PURPOSE: Air leak following pulmonary resection accounts for higher morbidity, and is the most important cause of delayed hospital discharge. It has been proposed that successful aerostasis will result in increased patient comfort, lower rate of complications and decreased hospitalization and cost. In a preliminary study we studied the use of human fibrin sealant (Evicel) in attaining aerostasis following pulmonary resection. This retrospective study was performed as a pilot for a larger multi-institutional prospective randamized trial.
METHODS: Following pulmonary resection (Evicel) which consists of human nanofiltered thrombin and fibrinogen was applied to the pulmonary and bronchial staple lines. The two agents were mixedusing a spray system with 45psi pressure in order to form fibrin on the tissue surface. The presence of an air leak was recorded immediately postop and daily by the same observer until the removal of the chest tubes. The air leak was not quantitated but recorded as a negative or positive observation. The results were compared to previously published historic data in a similar group of patients.
RESULTS: From 1/05 until 1/07, 74 patients underwent lung resection followed by application of human fibrin (Evicel). There were 30 lobectomies, and 44 sublobar resections. Results are summerized below: AIR LEAK: PostOp (90% w/o sealnt vs. 5% w/ sealant p<0.05),Day 1(90% w/o sealant vs. 4% w/ sealant, p<0.05),Day 3 (50% w/o sealant vs. 4% w/ sealant, p<0.05), Day 7 (15% w/o sealant vs. 1% w/ sealant, p<0.05).
CONCLUSION: The use of human fibrin (Evicel) as a sealant for pulmonary and bronchial staple lines results in superior aerostasis. These preliminary results should serve as the basis for a more complete muti-institutional randomized prospective trial.
CLINICAL IMPLICATIONS: Successful aerostasis following pulmonary resection should result in greater patient comfort, lower complications, shorter hospitalization and lower overall cost. Human fibrin sealant may represent an excellent means of achieving aerostasis.
DISCLOSURE: Barbara Tempesta, No Financial Disclosure Information; No Product/Research Disclosure Information