Fibrin glue in pulmonary resection: a prospective, randomized, blinded study

Area of Science:

• Thoracic Surgery
• Surgical Innovation
• Pulmonary Medicine

Background:

• Alveolar air leaks (AAL) are common after lung resection, increasing hospital stay and morbidity.
• Previous studies showed topical fibrin glue lacked efficacy for reducing AAL.
• This study reevaluated fibrin glue's effectiveness in routine pulmonary resections.

Purpose of the Study:

• To assess the efficacy and safety of aerosolized fibrin glue in reducing alveolar air leaks (AAL) post-lung resection.
• To determine the impact of fibrin glue on the incidence and duration of AAL and prolonged AAL (PAAL).

Main Methods:

• 100 patients undergoing lung resection were randomized into two groups: control (no intervention) and experimental (5 mL aerosolized fibrin glue).
• Outcomes including AAL incidence, duration, prolonged AAL (PAAL), chest tube drainage, time to tube removal, and length of stay (LOS) were recorded by a blinded observer.
• Fibrin glue was applied using a pressurized, aerosolized spraying mechanism post-resection.

Main Results:

• The fibrin glue group showed significantly lower AAL incidence (34% vs. 68%, p=0.001) and mean AAL duration (1.1 vs. 3.1 days, p=0.005).
• A significant reduction in prolonged AAL (PAAL) incidence was observed (2% vs. 16%, p=0.015) in the fibrin glue group.
• Mean chest tube removal time decreased (3.5 vs. 5.0 days, p=0.02) with no significant difference in drainage volume or length of stay (LOS).

Conclusions:

• Aerosolized fibrin glue is a safe and effective method for reducing alveolar air leaks (AAL) after lung surgery.
• The treatment halved the overall AAL incidence and markedly reduced PAAL.
• Further research is needed to define optimal use, compare methods, and assess cost-effectiveness.