Incidence Of Air Leak Research Articles

Incidence of air leaks in patients undergoing robotic thoracic surgery and video-assisted thoracic surgery.

Postoperative air leakage is the most common complication in surgery for malignant lung tumors, leading to extended hospital stays and substantial medical expenses. This study aimed to identify the incidence and characteristics of intraoperative and postoperative air leaks in both robotic-assisted thoracic surgery (RATS) and video-assisted thoracic surgery (VATS), as well as the causes of persistent air leakage following RATS. We conducted a retrospective analysis of patients who underwent lung resection for malignant lung tumors at our institution from October 2018 to August 2022. We compared the incidence rates of intraoperative air leak, postoperative air leak, and persistent air leak between patients who underwent RATS and those who underwent VATS. Background factors were adjusted using propensity score matching. A subanalysis was performed to compare unexpected air leaks, defined as air leaks not observed intraoperatively but confirmed postoperatively. The study included 295 cases of RATS and 227 cases of VATS. In both the overall population and the matched group (187 cases each for RATS and VATS), RATS demonstrated a significantly higher incidence of persistent air leaks compared to VATS (11% vs 3%, p < 0.01; 9% vs 3%, p = 0.02, respectively). RATS also had a significantly higher incidence of unexpected air leaks compared with VATS (29% vs 18%, p = 0.05). Although there was no statistically significant difference in hospital stays, RATS showed a higher incidence of postoperative persistent air leaks and unexpected postoperative air leaks than VATS.

RAM Cannula Versus Bi-Nasal Prongs as Respiratory Device Interfaces in Neonates of Thirty-Two or More Weeks of Gestation With Respiratory Distress: The First "ProRAM" Randomized Trial Report.

Using bilateral short nasal prongs as an interface for noninvasive respiratory support is challenging, and it is associated with nasal injury. We aimed to compare RAM cannula with nasal prongs in delivering noninvasive ventilation to newborn infants. This is a single-center randomized trial (trial registry: ISRCTN10561691). The setting involves a tertiary neonatal unit with a capacity of 30 beds and more than 13 years of experience in neonatal noninvasive ventilation. We included 50 infants born at ≥ 32 weeks of gestation, who had respiratory distress at birth. We excluded those with major congenital anomalies and those who required intubation in the delivery room. Primary outcomes were intubation rate and use of noninvasive positive-pressure ventilation (NIPPV); other outcomes included air leak and nasal injury rate. The infants were assigned using randomly generated numbers into bi-nasal prong and RAM canula groups in a 1:1 ratio. Two and four babies in the RAM and prong groups, respectively, were upgraded to NIPPV (P = 0.600). One versus no baby in the RAM vs. prong groups was intubated (P = 1.000). Newborns in the prong group required oxygen support for a longer period (mean duration: 154.6 ± 255.2 h) than those in the RAM group (40.7 ± 72.6 h, P = 0.030). None of the patients in the RAM group had traumatic nasal injury compared to five babies in the prong group (P = 0.050). Four babies in our study developed air leaks, with two in each group. The use of RAM cannula in delivering noninvasive ventilation to newborns ≥ 32 weeks of age did not affect the noninvasive ventilation failure rate or incidence of air leak. The use was associated with a shorter duration of respiratory support and a reduced risk of nasal septal injury.

Video assisted thoracoscopic surgery vs thoracotomy in management of post traumatic retained hemothorax: a randomized study

