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A Novel Rescue Technique for Difficult Intubation and Difficult Ventilation
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Management of Persistent Air Leaks.

Karen C Dugan1, Balaji Laxmanan1, Septimiu Murgu1

  • 1Department of Medicine, Section of Pulmonary and Critical Care, University of Chicago, Chicago, IL.

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|March 8, 2017
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Summary

Persistent air leaks from alveolar-pleural fistulas (PALs) pose challenges. Newer, less invasive treatments like chemical pleurodesis and endobronchial valves show promise, but further research is needed.

Keywords:
bronchopleural fistulapersistent air leakpneumothorax

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Area of Science:

  • Pulmonology
  • Thoracic Surgery
  • Interventional Pulmonology

Background:

  • Alveolar-pleural fistulas leading to persistent air leaks (PALs) are a significant clinical problem.
  • Traditional surgical repair has limited success and is not always feasible.
  • Limited treatment options exist for patients with contraindications to surgery or recent thoracic procedures.

Purpose of the Study:

  • To review the historical and current treatment guidelines for persistent air leaks.
  • To describe newer, less invasive therapeutic options for PALs.
  • To highlight the need for further research and comparative studies.

Main Methods:

  • Literature review of treatment options for persistent air leaks.
  • Discussion of historical surgical approaches.
  • Detailed description of emerging minimally invasive techniques.

Main Results:

  • While surgery was the gold standard, its success is limited.
  • Anecdotal success has been reported with fibrin sealants, ethanol injection, metal coils, and Watanabe spigots.
  • More recent evidence supports chemical pleurodesis, autologous blood patch pleurodesis, and endobronchial valves.

Conclusions:

  • A range of less invasive treatments for persistent air leaks has emerged.
  • These newer methods offer alternatives for patients unsuitable for surgery.
  • Randomized controlled trials are necessary to compare efficacy and long-term outcomes.