Management of air leak after pulmonary resection

Objective: We prospectively evaluated the efficacy of water seal in the management of air leak after pulmonary resection. Methods: Eighty-seven patients who underwent lobectomy were enrolled. Air leak was qualitatively described on each postoperative day using a six-grade scale. All chest tubes were continuously suctioned at a negative pressure of 12 cm H₂O until the morning of postoperative day (POD) 1. Switch was made to water seal if the air leak was graded as “minor at expiration” or lower. This procedure is referred to as “the water seal challenge”. Results: On POD 1, 58 patients had air leaks. The water seal challenge was attempted on POD 1.6±1.0. While 45 patients (78%) continued to receive the water seal, the remaining 13 patients were switched to suctioning at −5 cm H₂O followed by the successful second water seal challenge within 3 days from the first challenge. The air leak stopped 3.1±3.0 days after the application of the water seal in the 58 patients. None of the following correlated with the duration of air leak: preoperative pulmonary function tests, type of lobectomy, age, and gender. Only the leak grade on POD 0 correlated significantly with the duration of air leaks (p<0.0001). Conclusion: These results show that water seal is a safe and effective management option for air leak during the early postoperative period.