PURPOSE: Persistent air leak (PAL, >7 days) is one of the most frequent complications after lung resection and significatively prolongs hospital stay. Its occurrence remain impredictable, as no evident predictive factor has been identified yet. The study hypothesis was that postoperative digital recording of air leaks may help in identifying new PAL predictors.
METHODS: Air leaks from a consecutive series of 50 patients undergoing pulmonary resection was monitored by the use of a digital chest drainage system (DigiVent®, Millicore AB, Sweden). Patients were divided in two groups, according to the presence (group A) or absence (group B) of PAL. Preoperative (sex, age, smoking status, FEV1, induction treatment), intraoperative (pleural adhesions, procedure of fissure completion, type of resection, use of aerostatic device) and postoperative variables (median air leak expressed in ml/min on each postoperative day, POD, amount of maximal intrapleural negative pressure, patterns of air leak) were compared between groups.
RESULTS: Postoperative PAL was recorded in 15 out of the 51 patients enrolled in the study (29.4%). None of the examined variables resulted as being significant at univariate analysis. By serendipity, it was noted that none of the patients presenting a rapid deflection in the maximal intrapleural pressure (defined as the “pleural swoop” sign, n=9) had PAL (p 0.04). Considering patients having air leak on POD3 (n= 24), the “pleural swoop” sign was the only predictor of air leak resolution within POD7 (OR 2.6, CI 1.8-3.9).
CONCLUSIONS: The absence of the “pleural swoop” sign during the first 96 postoperative hours allows to define patients likely to develop PAL.
CLINICAL IMPLICATIONS: This information, if confirmed, may improve standardization in chest tube management after lung resection.
DISCLOSURES: No Financial Disclosure Information; No Product/Research Disclosure Information.