BackgroundRetained hemothorax is a serious problem that can lead to empyema or fibro-thorax. Evacuation of the retained hemothorax is commonly performed via open thoracotomy. This randomized study was conducted to represent our center's expertise with this issue, we compared the outcomes of video-assisted thoracoscopic surgery (VATS) against open thoracotomy in managing post-traumatic retained clotted hemothorax.MethodsThis prospective randomized research was conducted on sixty cases with posttraumatic remaining clots of at least 500 ml or at least one-third of haemothorax that cannot be evacuated by a chest tube after 72 h of first intervention, as detected by computed tomography imaging who underwent open thoracotomy or VATS in the management of posttraumatic retained clotted hemothorax. Cases were allocated to equal groups; group A: cases who underwent VATS and group B: cases who underwent open thoracotomy.ResultsPreoperative intercostal chest tube (ICT) placement period was insignificantly different between the two groups. Group A had a significantly lesser post-operative amount of ICT drainage, and ICT was removed after significantly fewer days than in group B (P value < 0.001). Post-operatively, the numerical rating scale (NRS) was significantly higher at post-extubation and 6 h after extubation in group B than group A (P value < 0.05) and was insignificantly different between both groups the next morning, after chest tube removal and before discharge. group A had statistically better NRS versus group B (P value < 0.001). Wound infection incidence was significantly less in group A compared to group B (P value = 0.025); the incidence of air leak was insignificantly different between both groups. Group A has significantly shorter hospitalization than group B (P value < 0.001). Wound infection and empyema in outcases were insignificantly different between both groups (P value = 0.492). Cases in group A returned to normal activity earlier than group B (P value < 0.001).ConclusionsVATS in managing posttraumatic retained hemothorax was a more effective, well-tolerated, and reliable intervention that can be easily utilized for managing posttraumatic retained hemothorax in comparison to open thoracotomy.

Incidence of Air Leaks in Critically Ill Patients with Acute Hypoxemic Respiratory Failure Due to COVID-19.

Subcutaneous emphysema, pneumothorax and pneumomediastinum are well-known complications of invasive ventilation in patients with acute hypoxemic respiratory failure. We determined the incidences of air leaks that were visible on available chest images in a cohort of critically ill patients with acute hypoxemic respiratory failure due to coronavirus disease of 2019 (COVID-19) in a single-center cohort in the Netherlands. A total of 712 chest images from 154 patients were re-evaluated by a multidisciplinary team of independent assessors; there was a median of three (2-5) chest radiographs and a median of one (1-2) chest CT scans per patient. The incidences of subcutaneous emphysema, pneumothoraxes and pneumomediastinum present in 13 patients (8.4%) were 4.5%, 4.5%, and 3.9%. The median first day of the presence of an air leak was 18 (2-21) days after arrival in the ICU and 18 (9-22)days after the start of invasive ventilation. We conclude that the incidence of air leaks was high in this cohort of COVID-19 patients, but it was fairly comparable with what was previously reported in patients with acute hypoxemic respiratory failure in the pre-COVID-19 era.

The role of new staplers in reducing the incidence of air leak.

Surgical staplers play an important role in the contemporary minimally invasive thoracic surgery including resection of lung tissue. However, staple line failure resulting in postoperative air leaks is a common complication after lung surgery, that if persist more than five days are defined as prolonged air leaks (PALs). PALs are associated with increased length of stay, patient morbidity and mortality, and hospital costs. To reduce the incidence of PALs, stapler devices underwent in the last years ongoing development aimed at improving device-to-tissue interaction. This clinical practice review explores the most important aspects of the evolution of surgical staplers, based on the review of the available literature. Modern staple cartridges entail small bumps to engage tissue and minimize tissue movement during compression and firing. Staplers with graduated staple heights are advocated to generate less stress on tissue during compression and clamping, thus affording greater perfusion into the staple line. However, air leaks may occur from an appropriate staple line with complete pleural coverage and perfusion due to enlarged staple canals after lung inflation, particularly in case of emphysema. To buttress staple line, thus prevent air leaks in high-risk patients, several types of tissue coverage (bovine pericardium, polytetrafluoroethylene, knitted calcium alginate, bioabsorbable polyglycolic acid) have been successfully developed in the last years. Finally, the most advanced stapler technology is represented by the new energy powered staplers, able to eliminate the manual firing force, monitor tissue compression during firing, and making automatic adjustments to optimize the staple line.

Incidence of radiographic pulmonary abnormalities after posterior spinal fusion surgery for pediatric scoliosis.

