Effectiveness of Dextrose Pleurodesis for the Management of Post-Operative Air Leak

Dextrose Pleurodesis Versus Standard of Care for the Management of Post-Operative Air Leak: A Single Center Prospective Trial

A common complication following lung resection surgery is the presence of a post-operative air leak. This occurs when the resected lung tissue does not seal adequately, resulting in continued leakage of air from the lung. For most patient, an air leak will self-resolve by maintaining a drainage catheter in the chest for a prolonged period. However, for some patients, additional measures are required to help seal the affected tissue. Known strategies for managing post-operative air leak include placing one-way valves, surgical revision, and chemical pleurodesis. Chemical pleurodesis involves injecting an irritant through the chest drainage catheter to promote sealing of the leaking lung tissue. While many agents exist for chemical pleurodesis, a relatively new method for treating an air leak is by using dextrose solution. Dextrose is appealing due to low cost and availability. Dextrose solution has shown some efficacy in other countries and undergone Phase 1 clinical investigation in Canada to show its safety and dosing recommendations. In this study, our aim is to compare the effectiveness of using dextrose solution for treating post-operative air leak compared to usual care with chest tube drainage alone.

Inclusion Criteria:

• Adult patients who have undergone lung resection
• Persistent post-operative air leak >24 hours after surgery with air leak >20 mL/min

Exclusion Criteria:

• pregnant patients
• incarcerated patients
• patients with early post-operative complications
• hemodynamic instability
• need for mechanical ventilator support
• high volume chest tube output (>750 mL over 24h)