Recommendations for the standardization and management of prolonged air leaks in lung surgery

BACKGROUND: Prolonged air leaks (PAL) are a common postoperative complication following lung surgery, associated with increased morbidity, extended hospital stays, and heightened healthcare costs. The incidence of air leaks ranges from 20 to 33%, with PAL occurring in 6%-26% of cases. Management strategies for PAL remain inconsistent, highlighting the need for standardized guidelines to address this issue. This study employed the GRADE approach to develop consensus-based recommendations for detecting and managing post-lung surgery PAL. METHODS: A task force of 18 thoracic surgeons, including a methodologist, conducted a systematic literature review focusing on 14 critical clinical questions. Recommendations were developed based on evidence from meta-analyses, randomized controlled trials, and observational studies, and graded according to the quality of evidence and the strength of the recommendation. RESULTS: Thirty-five studies were included in the final analysis. The consensus highlighted the lack of standardization in defining PAL and emphasized the need for personalized management based on clinical context. Key recommendations included the use of reinforced staples, parenchymal sutures, and sealants in high-risk patients, the preference for digital drainage systems, and the management of confirmed PALs with strategies such as chemical pleurodesis and surgical exploration. CONCLUSIONS: The consensus underscores the importance of a multidisciplinary approach in managing PAL, the need for standardizing definitions, and the ongoing requirement for evidence-based guidelines to improve patient outcomes. Future research should focus on addressing the limitations identified in this study.