The invention will be described in conjunction with the following drawings in which like reference numerals designate like elements and wherein:
In one embodiment, a biphasic air leak sealing system is used to seal air leaks, without surgery, by importing into the lung a liquid that follows the path of the escaping gas. The liquid finds the leaks because those are the only areas with any air flow. This does not require the operator to find the leaks. The same premise is also used to find air leaks by using a tracer liquid, which also follows the path of the escaping gas.
An exemplary leak sealing system comprises two components: a prosealant and an activator. The prosealant can be a building block compound that remains liquid until cross-linked or coagulated by the activator. With a chest tube that is inserted into the patient's chest cavity on suction, the prosealant is introduced into the air stream in a nebulized form. The liquid selectively accumulates at all leak sites. Because the prosealant does not seal by itself, the lung passageways are not blocked and the sealant collects only at the site of the air leak. After a sufficient amount of prosealant has accumulated, the chest tubes are removed from suction and the activator is introduced into the chest cavity through the chest tube. This is a common practice in thoracic surgery, instilling doxycycline or talc through a chest tube for the purpose of pleurodesis. It has been well established byradionuclide studies that a liquid introduced through a chest tube is rapidly distributed throughout the chest cavity within several breaths. Wherever the activator comes in contact with the prosealant, a sealant then forms, thereby plugging the holes in the surface of the lung at exactly the correct sites.
It may not be possible in all cases for the prosealant to be aerosolized into small enough particles that can reach a leak, in which case an alternative embodiment can comprise an aerosolized activator that is introduced the air stream and a prosealant that is introduced into the chest cavity. One possible such paring comprises gelatin as the prosealant and polylactic-co-glycolic acid (“PLGA”) as the activator that is introduced into the air stream. These two compounds form a well known hydro-gel reaction involving cross linking. This reaction is described in Y. Otani et al. Biomaterials 19 (1998) pp. 2167-2173, which is incorporated by reference herein.
In a further embodiment, the prosealant is activated by light instead of a second component.
The prosealant will have certain properties. It will be nontoxic, bioabsorbable, readily vaporized or nebulized and, likely, of low viscosity. The sealant activator and the activated sealant will also be bioabsorbable and non toxic. The ideal sealant would stretch with expansion of the lung and serve as a scaffolding for ingrowth of fibroblasts, etc, the cells responsible for the body's natural healing mechanisms. Like trying to cross a busy highway, it is suspected that the constant flow of air across a hole in the lung prevents these cells from being able to gain a foothold for sealing the leak in diseased lungs or in setting larger holes with high flow. After the body is able to scar in the hole in the lung, the ideal sealant would be absorbed by the normal mechanisms.
After the prosealant accumulates at the site of all leaks, the activator is introduced through the chest tube into the chest cavity. This bathes the lung surface in the activating agent. Wherever the prosealant and activator come in contact, the prosealant is converted into the sealant. The chest tube is then replaced to suction to evacuate any excess activator and to re-expand the lung. An exemplary activator would be nontoxic, have low viscosity and be bioabsorbable.
It is also possible that the components of fibrin glue could be used as a prosealant and activator.
In a still further embodiment, a hydroscopic single component sealant can be inhaled into the air stream. The sealant would expand upon exposure to moisture at the site of the injury. Because the lung has moisture everywhere, a liposome-type preparation could be used that shields the sealant particles from absorbing moisture for a period of time until a sufficient number of particles has begun to fill up the opening. The single component sealant would have to be bioabsorbable, nontoxic and swell in the presence of water. The particle size would have to be such that the sealant could capitalize on the selective flow phenomenon disclosed herein.
An exemplary method for leak detection and a demonstration that a liquid introduced into the lungs in a nebulized form will accumulate only at a leak site is shown in
In order for the particles of an aerosolized liquid to be diagnostically useful, they must, at a minimum, be small enough to travel throughout the bronchopulmonary tree and to the sites of parenchymal injury. Nebulized methylene blue particles are approximately between 0.4 and 2.1 microns in diameter, which makes them small enough to travel to the terminal alveoli of the human lung. In addition, it is suspected that other properties of the liquid are relevant to the ability to perform as methylene blue does in the example described herein. These properties include: the degree to which the compound is hydrophyillic or hydrophobic, distensiblity, specific weight and electrical charge.
Methylene blue is a widely used aromatic chemical compound. It is a solid, dark green odorless powder that yields a blue solution when dissolved in water. Due to its reducing agent properties, it is employed as a medication for the treatment of methemoglobinemia and cyanide toxicity. It is also used as a dye and staining agent in multiple surgical arenas, including the identification of sentinel lymph nodes in breast cancer, melanoma, and lung cancer. It is also being used for the localization of pulmonary nodules in adult and pediatric patients.
The method for accumulating a liquid at a pulmonary leak point as demonstrated in
The advantages of the system described herein over every other system currently in use are significant. The system finds the leaks by itself. There is no need for bronchoscopy or surgery, both of which are minimally or partially successful at best for locating all sites of leakage in many situations. Allowing the leaks to determine where the prosealant accumulates is really the only way to localize all leaks. The procedure can be performed at the bedside with the patient awake—no need to travel to the operating room or a bronchoscopy suite. Lastly, once the procedure is commercialized, it could be performed by any physician and would be the procedure of choice for any patient with an air leak from any cause. Any such patient would already have a chest tube in place and that would represent the only procedural part of the biphasic sealant system.
While the invention has been described in detail and with reference to specific examples thereof, it will be apparent to one skilled in the art that various changes and modifications can be made therein without departing from the spirit and scope thereof.
Number | Date | Country | |
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60795770 | Apr 2006 | US |