{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T16:55:51Z","timestamp":1792688151950,"version":"4.5.0"},"reference-count":29,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,1,22]],"date-time":"2026-01-22T00:00:00Z","timestamp":1769040000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Bioeng. Biotechnol."],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>\n                      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\n                      <jats:italic>ex vivo<\/jats:italic>\n                      negative pressure ventilation of lungs, equipped with PAL-oriented features.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Reproducibility and system capabilities were assessed using a lung simulation model capable of controlling the effective area of the defect, then validated with\n                      <jats:italic>ex vivo<\/jats:italic>\n                      specimens.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Our system enables dynamic control of ventilation using either pressure (PCV) or volume (VCV) targets, with respective standard deviations of \u00b10.08 cm H2O and \u00b12.1 mL with moderate air leaks (&amp;lt;1,000 mL\/min) and respective standard deviations of \u00b10.18 cm H2O and \u00b111 mL with severe air leaks (&amp;gt;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 (&amp;lt;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\n                      <jats:italic>Thopaz<\/jats:italic>\n                      + proved to systematically report lower leak rates values (\n                      <jats:italic>Thopaz<\/jats:italic>\n                      + 420.0 \u00b1 10.0 mL\/min vs. PCV-derived 449.0 \u00b1 19.9 mL\/min, p &amp;lt; 0.05) and (\n                      <jats:italic>Thopaz<\/jats:italic>\n                      + 1,200.0 + 0.0 mL\/min vs. PCV-derived 1,239.7 \u00b1 21.1 mL\/min, p &amp;lt; 0.001). Unlike current systems, coughing was predictably replicated using peak pressure targets ranging from 100 to 300 cm H2O with a standard deviation of \u00b11.30 cm H2O from target. Our system allows extraction of biomechanical parameters at every breath, with theoretically expected pressures matching experimental measurements with a goodness fit value (R2) above 0.95 for the vast majority of breaths.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>\n                      The\n                      <jats:italic>Ex vivo<\/jats:italic>\n                      Pulmonary Air Leak Model (Ex-PALM) provides a preclinical PAL testing platform with high translational potential and applications in studying biomechanical mechanisms of PAL and developing intraoperative mitigation strategies.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fbioe.2025.1725254","type":"journal-article","created":{"date-parts":[[2026,1,22]],"date-time":"2026-01-22T06:55:08Z","timestamp":1769064908000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Ex-PALM: a negative pressure ventilation system for air leak evaluation in ex vivo lungs"],"prefix":"10.3389","volume":"13","author":[{"given":"Mark","family":"Vartazarmian","sequence":"first","affiliation":[{"name":"Department of Mechanical Engineering, Institute of Biomedical Engineering, Polytechnique Montr\u00e9al","place":["Montreal, QC, Canada"]},{"name":"TID Laboratory, Centre de Recherche du Centre Hospitalier de l\u2019Universit\u00e9 de Montr\u00e9al (CRCHUM)","place":["Montreal, QC, Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandre","family":"Abid","sequence":"additional","affiliation":[{"name":"TID Laboratory, Centre de Recherche du Centre Hospitalier 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