Pulmonary complications are the most common non-neurologic complications following surgical correction of scoliosis. These can affect postoperative recovery by increasing the length of stay and/or the need for ventilatory support. The aim of this retrospective study is to determine the incidence of radiographic abnormalities reported in chest radiography after posterior spinal fusion surgery for the treatment of scoliosis in children. A retrospective chart review of all patients who underwent posterior spinal fusion surgery in our center between January 2016 and December 2019 was attempted. Radiographic data including chest and spine radiographs were reviewed on the national integrated medical imaging system using medical record numbers for all patients in the 7 postoperative days. Seventy-six (45.5%) of the 167 patients developed radiographic abnormalities in the postoperative period. There was evidence of atelectasis in 50 (29.9%) patients, pleural effusion in 50 (29.9%) patients, pulmonary consolidation in 8 (4.8%) patients, pneumothorax in 6 (3.6%) patients, subcutaneous emphysema in 5 (3%) patients, and rib fracture in 1 (0.6%) patient. Four (2.4%) patients were noted to have an intercostal tube inserted postoperatively, three for treating pneumothorax, and one for pleural effusion. A large number of radiographic pulmonary abnormalities were encountered in children following surgical treatment of pediatric scoliosis. Although not all radiographic findings may be clinically significant, early recognition may guide clinical management. The incidence of air leak (pneumothorax, subcutaneous emphysema) was significant and could influence local protocol formulation with regards to obtaining immediate postoperative chest radiograph and intervention if clinically necessary.

Incidence of Air Leak in Stapled Versus Hand Sewn Pulmonary Resections

Postoperative air leak is a frequent complication after pulmonary resection. Different approaches have been used to control the incidence of air leaks after pulmonary resection. Objectives: To compare stapled pulmonary resection and hand-sewn, i.e. manual pulmonary resection for the incidence and duration of resolution of air leaks. Methods: This was a prospective comparative study, conducted from August 2019 to July 2020 in the Department of Thoracic Surgery Jinnah Postgraduate Medical Centre, Karachi. Patients indicated for pulmonary resection were randomized to either stapled pulmonary resection (Group A) or manually sutured (Group B) pulmonary resection and were followed till their discharge or resolution of air leak. Results: The total number of air leaks in group A was 9 (30%), out of which 8 (26.6%) resolved conservatively and only one (3.3%) required re-exploration and surgical intervention. The total number of air leaks in group B was 7 (25%), out of which 6 (21.4%) resolved conservatively and only one (3.5%) required re-exploration and surgical intervention. The difference was not significant in the incidence of air leak of both groups. Persistent air leak (PAL) was present in 5 (16.6%) patients in group A and 3 (10.7%) patients in group B. Conclusion: Our study suggests that both stapled pulmonary resection and manually sutured pulmonary resection techniques are comparable in terms of incidence of air leak and its resolution. Hence, the choice of technique should be based on parameters, including the technical aspects and surgeon's preference.

Air leaks in COVID-19.

Coronavirus disease 2019 (COVID-19) continues to create havoc and may present with myriad complications involving many organ systems. However, the respiratory system bears the maximum brunt of the disease and continues to be most commonly affected. There is a high incidence of air leaks in patients with COVID-19, leading to acute worsening of clinical condition. The air leaks may develop independently of the severity of disease or positive pressure ventilation and even in the absence of any traditional risk factors like smoking and un-derlying lung disease. The exact pathophysiology of air leaks with COVID-19 remains unclear, but multiple factors may play a role in their development. A significant proportion of air leaks may be asymptomatic; hence, a high index of suspicion should be exercised for enabling early diagnosis to prevent further deterioration as it is associated with high morbidity and mortality. These air leaks may even develop weeks to months after the disease onset, leading to acute deterioration in the post-COVID period. Conservative management with close monitoring may suffice for many patients but most of the patients with pneumothorax may require intercostal drainage with only a few requiring surgical interventions for persistent air leaks.

Outcomes of Nonvigorous Neonates Born through Meconium-Stained Amniotic Fluid after a Practice Change to No Routine Endotracheal Suctioning from a Developing Country.

