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Original Research: Disorders of the Pleura |

Pleural Hypercarbia After Lung Surgery Is Associated With Persistent Alveolopleural Fistulae

Ankit Bharat, MD; Nicole Graf, CNP; Andrew Mullen, PA; Jacob Kanter, BS; Adin-Cristian Andrei, PhD; Peter H.S. Sporn, MD; Malcolm M. DeCamp, MD; Jacob I. Sznajder, MD
Author and Funding Information

FUNDING/SUPPORT: Dr Bharat is supported by HL-125940, and Dr Sznajder is supported by HL-48129 and HL-85534.

CORRESPONDENCE TO: Ankit Bharat, MD, Department of Surgery, Northwestern Medicine, 676 N. Saint Clair St, Ste 650, Chicago IL 60611


Copyright 2016, American College of Chest Physicians. All Rights Reserved.


Chest. 2016;149(1):220-227. doi:10.1378/chest.15-1591
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Background  Persistent air leak (PAL) > 5 days due to alveolopleural fistulae is a leading cause of morbidity following surgical resection. Elevated CO2 levels reportedly inhibit alveolar epithelial cell proliferation and impair wound healing in vitro. Because the injured lung surface is in direct communication with the pleural cavity, we investigated whether the pleural gaseous milieu affected lung healing.

Methods  Oxygen and CO2 levels in pleural gas were determined prospectively in consecutive patients (N = 116) undergoing lung resection by using an infrared spectroscopy-based analyzer. Poisson and logistic regression analyses were used to determine the relationship between time to resolution of air leaks and pleural oxygen and CO2. In addition, patients with pleural CO2 concentrations ≥ 6% on postoperative day 1 (n = 20) were alternatively treated with supplemental oxygen and extrapleural suction to reduce the pleural CO2 levels.

Results  Poisson analyses revealed that every 1% increase in CO2 was associated with a delay in resolution of air leak by 9 h (95% CI, 7.1 to 10.8; P < .001). Linear regression showed that every 1% increase in CO2 increased the odds of PAL by 10-fold (95% CI, 2.2 to 47.8; P = .003). In patients with pleural CO2 ≥ 6%, a reduction in CO2 promoted resolution of air leak (6.0 ± 1.2 vs 3.4 ± 1.1 days; P < .001).

Conclusions  Pleural hypercarbia seems to be associated with persistent alveolopleural fistulae following lung resection. Analysis of pleural gases could allow for better chest tube management following lung resection. Patients with intrapleural hypercarbia seem to benefit from supplemental oxygen and suction, whereas patients who do not have hypercarbia can be maintained on water seal drainage.

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