural Diseases / Q000150:complications / Q000628:therapy*; D018700:Pleurodesis / Q000295:instrumentation / Q000379:methods; D011030:Pneumothorax / Q000209:etiology; D017410:Practice Guidelines as Topic; D016156:Respiratory Tract Fistula / Q000150:complications / Q000628:therapy*; D012307:Risk Factors; D012737:Sex Factors
keywords: bronchopleural fistula; persistent air leak; pneumothorax