Venting subcutaneous emphysema

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There are several thoracic surgeons who treat airleaks with less or no 
suction rather than increasing suction.  This has been shown to be true in 
LVR patients, these patients can have massive airleaks post op and are often 
treated with minimal suction.  We thoracic surgeons will often accept a small 
airspace in order to achieve a smaller airleak.  If in doubt ask your 
thoracic surgeon.  You can get portable suction and do CTs ON Suction.  I so 
it all the time. Also if an airleak persists for a week or more following 
trauma and is otherwise stable, he/she may be a candidate for VATS. If the 
patient is on the vent, Pressure control vent will result in smaller airleaks 
and less volume loss than Volume control vent.  There are several tricks that 
thoracic surgeons use to control leaks.  I feel that any leak that persists 
greater than a couple of days should be seen by a thoracic surgeon,  but 
maybe that is because I am thoracic surgeon
BWolfer

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