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Updated: May 15, 2026

Local Anesthetic Thoracoscopy for Undiagnosed Pleural Effusion
Published on: November 10, 2023
How to distinguish an active air leak from a pleural space effect
Rita Daniela Marasco1, Gabriella Giudice, Cosimo Lequaglie
1Department of Thoracic Surgery, I.R.C.C.S.–C.R.O.B. Basilicata Regional Cancer Institute, Rionero in Vulture, Italy. d.marasco@inwind.it
Aim:
We aimed to distinguish a pleural space effect from an active air leak, using a digital chest drain system that provided continuous air flow and pleural pressure checks.
Methods:
between March 2010 and October 2011, we employed 144 digital drains for 138 thoracic surgical procedures.
Results:
We observed 18 (12.5%) active air leaks, among which 4 (2.8%) were prolonged air leaks characterized by high differential pleural pressure due to increased mean expiratory pressure (>1 cm H(2)O; p<0.0001), and 3 (2.1%) late air leaks, all long-lasting (p<0.0001), predicted by pressure curve divergence before the air flow appearance. We also reported 25 (17.4%) pleural space effects characterized by a high differential pleural pressure, but mainly due to a lower mean inspiratory pressure (<20 cm H(2)O; p<0.0001), and especially related to surgical pleurodesis procedures (p<0.0003) and wide lung resections (p<0.0002); there was no increasing pneumothorax after provocative clamping.
Conclusions:
A digital chest drain system, ensuring continuous air flow and pleural pressure measurement, could clearly identify a pleural space effect, avoiding the frequent misinterpretation of an active air leak, and allowing safe removal of the chest tube at the right time.
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