By Alessandro Brunelli MD
This factor of Thoracic surgical procedure Clinics is dedicated to the prevention and administration of air leak after pulmonary surgery. regardless of fresh progresses in surgical process and stronger perioperative care, lengthy air leak is still a common problem after pulmonary resection. Articles will tackle themes equivalent to the physics and dynamics of the pleural area, possibility elements of lengthy air leak, surgical strategies and interoperative measures, using sealants or buttressing fabric; postoperative rescue concepts and postoperative administration of the chest tube, together with using new digitalized structures and conveyable units.
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Extra info for Air Leak after Pulmonary Resection (Thoracic Surgery Clinics of North America, Vol 20, Issue 3 Aug10)
31 Polyethylene glycol sealants Unlike other sealants, polyethylene glycol–based sealants do not form a covalent bond with tissue, but create a mechanical bond by interpolation of the sealant into irregular surfaces. These hydrogels absorb water for 24 hours and therefore can tolerate moist surfaces, but not bleeding. The sealant is degraded by hydrolysis. 32 Higher burst pressures were measured for the polyethylene glycol sealant at time 0 and day 3, but not day 7. 33 In this combination sealant, resistance to air leak with increasing inflation pressure was better at 5 minutes, 1 hour, and 3 hours after application, and increased with time.
Guyatt G, Gutterman D, Baumann MH, et al. Grading strength of recommendations and quality of evidence in clinical guidelines: report from an American College of Chest Physicians Task Force. Chest 2006;129:174–81. 4. Tu¨rk R, Weidringer JW, Hartel W, et al. Closure of lung leaks by fibrin gluing. Experimental investigations and clinical experience. J Thorac Cardiovasc Surg 1983;31:185–6. 5. Bergsland J, Kalmbach T, Balu D, et al. Fibrin seal— an alternative to suture repair in experimental pulmonary surgery.
Fibrin also has a role in stabilization and early healing of wounds. Commercially available products may include factor XIII, which facilitates cross-linking of fibrin; fibronectin, which facilitates fibrin adhesion; and aprotinin, which stabilizes fibrin. Funded in part by the Daniel and Karen Lee Endowed Chair in Thoracic Surgery (Dr Rice) and the Kenneth Gee and Paula Shaw, PhD, Chair in Heart Research (Dr Blackstone). a Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue/Desk J4-1, Cleveland, OH 44195, USA b Department of Quantitative Health Sciences, Research Institute, Cleveland Clinic, 9500 Euclid Avenue/Desk JJ-4, Cleveland, OH 44195, USA * Corresponding author.
Air Leak after Pulmonary Resection (Thoracic Surgery Clinics of North America, Vol 20, Issue 3 Aug10) by Alessandro Brunelli MD