Pleural gas analysis for detection of alveolopleural fistulae

Ankit Bharat*, Nicole Graf, Emily Cassidy, Sean Smith, Colin Thomas Gillespie, Shari Lynn Meyerson, Peter H Sporn, Jacob I Sznajder, Malcom McAvoy DeCamp Jr

*Corresponding author for this work

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Purpose Visual inspection (VI) of bubbles in the chest drainage unit does not differentiate a true leak of alveolopleural fistula (APF) from a false leak. We hypothesized that detection of elevated levels of carbon dioxide, increase in oxygen content, or both, in pleural gas upon the administration of supplemental oxygen would accurately identify APF. Description Prospective study comparing pleural gas analysis (GA) with VI to detect APF after surgical lobectomy (n = 50). Evaluation APF was found in 22 (44%) patients at the time of analysis. VI revealed air bubbles in 31 (62%) patients, indicating the presence of APF, of whom 12 (38.7%) were false leaks. VI failed to identify APF in 3 (6%) patients that resulted in post-tube removal pneumothorax. By contrast, GA accurately demonstrated APF in 21 patients, with only one false negative and no false positives. GA demonstrated better sensitivity (95.5% vs 86.4%), specificity (100% vs 57.1%), positive predictive value (100% vs 61.3%), and negative predictive value (96.6% vs 84.2%) compared to VI. Conclusions Pleural gas analysis is an effective technique to detect APF and can facilitate timely and safe chest tube removal.

Original languageEnglish (US)
Pages (from-to)2179-2182
Number of pages4
JournalAnnals of Thoracic Surgery
Volume99
Issue number6
DOIs
StatePublished - Jun 1 2015

Fingerprint

Fistula
Gases
Oxygen
Chest Tubes
Pneumothorax
Carbon Dioxide
Drainage
Thorax
Air
Prospective Studies

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine
  • Medicine(all)

Cite this

Bharat, Ankit ; Graf, Nicole ; Cassidy, Emily ; Smith, Sean ; Gillespie, Colin Thomas ; Meyerson, Shari Lynn ; Sporn, Peter H ; Sznajder, Jacob I ; DeCamp Jr, Malcom McAvoy. / Pleural gas analysis for detection of alveolopleural fistulae. In: Annals of Thoracic Surgery. 2015 ; Vol. 99, No. 6. pp. 2179-2182.
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abstract = "Purpose Visual inspection (VI) of bubbles in the chest drainage unit does not differentiate a true leak of alveolopleural fistula (APF) from a false leak. We hypothesized that detection of elevated levels of carbon dioxide, increase in oxygen content, or both, in pleural gas upon the administration of supplemental oxygen would accurately identify APF. Description Prospective study comparing pleural gas analysis (GA) with VI to detect APF after surgical lobectomy (n = 50). Evaluation APF was found in 22 (44{\%}) patients at the time of analysis. VI revealed air bubbles in 31 (62{\%}) patients, indicating the presence of APF, of whom 12 (38.7{\%}) were false leaks. VI failed to identify APF in 3 (6{\%}) patients that resulted in post-tube removal pneumothorax. By contrast, GA accurately demonstrated APF in 21 patients, with only one false negative and no false positives. GA demonstrated better sensitivity (95.5{\%} vs 86.4{\%}), specificity (100{\%} vs 57.1{\%}), positive predictive value (100{\%} vs 61.3{\%}), and negative predictive value (96.6{\%} vs 84.2{\%}) compared to VI. Conclusions Pleural gas analysis is an effective technique to detect APF and can facilitate timely and safe chest tube removal.",
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Pleural gas analysis for detection of alveolopleural fistulae. / Bharat, Ankit; Graf, Nicole; Cassidy, Emily; Smith, Sean; Gillespie, Colin Thomas; Meyerson, Shari Lynn; Sporn, Peter H; Sznajder, Jacob I; DeCamp Jr, Malcom McAvoy.

In: Annals of Thoracic Surgery, Vol. 99, No. 6, 01.06.2015, p. 2179-2182.

Research output: Contribution to journalArticle

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AU - Cassidy, Emily

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AU - Sporn, Peter H

AU - Sznajder, Jacob I

AU - DeCamp Jr, Malcom McAvoy

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N2 - Purpose Visual inspection (VI) of bubbles in the chest drainage unit does not differentiate a true leak of alveolopleural fistula (APF) from a false leak. We hypothesized that detection of elevated levels of carbon dioxide, increase in oxygen content, or both, in pleural gas upon the administration of supplemental oxygen would accurately identify APF. Description Prospective study comparing pleural gas analysis (GA) with VI to detect APF after surgical lobectomy (n = 50). Evaluation APF was found in 22 (44%) patients at the time of analysis. VI revealed air bubbles in 31 (62%) patients, indicating the presence of APF, of whom 12 (38.7%) were false leaks. VI failed to identify APF in 3 (6%) patients that resulted in post-tube removal pneumothorax. By contrast, GA accurately demonstrated APF in 21 patients, with only one false negative and no false positives. GA demonstrated better sensitivity (95.5% vs 86.4%), specificity (100% vs 57.1%), positive predictive value (100% vs 61.3%), and negative predictive value (96.6% vs 84.2%) compared to VI. Conclusions Pleural gas analysis is an effective technique to detect APF and can facilitate timely and safe chest tube removal.

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