The International Liaison Committee on Resuscitation (ILCOR) 2015 gave a weak recommendation based on low certainty of evidence against routine endotracheal (ET) suctioning in non-vigorous (NV) neonates born through meconium-stained amniotic fluid (MSAF) and suggested for immediate resuscitation without direct laryngoscopy. A need for ongoing surveillance post policy change has been stressed upon. This study compared the outcomes of NV MSAF neonates before and after implementation of the ILCOR 2015 recommendation. This was a prospective cohort study of term NV MSAF neonates who underwent immediate resuscitation without ET suctioning (no ET group, July 2018 to June 2019, n = 276) compared with historical control who underwent routine ET suction (ET group, July 2015 to June 2016, n = 271). Baseline characteristics revealed statistically significant higher proportion of male gender and small for gestational age neonates in the prospective cohort. There was no significant difference in the incidence of primary outcome of meconium aspiration syndrome (MAS) between the groups (no ET group: 27.2% vs ET group: 25.1%; p = 0.57). NV MSAF neonates with hypoxic ischemic encephalopathy (HIE) was significantly lesser in the prospective cohort (no ET group: 19.2% vs ET group: 27.3%; p = 0.03). Incidence of air leaks and need for any respiratory support significantly increased after policy change. In NV MSAF neonates with MAS, need for mechanical ventilation (MV) (no ET group: 24% vs ET group: 39.7%; p = 0.04) and mortality (no ET group: 18.7% vs ET group: 33.8%; p = 0.04) were significantly lesser. Current study from a developing country indicates that immediate resuscitation and no routine ET suctioning of NV MSAF may not be associated with increased risk of MAS and may be associated with decreased risk of HIE. Increased requirement of any respiratory support and air leak post policy change needs further deliberation. Decreased risk of MV and mortality among those with MAS was observed. · Not performing ET suction in NV MSAF infants is not associated with increase in the incidence of MAS.. · Initiating immediate resuscitation without ET suctioning was associated with decreased risk of HIE but increased receipt of any respiratory support and air leak.. · Large multicentric trial is required to generate robust evidence..

Application of ERAS Protocol after VATS Surgery for Chronic Empyema in Immunocompromised Patients

Enhanced recovery after surgery protocols have shown improved clinical outcomes after lung resection surgery, but their application after empyema surgery is still limited. We retrospectively evaluated the outcomes of an adapted enhanced recovery after surgery (ERAS) protocol for immunocompromised patients who underwent video-assisted thoracoscopic surgery (VATS) surgery for chronic empyema between December 2013 and December 2021. The patients were divided into an ERAS group and a conventional treatment group. Peri-operative data were collected and compared between the two groups. The primary outcome was post-operative length of stay. Secondary outcomes were post-operative pain and post-operative complications (air leaks, atelectasis). A total of 86 patients, 45 in the ERAS group and 41 in the non-ERAS group, were considered. Chest tube duration (6.4 ± 2.3 vs. 13.6 ± 6.8 days) and post-operative length of stay (7.6 ± 1.6 vs. 16.9 ± 6.9 days) were significantly shorter in the ERAS group. The volume of chest drainage (103 ± 78 vs. 157 ± 89 mL/day) was significantly smaller in the ERAS group. There were no significant differences in operative time, blood loss, need for transfusion, tube reinsertion and median VAS score. The incidence of air leaks and atelectasis was significantly reduced in the ERAS group, as was the need for bronchoscopic aspiration. The application of an ERAS protocol after empyema VATS surgery for immunocompromised patients improved the surgical outcome, reducing the post-operative length of stay and rate of complications.

Risk Factors, Clinical Characteristics, and Outcome of Air Leak Syndrome in COVID-19: A Systematic Review.

IntroductionAir leak consisting of pneumothorax, pneumomediastinum, and subcutaneous emphysema has been described as one of the complications of coronavirus disease-2019 (COVID-19) infection affecting disease course and outcome. We aimed to conduct a systematic review of published literature to highlight the risk factors, types, and outcomes in COVID-19.MethodA systematic search of PubMed, Embase, Scopus, and Google Scholar was performed from November 1, 2019, to February 28, 2021. Seventy-one studies fulfilled the inclusion criteria and 136 adult patients were included in the final analysis.ResultsMajority of patients were male (75.2%) with the mean age of 58 years. Hypertension was the most common comorbidity followed by diabetes mellitus. Moreover, 12.5% of patients had a history of smoking while 11.7% had preexisting lung disease. Isolated pneumothorax (48.5%) was the most common and 17.65% had developed spontaneous pneumothorax. Mean onset time was 11.6 days and 67% of patients required an intercostal drainage tube for management. Mortality was 40%, and elderly, female gender, obese and hypertensive were at higher risk.ConclusionCOVID-19-related air leaks are associated with higher mortality and longer hospital stay and can occur even without positive pressure ventilation. History of smoking and preexisting lung disease has not been shown to increase the incidence of air leak. A well-designed study is required for a better understanding of COVID-19-related air leak.How to cite this articleSingh A, Singh Y, Pangasa N, Khanna P, Trikha A. Risk Factors, Clinical Characteristics, and Outcome of Air Leak Syndrome in COVID-19: A Systematic Review. Indian J Crit Care Med 2021;25(12):1434–1445.

