H. Zhang*a (Prof), C. Gea (Mr), C. Chenb (Ms), Z. Zhenga (Mr), G. Xuea (Mr), W. Xua (Mr), C. Duana (Mrs), Y. Caia (Mr), W. Zhanga (Mrs), L. Wanga (Mrs), Z. Suna (Mrs), Z. Lia (Mrs)

a Department of Respiratory and Critical Care Medicine, Rizhao Hospital of Traditional Chinese Medicine, Rizhao City,shandong Province, CHINA ; b Department of Respiratory Medicine,Rizhao People’s Hospital, Rizhao City,shandong Province, CHINA

* huxizhanghua@163.com

Background Persistent air leakage (PAL),generally defined as air leakage persisting despite 3 days of water seal drainage, is a common complication of thoracotomy and VATS.It may result in poor prognosis. Our innovative medical thoracoscopic intervention for spontaneous pneumothorax and giant emphysematous bulla (MTIFSPGEB) also faced PAL. We had proposed an effective innovative comprehensive intervention method, utilizing the effects of position selection, continuous negative pressure suction and thrombin (hereinafter referred to as "position plus 1.0") in PAL with expanded lung after MTIFSPGEB.For PAL patients with an unexpanded lung or those who failed to respond to "position plus 1.0", 100ml autologous blood and 5000IU thrombin dissolved in 10ml physiological saline were injected into thoracic cavity in turn combined with body position selection, namely "position plus 2.0". The efficacy and safety of "position plus 2.0" were investigated in this study.

Methods It was a prospective study conducted from 2020 to 2022. PAL after MTIFSPGEB with an unexpanded lung on CT or PAL after the application of “position plus 1.0” was treated by "position plus 2.0".Catheter drainage was continued with or without negative pressure suction(-16~-20cmH2O),while maintaining the selected body position for 24~48 hours. If there was still air leakage after 48 hours,the above steps would be repeated until leakage stoped,up to 3 times.

Results 17 patients were included.After the intervention of “position plus 2.0”,PAL was stopped successfully in 16 cases (94.12%).The times of “position plus 2.0” applied was 1.0(1.0,1.5).During hospitalization,PAL relapsed in 3 cases(17.65%).Complications included fever(4cases),pleural effusion(4cases) and empyema(1case).

Conclusion The comprehensive intervention “position plus 2.0” is safe, effective and easy to operate for the treatment of PAL with unexpanded lung after MTIFSPGEB or PAL afer the application of “position plus 1.0”.

Disclosure of funding source(s):

Shandong Province Development Project for Medical Health Science and Technology ( 202003021202)