Predictors and treatment of persistent air leaks
Predictors and treatment of persistent air leaks
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DOI：
10.1016/s0003-4975(02)03531-2
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发表时间：
2002-06-01
影响因子：
4.6
通讯作者：
Katholi, CR
中科院分区：
文献类型：
--
作者：
Cerfolio, RJ;Bass, CS;Katholi, CR
背景空气泄漏延长住院时间。对患者应用前瞻性算法。如果患者准备出院但仍有漏气，则放置Heimlich阀并出院。如果2周后仍然存在泄漏，则将管夹闭一天并取出。共有669名患者。预测持续性漏气的因素包括FEV1%小于79%（p = 0.006）、类固醇使用史（p = 0.002）、男性（p = 0.05）和肺叶切除术（p = 0.01）。第1天最终需要使用Heimlich阀的漏气类型为呼气漏气（p = 0.02）、呼气漏气4次或以上（p <0.0001）以及气胸伴漏气（p <0.0001）。33名患者放置了Heimlich阀，6名患者发生气胸或皮下气肿;所有患者均发生呼气5漏或更大（p <0.0001）。33名患者使用瓣膜回家。17例患者的渗漏在1周内解决，6例在2周内解决，其余9例患者的插管均顺利取出。类固醇使用、男性、大渗漏、渗漏伴气胸和肺叶切除术都是持续性渗漏的风险因素。对于持续性漏气的患者，使用海姆利克氏阀排气是安全有效的，除非漏气是呼气5次或以上。一旦安装上阀门，大多数漏气将在2周内密封;如果没有，无论漏气的大小或是否存在气胸，都可以安全地取出胸管。
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 I 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.