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Intrapleural hypercarbia linked to delayed alveolopleural fistulae resolution after lung surgery

Patients who underwent a lobectomy and had reduced pleural CO2 levels appeared significantly more likely to resolve postoperative pleural leaks.

“We provide evidence that the intrapleural hypercarbia appears to be associated with delayed resolution of alveolopleural fistulae in patients undergoing lobectomy,” Ankit Bharat, MD, of the division of thoracic surgery and department of surgery at Northwestern University, and colleagues wrote. “Reducing pleural CO2 was associated with faster resolution of air leaks. Further randomized trials are warranted to validate these observations and determine the clinical benefits to patients with prolonged pleural leaks after thoracic surgery.”

Bharat and colleagues prospectively evaluated 116 patients who were undergoing lung resection using infra-red spectroscopy. For patients with pleural CO2 concentration of 6% or greater at 1 day postoperative, the researchers reduced pleural CO2 levels using supplemental O2 and extrapleural suction.

The researchers found that a 1% increase in CO2 was associated with a delay in air leak resolution of 9 hours (95% CI, 7.1-10.8) and 10-fold increased odds of a persistent air leak (95% CI, 2.2-47.8).

Poisson logistic regression analysis showed lower rates of persistent air leak lasting 6 days or more was associated with patients with higher pleural O2 levels, with an odds ratio of 0.33 for every 1% increase (95% CI, 0.1-1.2).

Of the 12 patients in the intervention group who received supplemental O2 and extrapleural suction, pleural CO2 levels were reduced from 6.6 ± 0.7 to 3.1 ± 0.5 and pleural O2 levels were increased from 15.4 ± 2.0 to 27.1 ± 3.2. Bharat and colleagues noted that decreasing the pleural CO2 levels decreased duration of pleural leak. – by Jeff Craven

Disclosure: The researchers report no relevant financial disclosures.