Persistent air leak - review

A persistent air leak (PAL) can be caused by either an alveolar-pleural fistula (APF) or bronchopleural fistula (BPF). Complications from PAL lead to an increase in morbidity and mortality, prolonged hospital stay, and higher resource utilization. Pulmonary physicians and thoracic surgeons are often tasked with the difficult and often times frustrating diagnosis and management of PALs. While most patients will improve with chest tube thoracostomy, many will fail requiring alternative bronchoscopic or surgical strategies. Herein, we review the bronchoscopic and surgical diagnostic and treatment options for PAL as it pertains to the field of interventional pulmonology and thoracic surgery. •Persistent air leaks are associated with multiple complications.•The mainstay of treatment is chest tube thoracostomy for up to 5 days.•If additional interventions are required, the treatment should be individualized.•There are numerous medical and surgical options available.•There are no robust studies that have shown one method is superior to another.