Ex-PALM: a negative pressure ventilation system for air leak evaluation in

Introduction: Prolonged air leaks (PAL) are considered to be one of the leading causes of postoperative complications following lung surgery. There are currently no clinically relevant methods for efficiently and systematically evaluating the underlying causes of PAL. Here, we introduce a new intuitive, physiologically-representative system for Methods: Reproducibility and system capabilities were assessed using a lung simulation model capable of controlling the effective area of the defect, then validated with Results: Our system enables dynamic control of ventilation using either pressure (PCV) or volume (VCV) targets, with respective standard deviations of ±0.08 cm H2O and ±2.1 mL with moderate air leaks (<1,000 mL/min) and respective standard deviations of ±0.18 cm H2O and ±11 mL with severe air leaks (>1,000 mL/min). Additionally, leak quantification features proved comparable to that of the Thopaz+ (Medela Healthcare, Baar, Switzerland), a standard commercial digital thoracic drainage system, offering sufficient resolution to differentiate among clinically relevant air leaks. In the lower leak ranges (<400 mL/min) across all methods of evaluations, there were no significant differences between measured leak rates. For higher leak ranges, although there remained no significant differences between the Ex-PALM methods evaluated, the Discussion: The