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Review
. 2017 Aug;152(2):417-423.
doi: 10.1016/j.chest.2017.02.020. Epub 2017 Mar 4.

Management of Persistent Air Leaks

Karen C Dugan  1 , Balaji Laxmanan  1 , Septimiu Murgu  1 , D Kyle Hogarth  2
Affiliations
Review

Management of Persistent Air Leaks

Karen C Dugan et al. Chest. 2017 Aug.

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.

Keywords: bronchopleural fistula; persistent air leak; pneumothorax.

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Comment in

  • Persistent Air Leaks.
    Eberlein M, Reed RM, Redwan B, Bolukbas S. Eberlein M, et al. Chest. 2017 Aug;152(2):449-450. doi: 10.1016/j.chest.2017.03.060. Chest. 2017. PMID: 28797391 No abstract available.
  • Response.
    Dugan KC, Laxmanan B, Murgu S, Hogarth DK. Dugan KC, et al. Chest. 2017 Aug;152(2):450. doi: 10.1016/j.chest.2017.04.165. Chest. 2017. PMID: 28797392 No abstract available.
  • Pleurodesis.
    Acton V. Acton V. Chest. 2017 Dec;152(6):1351-1352. doi: 10.1016/j.chest.2017.05.048. Chest. 2017. PMID: 29223264 No abstract available.
  • The Surgical Point of View About Persistent Air Leaks: Prevention First!
    Venuta F, Mantovani S, Diso D, Poggi C, Anile M. Venuta F, et al. Chest. 2017 Dec;152(6):1352-1353. doi: 10.1016/j.chest.2017.09.051. Chest. 2017. PMID: 29223266 No abstract available.

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