The typically utilized 5-day cut off to define PAL is based on the expected length of stay after lobectomy. Such persistent leaks often require additional treatment beyond chest tube drainage and time.ĭefinition and etiology of persistent air leak (PAL)Ī PAL is arbitrarily defined as an air leak that lasts longer than 5–7 days ( 2, 4- 6), although some authors suggest that an air leak in the setting of secondary spontaneous pneumothorax should be called persistent after more than 48 hours ( 7, 8). Although most air leaks resolve spontaneously with conservative management ( 2), some leaks are prolonged and contribute to significant morbidity ( 3, 4). The former is the more prevalent entity and it is the one we will focus on in this manuscript. An air leak is defined as the flow of air into the pleural space, generally through a fistulous tract either in the periphery of the lung (alveolar-pleural fistula) or in the more central airways (bronchopleural fistula). Pneumothorax caused by an abnormal connection between the bronchial or alveolar spaces and the pleura is sometimes associated with an air leak. Air is able to enter the pleural space due to a connection between alveolar or bronchial spaces and the pleura, due to communication between the atmosphere and the pleural space, or due to gas forming organisms present in the pleural space ( 1). Pneumothorax is defined as the presence of air in the pleural space between the visceral and parietal pleura ( 1). Keywords: Persistent air leak (PAL) bronchopleural fistula (BPF) alveolar-pleural fistula intrabronchial valves (IBVs) pleurodesis The following article will review the basic principles of management of PAL particularly focusing on bronchoscopic techniques. Future comparative trials are needed to refine our understanding of the indications, effectiveness, and complications of bronchoscopic techniques for treating PAL. Recently, removable one-way valves have been developed that are able to be placed bronchoscopically in the affected airways, ameliorating air-leaks in patients who are not candidates for surgery. These techniques include bronchoscopic use of sealants, sclerosants, and various types of implanted devices. More recently numerous bronchoscopic procedures have been introduced to treat PAL in those patients who are poor candidates for surgery or who decline surgery. Surgical management and medical pleurodesis have long been the usual treatments for PAL. Although conservative treatment with chest drain and observation is usually effective, other invasive techniques are needed when conservative treatment fails. Its management can be complex and challenging. Interviews with Outstanding Guest EditorsĪbstract: Persistent air leak (PAL) is a cause of significant morbidity in patients who have undergone lung surgery and those with significant parenchymal lung disease suffering from a pneumothorax.Policy of Dealing with Allegations of Research Misconduct.Policy of Screening for Plagiarism Process.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |