Digital quantification of air leak to identify the location of an alveolopleural fistula

Our plain-English summary of Digital quantification of air leak to identify the location of an alveolopleural fistula, by T.M. Saettele, C.A. Jimenez (Annals of the American Thoracic Society, 2014).

The study

• Authors: T.M. Saettele, C.A. Jimenez
• Journal: Annals of the American Thoracic Society
• Published: 2014;11(7):1152-4
• Type of article: Case report
• Cited by: 6 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

A patient developed a prolonged air leak after thoracic surgery for mesothelioma. The alveolopleural fistula was localized bronchoscopically by selective balloon occlusion of the right upper lobe segments and confirmation of decreased air leak on a digital thoracic drainage system. Five endobronchial valves were placed in the right upper lobe with resolution of the air leak.

PubMed has no abstract for this study. This is the authors' abstract, copied from the article.

In plain English

This case report from The University of Texas MD Anderson Cancer Center described one 62-year-old man who had surgery on the right lung and its lining (pleura) for a stage III mixed histology mesothelioma. The article did not discuss asbestos or how the cancer arose. After surgery he had a persistent air leak, which a digital chest drainage system measured at 0.1 to 0.2 L/min with suction applied at 27 mbar. On day 12 after surgery, doctors used a bronchoscope and balloon to block airways one at a time while watching the digital reading. Blocking the right upper lobe airway lowered the leak to near 0 L/min. Blocking that lobe's segments one by one did not change it. They then placed five one-way valves covering the whole right upper lobe, and the leak fell and stayed lower. The chest tube was removed 7 days later. The authors said they had used the method in two more patients. They concluded that digital leak measurement may help locate the leak's source, and noted the method needs a continuous leak and patience.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Case report (single patient), with brief mention of the authors' experience in two further patients
• Who was studied: One 62-year-old man with stage III mixed histology mesothelioma who had parietal pleurectomy and decortication of the right lung and other resections. The authors were at The University of Texas MD Anderson Cancer Center, Houston, Texas. Dates of treatment were not given.
• Main results:
  • After surgery, the patient had a persistent air leak of 0.1 to 0.2 L/min with suction at 27 mbar, measured on a digital thoracic drainage system
  • At bronchoscopy on postoperative day 12, blocking the right main bronchus nearly stopped the leak, and blocking the bronchus intermedius caused no change
  • Blocking the right upper lobe bronchus lowered the leak to near 0 L/min, which placed the fistula in that lobe
  • Blocking each right upper lobe segment one at a time did not change the leak, which the authors took to mean collateral ventilation was likely. Valves were therefore placed in all segments of that lobe.
  • Five valves (6 mm and 7 mm) were placed, and the leak fell and stayed lower
  • The chest tube was removed 7 days after valve placement. The patient went home and returned 44 days later to have the valves removed.
  • The authors used the same device in two more patients. All three patients had reductions in air leak after the procedure.
• The authors' conclusion: The authors concluded that endobronchial valves can be useful for persistent air leaks after lung surgery, and that digital measurement of the air leak may help locate the fistula accurately
• Limitations the authors state:
  • The method needs a continuous air leak to locate the fistula clearly. One other patient with an intermittent leak needed a larger chest tube and a change of body position during the procedure.
  • Air leaks may fall only slowly after the balloon blocks an airway. In one patient, the leaking segment was found only after 5 minutes of blocking.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Pleural plaques and thickening.

Medical terms in this study, explained in our Lexicon: Thoracic Surgery, Mesothelioma.

Related studies

• Transsternal transpericardial operations in the treatment of bronchopleural fistulas after pneumonectomy — G. Stamatis, G. Martini, et al. (1996)
• Amplatzer Device in Bronchial Stump Fistula after Extrapleural Pneumonectomy — J. Turtiainen, J.V. Räsänen, et al. (2016)
• Treatment of bronchial fistula after extraplural pneumonectomy using flexible bronchoscopy with the administration of OK432, fibroblast growth factor basic and fibrin glue sealant — N. Kondo, M. Hashimoto, et al. (2020)
• Single site venovenous extracorporeal membrane oxygenation as an alternative to invasive ventilation in post-pneumonectomy fistula with acute respiratory failure — M. Fica, F. Suárez, et al. (2012)
• Squamous cell carcinoma arising from the pleura after pneumonectomy for squamous cell carcinoma of the lung — M. Franke, H.D. Chung, et al. (2010)
• First report of probe based confocal laser endomicroscopy during medical thoracoscopy — O. Bonhomme, B. Duysinx, et al. (2019)

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