Master of Science
Malthaner, Richard A
Introduction: Pulmonary air leaks from unhealed lung tissue are one of the most common complications after lung surgery. This adverse event leads to a delay in chest tube removal, prolonged pain, increased infections, prolonged hospital stay, and increased costs to the health care system. Objective: To define the most appropriate safe dose of dextrose 50% (D50) to seal air leaks in patients that have undergone lung resection surgery. Primary outcome was the occurrence of any adverse event. Methods: Prospective, single-arm, single-center, rule-based escalation traditional 3+3 design phase I trial where patients with an active air leak on postoperative day #2 received intrapleural D50 at various dosage. Results: 12 patients were recruited. Increments of 50 mL, 100 mL, 150 mL and 200 mL were tested. There was no severe adverse event. Air leak volume significantly decreased in the 24 hours following D50 administration compared to before (221 vs 31 L, p=0.013). Chest tube output remained similar (282 vs 365 mL, p=0.198). Transient non-significant increase of glycemia was noted 1 hours after D50 (7.4 vs 10.0 mmol/L, p=0.156). 33% (4/12) were discharged home with a one-way valve. Pain level was not impacted by D50. Conclusion: Hypertonic intrapleural glucose to treat air leaks after lung resection appears safe. The optimum dose is 150 mL. Its efficacy is promising and needs to be further studied prospectively.
Summary for Lay Audience
Lung resection surgery is frequently performed to remove lung cancer. Lung tissue is cut, and a drainage tube is left beside the lung at completion of the surgery to remove fluid that could accumulate around the lung. Air may also be leaking out of the lung, preventing the tube from being removed as the lung would collapse. Air leaks are also associated to infections around the lung, and the longer the leakage persists, the higher the risk of infections. Air leaks prolong length of hospital stay, and therefore once a leak occurs efforts are made to seal it as soon as possible.
Several ways exist to stop those air leaks, including injecting a product in the chest through the existing tube to create inflammation around the lung. This process called pleurodesis has been performed using various agents, including talc. High concentration glucose (sugar) has emerged from reports as being a promising agent to achieve the same purpose, with less toxicity.
Before larger scale studies are performed, we aimed at assessing the safety of various dose of high concentration sugar. We enrolled 12 patients. No major side effects were linked to the injection of sugar in the chest. The air leak rate decreased dramatically. The pain level and fluid drainage did not change. The blood sugar temporarily rose without any meaningful consequence.
Using this data, we can design a larger scale trial where we measure how effective sugar is compared to placebo in sealing those air leaks after lung resection surgery.
Qiabi, Mehdi, "PLeurodesis Using hypertonic Glucose administration to treat post-operative air leaks following lung resection surgery (PLUG): Phase I trial" (2021). Electronic Thesis and Dissertation Repository. 7773.