The clinical effects of high-frequency oscillatory ventilation in the treatment of neonatal severe meconium aspiration syndrome complicated with severe acute respiratory distress syndrome

ObjectiveTo explore the efficacy and safety of high-frequency oscillatory ventilation (HFOV) in the treatment of severe meconium aspiration syndrome (MAS) complicated with severe acute respiratory distress syndrome (ARDS).MethodsA total of 65 infants with severe MAS complicated with severe ARDS were included in the study. The clinical efficacy of treatment for the HFOV group (n = 31) and the conventional mechanical ventilation (CMV) group (n = 34) was retrospectively analysed. The partial pressure of oxygen (PaO2), partial pressure of carbon dioxide (PaCO2), PaO2/fraction of inspired oxygen (FiO2), and oxygen index values before and at 6, 12, 24, 48, and 72 h after mechanical ventilation, the mechanical ventilation time, oxygen inhalation time, incidence of complications, and outcomes of the two groups were compared.ResultsAt 6, 12, 24, and 48 h after mechanical ventilation, the PaO2 in the HFOV group was significantly higher than in the CMV group, while the PaCO2 in the HFOV group was significantly lower than in the CMV group (P < 0.05). At 6, 12, 24, 48, and 72 h after mechanical ventilation, PaO2/FiO2 in the HFOV group was significantly higher than in the CMV group, and the OI in the HFOV group was significantly lower than in the CMV group (P < 0.05). Mechanical ventilation time, oxygen inhalation time, and the incidence of air leakage were significantly lower in the HFOV than in the CMV group (P < 0.05).ConclusionsOverall, HFOV can effectively improve lung ventilation and oxygenation function, shorten ventilator treatment time, and reduce the incidence rate of air leakage for neonatal MAS, making it a safe and effective treatment option.

Capitonnage surgery is effective in all types of pulmonary hydatid cysts

Background: Hydatid cyst still has worldwide distribution with many cases discovered yearly in endemic areas. It has a predilection to involve the liver and the lung. Capitonnage has been practiced long time to avoid postoperative complications mainly air leak in addition to empyema formation. It may be still controversy concerning the efficiency of capitonnage especially for complicated hydatid cyst which led us to evaluate. Aim of the study: To assess the efficacy of capitonnage surgery in minimizing the postoperative complications and hospital stay in complicated and non complicated pulmonary hydatid cysts. Patients and Methods: A prospective study has been done at the department of thoracic surgery in Al-Jumhory teaching hospital at right side of Mosul, Department of pediatric surgery in Al-Khansaa teaching hospital and in Al-Rabee private hospital at left side of Mosul / Iraq between February 2017 and December 2019. Totally 118 patients with hydatid cyst of lung, including all ages and on different types of complicated and non-complicated cysts were included for this study. Co-morbid diseases like acute myocardial ischemia and uncontrolled diabetes mellitus were excluded from our study. Patients were evaluated in responce to the gender, age, clinical presentation, cyst condition (size, site and where ruptured or not) and postoperative hospital stay. Enucleation of the HC and capitonnage were carried out for all patients. The patient followed for three months at monthly interval, then each year with the mean follow up of 22 months. Results: One hundred eighteen patients with median age of 32 years were operated using capitonnage method. In this study 49 (41.5%) of the patients found to have intact cyst and the remaining 69 (58.5%) had ruptured cyst. We recorded the early postoperative complications which include air leak in 10 cases, Atelectasis 8, pneumothorax 3, wound infection 3 and Hemoptysis in 2 cases. Conclusion: Capitonnage can decrease the incidence of air leak and shorten hospital stay in complicated and non-complicated lung hydatid cysts.

Complications of robot-assisted thymectomy: A single-arm meta-analysis and systematic review.

