Intraoperative and Postoperative Management of Air Leaks in Patients with Emphysema

Intraoperative
and Postoperative
Management of Air
Leaks in Patients
with Emphysema
Joseph B. Shrager, MDa,b,*,MalcolmM. DeCamp, MDc,
Sudish C.Murthy, MD, PhDd
Parenchymal air leaks (AL) that occur after pulmonary
resection are among the most common perioperative
problems that thoracic surgeons are called
upon to manage. Although most ALs seal spontaneously
within a few days and cause no clinical
sequelae, it appears clear in the literature that ALs
as a whole significantly increase morbidity and
costs.1–5 When ALs are large or persist (becoming
a prolonged air leak or PAL), they grow in importance
from simply serving as a nuisance to the
patient and surgeon to potentially leading to serious
problems including respiratory compromise, atelectasis,
pneumonia, and empyema. Rarely, PAL
may require reoperation. These prolonged and
complicated ALs occur most commonly in patients
who have substantial emphysema.

Intraoperaive