Chest surgery clinics of North America
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Air leaks are an unavoidable complication of pulmonary resection. The definition of a persistent air leak is arbitrary and may even be irrelevant in solving the problem. Persistent air leaks are more common in patients with severe COPD, and preoperative interventions are ineffective in reducing their prevalence. ⋯ The use of currently available sealants is ineffective for the treatment of this complication. To stop persistent air leaks, early cessation of suction and placing chest tubes to an underwater seal is more effective than continuous suction. The management of persistent air leaks may require provocative chest tube clamping and permissive chest tube removal or patient discharge from the hospital with a chest tube and a Heimlich valve.
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The authors believe that most patients who undergo pneumonectomy do not require drainage of the postpneumonectomy space. Needle or catheter aspiration is simple and usually adequate. In cases in which significant bleeding, rapid pleural fluid accumulation, or contamination is expected, however, drainage of the space is recommended. If drainage is used, the tube probably should be connected to a balanced drainage system to ensure proper physiologic positioning of the mediastinum during the critical immediate postoperative period.