BackgroundRecently, thymectomy using minimally invasive approaches has been increasing with the development of robotic video‐assisted thoracoscopic surgery (R‐VATS). Although multimodal approach is effective for robot assisted thymectomy, it is necessary to determine the approach (left, right or subxiphoid) associated with the least complications.MethodsAn electronic retrieval from PubMed, Embase, Web of Science, GreyNet International and The Cochrane Library. The single‐arm meta‐analysis was performed to compare the rate of complications of right‐ and left‐side approaches by R‐VATS.ResultsA total of 21 studies including 930 patients were identified. The pooled incidence of total complications was 12.2% (confidence interval: 10.0%–14.8%) for all studies. The overall complication rate was 17.3% for the right‐side compared with 7.4% for the left side (P < 0.001, odds ratio = 2.484, 1.601–3.852). The pooled incidence of air leak was significantly higher for the right versus left side (5.1% vs. 1.2%, respectively; p = 0.004). The incidence of atrial fibrillation was higher for the right‐side compared with the left‐side approach (4% vs. 1.2%, respectively; p = 0.004). The open conversion rate was significantly higher for the right versus the left‐side (6.5% vs. 2.9%, respectively; p = 0.004). However, there was no significant difference in the pooled incidence of pleural effusion and thoracic duct fistula when comparing the right‐ and left‐side approaches. In subgroup analysis, in the left approach, the incidence of overall complications (28.6% vs. 5.5%, respectively; p = 0.002) and pleural effusion (14.3% vs. 1%, respectively; p = 0.002) was higher for the ‘Old Age’ group compared with the ‘Youth’ group; However, In the subgroup analysis of gender, there was no significant difference in the incidence of complications after thymectomy.ConclusionRobotic video‐assisted thoracoscopic surgery can be performed on the left‐ and right‐sides; however, complications are minimal with the left‐side approach. These data demonstrate that the incidence of overall complications, atrial fibrillation, open conversion ratios, and air leak rate of left‐side R‐VATS thymectomy are lower than those of right‐side. Further subgroup analysis showed that the incidence of postoperative complications was higher in the older group.

The Impact of Surfactant Administration Techniques (LISA vs INSURE) on the Outcomes of Respiratory Distress Syndrome in premature babies.

Objective: We aimed this study to find out the Impact of Surfactant Administration Techniques (LISA vs INSURE) on the Outcomes of RDS in premature newborns. Study Design: Retrospective study. Setting: Children’s Hospital and The institute of Child Health Multan. Period: October 2018 to March 2020. Material &amp; Methods: 159 premature babies reported with RDS at Institute of child health, Multan were evaluated. Out of these 87 infants were given surfactant through LISA technique and 72 were given through INSURE. The surfactant used for all these babies was proractant alpha. Results: The duration of oxygen (O2) therapy was significantly less in LISA group (14.87 ± 11.21 days) as compare to INSURE (19.67 ± 9.79 days), p &lt;0.001. Number of patients who require mechanical ventilation was (23% vs 44%, p&lt; 0.05) and median days of nCPAP was (10.74 ± 3.07 vs 15.12 ± 8.79, p&lt;0.05). Our analysis shows that no significant difference in mortality, incidence of air leak and bronchopulmonary dysplasia (BPD) between the two groups. Conclusion: Patients administered surfactant through LISA technique requires significantly less duration of oxygen therapy and need of mechanical ventilation as well as duration of nCPAP. We conclude that LISA technique is preferable method for surfactant administration in premature infants.

Withdrawal: "Single versus double chest drains after pulmonary lobectomy: a systematic review and meta-analysis" Jinzhi You, Hailing Zhang, Wei Li, Ninghuang Dai, Zhongfeng Zheng.

