Department of Pulmonary and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
Dartmouth-Hitchcock Medical Center, Department of Pulmonary and Critical Care Medicine, 1 Medical Center Drive, Lebanon, NH, Lebanon.
Expert Rev Respir Med. 2023 Jul-Dec;17(10):865-872. doi: 10.1080/17476348.2023.2272701. Epub 2023 Nov 24.
Persistent air leaks (PAL) represent a challenging clinical problem for which there is not a clear consensus to guide optimal management. PAL is associated with significant morbidity, mortality, and increased length of hospital stay. There are a variety of surgical and non-surgical management options available.
This narrative review describes the current evidence for PAL management including surgical approach, autologous blood patch pleurodesis, chemical pleurodesis, endobronchial valves, and one-way valves. Additionally, emerging topics such as drainage-dependent air leak and intensive care unit management are described.
There has been considerable progress in understanding the pathophysiology of PAL and growing evidence to support the various non-surgical treatment modalities. Increased recognition of drainage-dependent persistent air leaks offers the opportunity to decrease the number of patients requiring additional invasive treatment. Randomized control trials are needed to guide optimal management.
持续性肺漏气（PAL）是一个具有挑战性的临床问题，目前尚无明确共识来指导最佳管理。PAL 与显著的发病率、死亡率和住院时间延长有关。有多种手术和非手术治疗选择。
本综述描述了 PAL 管理的当前证据，包括手术方法、自体血贴胸膜固定术、化学胸膜固定术、支气管内瓣膜和单向瓣膜。此外，还描述了一些新兴主题，如依赖引流的肺漏气和重症监护病房管理。
人们对 PAL 的病理生理学有了相当大的认识进展，并且有越来越多的证据支持各种非手术治疗方法。对依赖引流的持续性肺漏气的认识增加，为减少需要额外侵入性治疗的患者数量提供了机会。需要进行随机对照试验来指导最佳管理。
