BACKGROUND: Air leaks prolong hospital stay. METHODS: A prospective algorithm was applied to patients. If patients were ready for discharge but still had an air leak, a Heimlich valve was placed and they were discharged. If the leak was still present after 2 weeks, the tube was clamped for a day and removed. RESULTS: There were 669 patients. Factors that predicted a persistent air leak were FEV1% of less than 79% (p = 0.006), history of steroid use (p = 0.002), male gender (p = 0.05), and having a lobectomy (p = 0.01). Types of air leaks on day 1 that eventually required a Heimlich valve were expiratory leaks (p = 0.02), leaks that were an expiratory 4 or more (p < 0.0001), and the presence of a pneumothorax concomitant with an air leak (p < 0.0001). Thirty-three patients were placed on a Heimlich valve, and 6 patients had a pneumothorax or subcutaneous emphysema develop; all patients had an expiratory 5 leak or larger (p < 0.0001). Thirty-three patients went home on a valve. Seventeen patients had leaks that resolved by 1 week, 6 by 2 weeks, and the remaining 9 had their tubes removed without problems. CONCLUSIONS: Steroid use, male gender, a large leak, a leak with a pneumothorax, and having a lobectomy are all risk factors for a persistent leak. Discharge on a Heimlich valve is safe and effective for patients with a persistent leak unless the leak is an expiratory 5 or more. Once home on a valve, most air leaks will seal in 2 weeks; if not, chest tubes can be safely removed regardless of the size of the leak or the presence of a pneumothorax.
BACKGROUND: Air leaks prolong hospital stay. METHODS: A prospective algorithm was applied to patients. If patients were ready for discharge but still had an air leak, a Heimlich valve was placed and they were discharged. If the leak was still present after 2 weeks, the tube was clamped for a day and removed. RESULTS: There were 669 patients. Factors that predicted a persistent air leak were FEV1% of less than 79% (p = 0.006), history of steroid use (p = 0.002), male gender (p = 0.05), and having a lobectomy (p = 0.01). Types of air leaks on day 1 that eventually required a Heimlich valve were expiratory leaks (p = 0.02), leaks that were an expiratory 4 or more (p < 0.0001), and the presence of a pneumothorax concomitant with an air leak (p < 0.0001). Thirty-three patients were placed on a Heimlich valve, and 6 patients had a pneumothorax or subcutaneous emphysema develop; all patients had an expiratory 5 leak or larger (p < 0.0001). Thirty-three patients went home on a valve. Seventeen patients had leaks that resolved by 1 week, 6 by 2 weeks, and the remaining 9 had their tubes removed without problems. CONCLUSIONS:Steroid use, male gender, a large leak, a leak with a pneumothorax, and having a lobectomy are all risk factors for a persistent leak. Discharge on a Heimlich valve is safe and effective for patients with a persistent leak unless the leak is an expiratory 5 or more. Once home on a valve, most air leaks will seal in 2 weeks; if not, chest tubes can be safely removed regardless of the size of the leak or the presence of a pneumothorax.
Authors: Pier Luigi Filosso; Victor Auguste Nigra; Giovanni Lanza; Lorena Costardi; Giulia Bora; Paolo Solidoro; Riccardo Carlo Cristofori; Massimo Molinatti; Paolo Olivo Lausi; Enrico Ruffini; Alberto Oliaro; Francesco Guerrera Journal: J Thorac Dis Date: 2015-10 Impact factor: 2.895
Authors: Michael H Cho; Atul Malhotra; Dean M Donahue; John C Wain; R Scott Harris; Dimitri Karmpaliotis; Sanjay R Patel Journal: Ann Thorac Surg Date: 2006-07 Impact factor: 4.330
Authors: Muhanned Abu-Hijleh; Kim Styrvoky; Vikram Anand; Fernando Woll; Lonny Yarmus; Michael S Machuzak; Daniel A Nader; Timothy W Mullett; D Kyle Hogarth; Jennifer W Toth; Ghazwan Acash; Roberto F Casal; Stephen Hazelrigg; Douglas E Wood Journal: Lung Date: 2019-08-28 Impact factor: 2.584