Evaluation and management of persistent air leak

Area of Science:

• Thoracic Surgery
• Pulmonology
• Critical Care Medicine

Background:

• Persistent air leaks (PAL) present a complex clinical issue lacking standardized management protocols.
• PAL contributes to increased patient morbidity, mortality, and prolonged hospital stays.
• A range of surgical and non-surgical interventions exist for PAL management.

Purpose of the Study:

• To review the current evidence supporting various management strategies for persistent air leaks.
• To discuss emerging concepts in PAL, including drainage-dependent air leaks and ICU care.
• To identify gaps in knowledge and areas requiring further investigation, particularly randomized controlled trials.

Main Methods:

• This narrative review synthesizes existing literature on PAL management.
• Key interventions examined include surgical approaches, autologous blood patch pleurodesis, chemical pleurodesis, endobronchial valves, and one-way valves.
• The review also addresses contemporary topics like drainage-dependent air leaks and intensive care unit management.

Main Results:

• Progress has been made in understanding PAL pathophysiology, with growing evidence for non-surgical treatments.
• Recognizing drainage-dependent PAL can potentially reduce the need for more invasive procedures.
• Current evidence supports a variety of treatment modalities, but definitive guidelines are lacking.

Conclusions:

• Advances in understanding PAL pathophysiology support various non-surgical treatment modalities.
• Identifying and managing drainage-dependent air leaks may optimize patient care.
• Further randomized controlled trials are essential to establish optimal management strategies for persistent air leaks.