Intraoperative identification and effective "blood patch" prevention of persistent air leak in lung resections

Summary Intraoperative identification and effective “blood patch” prevention of per-sistent air leak in lung resections. V. Pagan, P. Fontana, A. Zaccaria, F. LoGiudice, A. Ferronato, R. Salvi, A. Busetto Persistent air leak (PAL) is the most common complication after lung resection,requiring additional treatments and hospital stay. Intraoperative prevention ofPAL is usually left to the surgeon’s subjective judgement, with inconsistentresults.The aim of the study was to establish systematic, reproducible quantification ofair leaks at thoracotomy in order to identify those which are potentially persistent,to be preventively treated by intraoperative “blood patch” pneumostasis.In a consecutive series of 570 lung resections, parenchymal suture air tightnesswas tested intraoperatively at end-inspiratory pressure intervals from 15 to 35cm H 2 O. Air leaks at 15 cm H 2 O (n = 40) were considered too critical, while airescape beyond 30 cm H 2 O (n = 437) was deemed quickly self-sealing posto-peratively; these conditions were managed by further surgery and standardchest tubes only, respectively. Air leaks between 16 and 30 cm H