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Case Presentations Managing Air Leaks

Case Presentations Managing Air Leaks. Bryan F. Meyers MD MPH Patrick and Joy Williamson Professor of Surgery. Case Presentation. 65 year old with FEV1 50% predicted undergoes open left upper lobectomy Take back for bleeding on POD#0

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Case Presentations Managing Air Leaks

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  1. Case PresentationsManaging Air Leaks Bryan F. Meyers MD MPH Patrick and Joy Williamson Professor of Surgery

  2. Case Presentation • 65 year old with FEV1 50% predicted undergoes open left upper lobectomy • Take back for bleeding on POD#0 • Subsequently found to have large air leak and partial pneumothorax despite two chest tubes

  3. Chest radiograph

  4. Initial course • Taken back to OR to address air leak on POD#1 • Bronchoscopy showed no stump leak • Pleural tent performed • Treated for MRSA LLL pneumonia • Developed renal dysfunction • Air leak continues • Transferred

  5. Options? • Sit tight? It has been 4 weeks now! • Re-explore to look for air leak source • Oversew or use sealant • TachoSil® • Bronchial valves- Spiration? • Other

  6. Resolution • Watchful waiting • Removed on chest drain • Heimlich valve • D/C home • Returned 1 week later, still leaking • ?????

  7. Case Presentation #2 • 40 year old woman with h/o pneumonia • Admitted, intubated, sedated, paralyzed due to severe ARDS elsewhere • Tracheostomy • Developed right PTX and chest tube placed, remained in place for weeks

  8. Case Presentation • Sent to rehab and chest tube continued to leak • Admit to hospital #2: anterior thoracotomy, debridement, placement of pectoralis muscle flap, drains • Continued to leak for several days

  9. Case Presentation • Transfer • Trache and g-tube in place, neither in use • On steroid taper, prednisone 20 mg qD • Unable to walk due to weakness and calf contractures • What next???

  10. Options? • Re-explore vs. Continue to watch and wait • Wean steroids • If re-explore: • Look for air leaks to oversew • ? Sealants • ?more muscle flap • ?other

  11. Resolution • Weaned steroids for a week • Got to know her • Placed a wound vac, removed chest tubes • Removed tracheostomy, g-tube

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