Elsevier

The Annals of Thoracic Surgery

Volume 90, Issue 5, November 2010, Pages 1658-1661
The Annals of Thoracic Surgery

Original article
General thoracic
Management of Localized Pneumothoraces After Pulmonary Resection With Intrapulmonary Percussive Ventilation

https://doi.org/10.1016/j.athoracsur.2010.06.092Get rights and content

Background

Intrapulmonary percussive ventilation (IPV) aims at clearing retained secretions through oscillary vibrations generated by high frequency bursts of gas delivered into the airways at rates between 200 and 300 breaths per minute and at a delivery pressure of 10 to 20 cm water. In addition, IPV can improve recruitment of alveolar units and deliver aerosolized medications. The use of IPV to resolve challenging postlobectomy localized pneumothoraces is hereafter described.

Methods

Between January 2005 and March 2009, four patients with long-term complicated postresectional residual air spaces persisting 6 months (mean, 187 days) after primary surgery were treated by IPV. The type of operation was upper lobectomy and lower lobectomy-wedge resection in 1 and 3 patients, respectively. Mean preoperative and immediate postsurgical forced expiratory volume in the first second of expiration were 2.31 L and 1.49 L, respectively. Mean preoperative and immediate postsurgical forced vital capacity were 3.13 L and 2.1 L, respectively. Patients were subjected to 12-minute-long IPV sessions up to a total of 8 to 12 sessions administered every other day in an outpatient setting.

Results

Complete resolution of the spaces within a mean of 22 days of beginning of treatment was noted. The post-IPV forced expiratory volume in the first second of expiration and forced vital capacity were 1.72 and 2.4 liters, respectively. No treatment-related morbidity was observed.

Conclusions

Intrapulmonary percussive ventilation can be expected to decisively contribute to resolving long-term localized pneumothoraces after subtotal pulmonary resections in an outpatient setting.

Section snippets

Material and Methods

Between January 2005 and March 2009, four patients with persistent localized pneumothoraces after pulmonary resection (mean, 187 days) were treated with IPV after failing medical treatment and physiotherapy (Table 1). There were 3 males and one female with a mean age of 64 years; two patients were current and two were former smokers. Mean preoperative and immediate postsurgical forced expiratory volume in the first second of expiration (FEV1) were 2.31 L and 1.49 L, respectively. Mean

Results

Complete lung reexpansion was obtained in all patients (Fig 1) within three weeks of beginning of treatment (mean, 22 days). Mean immediate postsurgical FEV1 and FVC were 1.49 L and 2.1 L, respectively. Mean FEV1 and FVC measured after IPV increased by 8.7% and 9.6% compared with immediate postsurgical FEV1 and FVC, respectively. Total loss of mean FEV1 and FVC compared with preoperative values was 17.7% and 14.7%, respectively. Moreover, Dlco measured at the end of IPV treatment was 83.7%;

Comment

Intrapulmonary percussive ventilation, a term coined by Bird in the 1980s [1], belongs to the modalities of noninvasive ventilation aimed at clearing secretions and enhancing oxygenation, especially in pediatric patients with cystic fibrosis [3, 4]. Reportedly, IPV facilitates airway clearance and expansion through “radial displacement” of the bronchial wall and by generating pulsatile expiratory flows of greater magnitude than the inspiratory ones at each respiratory cycle [5]. From a clinical

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