Background Previous randomized controlled trials have compared the efficacy and safety of singe chest drain (SCD) and double chest drains (DCD) in the patients with pulmonary lobectomy, yet the results remain inconsistent. Therefore, we aimed to conduct this present systematic review and meta-analysis to evaluate the role of SCD and DCD in the patients with pulmonary lobectomy. Methods PubMed, Medline, EMBASE, Cochrane library, Web of Science, China National Knowledge Infrastructure, Wanfang, Weipu and China Biomedical Literature databases were searched up to Feb 28, 2020 to identify the potential RCTs on SCD and DCD in the patients with pulmonary lobectomy. The main outcomes including verbal pain score, the duration of drainage(days), the length of hospital stay(days), the incidence of air leak and re-drainage were collected and analyzed. All the data were processed and analyzed with software RevMan 5.3. We calculated and analyzed the odds ratios (OR) for dichotomous outcomes and the mean difference (MD) for continuous outcomes. Results A total of 11 RCTs with 1214 patients were included, with 589 patients undergone SCD treatment, and 625 patients undergone DCD treatment. The verbal pain score(MD=-0.54, 95%CI (-0.87, -0.21)), the duration of drainage (MD=-0.65, 95%CI (-1.04, -0.26)) and the length of hospital stay(MD=-0.55, 95%CI (-0.80, -0.29)) in SCD group was significantly less than that of DCD group. There were no significant differences on the incidence of air leak (OR=1.35, 95%CI (0.86, 2.11)) and re-drainage (OR=0.88, 95%CI (0.41, 1.90)) among two groups. Conclusions SCD is a safe option, and it has the advantages of less postoperative pain, shortened duration of drain and reduced length of hospital stay when compared with DCD in the patients with pulmonary lobectomy.

Utility of the powered stapler for radical pulmonary resection: a propensity score-matched analysis.

Anatomical pulmonary resection, such as lobectomy, is a common procedure. Staplers play an important role in dividing an incomplete interlobular fissure, especially in thoracoscopic surgery. This study evaluates the effectiveness of a powered stapler for reducing the need for intraoperative fibrin glue and the incidence of air leakage after radical pulmonary resection. The subjects of this retrospective study were 478 patients who underwent radical pulmonary resection. Propensity score analysis generated two matched pairs of 177 patients treated using powered and manual staplers, respectively. The need for fibrin glue intraoperatively during radical pulmonary resection was significantly less in the powered-stapler group (47.5%) than in the manual-stapler group (58.8%, p = 0.033). The incidence of postoperative air leakage following radical pulmonary resection was also significantly lower in the powered-stapler group (2.8%) than in the manual-stapler group (10.7%, p = 0.003). Logistic regression analysis identified use of the powered stapler as a factor independently associated with both non-use of fibrin glue intraoperatively (odds ratio, 0.63; p = 0.040) and no postoperative air leakage (odds ratio, 0.26; p = 0.010). Using a powered stapler to divide the incomplete interlobular fissure decreased the need for additional intraoperative management using fibrin glue and reduced postoperative air leakage in radical pulmonary resection.

Single versus double chest drains after pulmonary lobectomy: a systematic review and meta-analysis

BackgroundPrevious randomized controlled trials have compared the efficacy and safety of single chest drain (SCD) and double chest drains (DCD) in the patients undergone pulmonary lobectomy, yet the results remain inconsistent. Therefore, we aimed to conduct this present systematic review and meta-analysis to evaluate the role of SCD and DCD in the patients undergone pulmonary lobectomy.MethodsPubMed, Medline, EMBASE, Cochrane library, Web of Science, China National Knowledge Infrastructure, Wanfang, Weipu, and China Biomedical Literature databases were searched up to February 28, 2020, to identify the potential RCTs on SCD and DCD in the patients undergone pulmonary lobectomy. The main outcomes including verbal pain score, the duration of drainage (days), the length of hospital stay (days), and the incidence of air leak and re-drainage were collected and analyzed. All the data were processed and analyzed with software RevMan 5.3. We calculated and analyzed the odds ratios (OR) for dichotomous outcomes and the mean difference (MD) for continuous outcomes.ResultsA total of 11 RCTs with 1214 patients were included, in which 589 patients received SCD treatment and 625 patients DCD treatment. The verbal pain score (MD = − 0.54, 95%CI (− 0.87, − 0.21)), the duration of drainage (MD = − 0.65, 95%CI (− 1.04, − 0.26)), and the length of hospital stay (MD = − 0.55, 95%CI (− 0.80, − 0.29)) in SCD group were significantly less than that of DCD group. There were no significant differences on the incidence of air leak (OR = 1.35, 95%CI (0.86, 2.11)) and re-drainage (OR = 0.88, 95%CI (0.41, 1.90)) among the two groups.ConclusionsSCD is a safe option, and it has the advantages of less postoperative pain, shortened duration of drain, and reduced length of hospital stay when compared with DCD in the patients undergone pulmonary lobectomy.

