PUB148 Efficacy of Heimlich Valve in Preventing Air Leaks

Abstract

One of the most common complications after a lung reduction surgery is prolonged air leak. This is a prospective study, which reports the routine use of Hiemlich valve and its impact on total hospital stay and a reoperation for a persistent leak. This article evaluates a type of treatment for air leaks using Hiemlich valves; the results also show a prospective algorithm for treatment of persistent air leaks. From September 2005, through November 2011, 150 patients were operated for elective pulmonary resection, which had a heterogenous pattern of lung disease, with post-operative mortality of 4 patients and average duration of total length of hospital stay of 10.61 days. Bilateral Hiemlich valves were applied to 18 patients, and unilateral Hiemlich valves in 132 patients. Dyspnea increased in 10 patients after switching to Heimlich valve and they were resumped on chest drainage with suction.Use of Heimlich valve was done irrespective of size of air leak. Grading of air leak was done as small defined if an occasional bubble was seen; moderate when frequent bubbles were seen or large if the bubbles were continuous in the water seal chamber. X-rays were obtained in patients after Hiemlich valve was placed which showed minimal size of air leak. Patients did not develop dyspnea after placement of Hiemlich valve. Follow up x-rays in all of the cases after removal of Hiemlich valve showed completely resolved apical air spaces. Mean number of postoperative days to placement of the Hiemlich valve was 7.2 ± 2.4. The mean number of days to postoperative discharge was 8.1 ± 1.6(range5 to 16) and the mean number of days after discharge until removal of the chest tubes and the Hiemlich valves was 3.61 ± 1.4(range 0, to 26). Almost all patient tolerated Hiemlich valve well after discharge. The average hospital stay was shortened by 56% with the use of Hiemlich valve in patients who underwent lung reduction surgery, considering the fact that all these patients would have stayed in the hospital, till the removal of their chest tube. The mean length of hospital stay was 11 days. The reduced hospital stay has certainly been caused by the use of Hiemlich valve. It is advisable to put chest drainage system to Hiemlich valves, as early as the third post-operative day. This eventually helps in providing better patient care.