From the Madigan Army Medical Center (J.W., B.P., A.F., M.W., M.P., M.V., J.F., E.R., J.H., J.B., J.K.), Tacoma, Washington; and Laboratory of Adaptive and Regenerative Biology (B.L., S.M., J.K.), Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
J Trauma Acute Care Surg. 2023 Nov 1;95(5):679-684. doi: 10.1097/TA.0000000000003956. Epub 2023 Mar 28.
Traumatic pulmonary injuries are common in chest trauma. Persistent air leaks occur in up to 46% of patients depending on injury severity. Prolonged leaks are associated with increased morbidity and cost. Prior work from our first-generation pectin patches successfully sealed pulmonary leaks in a cadaveric swine model. We now test the next-generation pectin patch against wedge resection in the management of air leaks in anesthetized swine.
A continuous air leak of 10% to 20% percent was created to the anterior surface of the lung in intubated and sedated swine. Animals were treated with a two-ply pectin patch or stapled wedge resection (SW). Tidal volumes (TVs) were recorded preinjury and postinjury. Following repair, TVs were recorded, a chest tube was placed, and animals were observed for presence air leak at closure and for an additional 90 minutes while on positive pressure ventilation. Mann-Whitney U test and Fisher's exact test used to compare continuous and categorical data between groups.
Thirty-one animals underwent either SW (15) or pectin patch repair (PPR, 16). Baseline characteristics were similar between animals excepting baseline TV (SW, 10.3 mL/kg vs. PPR, 10.9 mL/kg; p = 0.03). There was no difference between groups for severity of injury based on percent of TV loss (SW, 15% vs. PPR, 14%; p = 0.5). There was no difference in TV between groups following repair (SW, 10.2 mL/kg vs. PPR, 10.2 mL/kg; p = 1) or at the end of observation (SW, 9.8 mL/kg vs. PPR, 10.2 mL/kg; p = 0.4). One-chamber intermittent air leaks were observed in three of the PPR animals, versus one in the SW group ( p = 0.6).
Pectin patches effectively sealed the lung following injury and were noninferior when compared with wedge resection for the management of acute traumatic air leaks. Pectin patches may offer a parenchymal sparing option for managing such injuries, although studies evaluating biodurability are needed.
创伤性肺损伤在胸部创伤中很常见。根据损伤严重程度，多达 46%的患者会持续出现空气泄漏。长时间的泄漏与发病率和成本增加有关。我们第一代果胶贴片在尸体猪模型中成功地封闭了肺漏，之前的工作。现在，我们在麻醉猪模型中用第二代果胶贴片来测试楔形切除术在处理空气泄漏方面的效果。
在气管插管和镇静的猪的肺前表面造成 10%至 20%的持续空气泄漏。动物接受双层果胶贴片或缝合楔形切除术（SW）治疗。记录损伤前和损伤后的潮气量（TV）。修复后，记录 TV，放置胸腔引流管，并观察动物在闭合时是否存在空气泄漏，并在正压通气时再观察 90 分钟。使用 Mann-Whitney U 检验和 Fisher 确切检验比较两组之间的连续和分类数据。
31 只动物接受了 SW（15 只）或果胶贴片修复（PPR，16 只）。除了基线 TV（SW，10.3 毫升/公斤；PPR，10.9 毫升/公斤；p=0.03）外，动物之间的基线特征相似。根据 TV 丢失的百分比，两组之间的损伤严重程度没有差异（SW，15%；PPR，14%；p=0.5）。修复后两组之间的 TV 没有差异（SW，10.2 毫升/公斤；PPR，10.2 毫升/公斤；p=1）或在观察结束时（SW，9.8 毫升/公斤；PPR，10.2 毫升/公斤；p=0.4）。在 PPR 动物中有 3 只观察到一室间歇性空气泄漏，而在 SW 组中有 1 只（p=0.6）。
果胶贴片在受伤后有效地封闭了肺部，与楔形切除术相比，在治疗急性创伤性空气泄漏方面效果相当。果胶贴片可能为管理此类损伤提供一种节省实质的选择，尽管需要评估生物耐久性的研究。