Microbiological profile of tubercular and nontubercular empyemas and its impact on clinical outcomes: A retrospective analysis of 285 consecutively operated cases.

Background:Empyema thoracis is an entity seen across all age groups. This study aims at reporting a detailed microbiological profile of “pus and pleural tissue” in patients operated for empyema thoracis and also correlating it with perioperative clinical outcomes.Materials and Methods:Patients operated for empyema thoracis between 2012 and 2016 were included in the study. Patients were taken up for surgery after thorough preoperative evaluation. Perioperative outcomes were correlated with the results of microbiological analysis to evaluate their effect on clinical outcomes.Results:In the study, 285 patients were operated. There were 215 males (75.4%) and 70 females (24.6%). Tuberculosis (TB) was responsible for 58.2% of the cases (n = 166). Of 166, 32 patients were mycobacterial culture positive, suggesting 19.28% mycobacterial culture positivity rate. 21.8% of the total mycobacterial cultures were multidrug resistant. TB culture-positive patients had a significantly higher incidence of air leak (P = 0.03), inter-costal drain (ICD) duration (P = 0.03), and higher rates of recurrence (P = 0.03). Nontubercular empyema constituted 119 cases (41.8%). Forty-seven (39.5%) cases were culture positive. Gram-negative organisms were cultured in 30 (63.8%). Pseudomonas aeruginosa was the predominant isolate. Bacterial culture-positive patients had significantly higher conversions (P = 0.03), prolonged postoperative air leak (P = 0.04), and postoperative wound infections.Conclusions:This study highlights the emergence of Gram-negative organisms in bacterial empyema and emergence of multidrug resistance in tubercular empyema. Clinical outcome correlation revealed increased complications in culture-positive cases in both tubercular and nontubercular empyemas.

439 Risk of Air Leak and Mucosal Injury in Esophageal POEM After Prior Myotomy

INTRODUCTION: Peroral endoscopic myotomy (POEM) is deemed to be more challenging with more periprocedural adverse events. We aimed to assess the risk of air leak and mucosal injury in POEM after prior myotomy (Heller’s myotomy [HM] or POEM), the Redo POEM, in addition to extubation time when air leak occurs. METHODS: A retrospective study comparing Redo POEM to an index POEM at a tertiary center from March 2016 to August 2018. Table 1 summarizes the data collected. Air leak was defined by subcutaneous emphysema, pneumomediastinum, pneumoperitoneum, and/or pneumothorax documented by physical exam and/or imaging. Difficult procedures were determined by endoscopist impression as challenging or based on difficulty creating submucosal tunnel and/or difficulty performing myotomy. RESULTS: We identified 21 cases of Redo (1st myotomy: HM in 8/21, POEM in 13/21) and 56 cases of index POEM. One case had two prior HMs and two cases had HM and POEM each before Redo POEM. The results are summarized in Table 1. The Redo group was younger with more difficult procedures encountered, shorter myotomy length (due to difficulty with myotomy) and longer procedure time. There were more mucosal injuries with more clips used to close them in the Redo group. Short myotomy (≤5 cm) was performed in 5 cases in the Redo group (23.8%) and 5 cases in the index POEM (8.9%). There was a trend toward more air leak in the Redo group, but it was not statistically significant. Air leak was seen in 14/77 (18.2%) cases in the study. Extubation time was longer in cases with air leak (Table 2). Postprocedural symptoms did not predict air leak. Procedure difficulty did not predict air leak or mucosal injury. No intervention was required for air decompression and there was no ICU admission pertinent to air leak or mucosal injury in either group. CONCLUSION: Redo POEM appears to be more challenging, takes longer time to perform with a shorter than intended myotomy. Mucosal injuries are more common and more clips are used to close them. Air leak tends to be higher in Redo POEM, but not statistically significant. The incidence of air leak was likely underestimated as imaging was not routinely obtained for all procedures. Air leak is associated with a slight delay in postprocedural extubation time, but it does not appear to affect the overall procedural outcomes or prolong hospitalization. Postprocedural symptoms and procedure difficulty did not predict air leak or mucosal injury.