Management of Prolonged Pulmonary Air Leaks With Endobronchial Valve Placement

JSLS. Jul-Sep 2016;20(3):e2016.00055. doi: 10.4293/JSLS.2016.00055.

Abstract

Background: Prolonged pulmonary air leaks (PALs) are associated with increased morbidity and extended hospital stay. We sought to investigate the role of bronchoscopic placement of 1-way valves in treating this condition.

Methods: We queried a prospectively maintained database of patients with PAL lasting more than 7 days at a tertiary medical center. Main outcome measures included duration of chest tube placement and hospital stay before and after valve deployment.

Results: Sixteen patients were eligible to be enrolled from September 2012 through December 2014. One patient refused to give consent, and in 4 patients, the source of air leak could not be identified with bronchoscopic balloon occlusion. Eleven patients (9 men; mean age, 65 ± 15 years) underwent bronchoscopic valve deployment. Eight patients had postoperative PAL and 3 had a secondary spontaneous pneumothorax. The mean duration of air leak before valve deployment was 16 ± 12 days, and the mean number of implanted valves was 1.9 (median, 2). Mean duration of hospital stay before and after valve deployment was 18 and 9 days, respectively (P = .03). Patients who had more than a 50% decrease in air leak on digital monitoring had the thoracostomy tube removed within 3-6 days. There were no procedural complications related to deployment or removal of the valves.

Conclusions: Bronchoscopic placement of 1-way valves is a safe procedure that could help manage patients with prolonged PAL. A prospective randomized trial with cost-efficiency analysis is necessary to better define the role of this bronchoscopic intervention and demonstrate its effect on air leak duration.

Keywords: Air leak; Endoscopic; Lobectomy; Valve; Wedge.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Bronchoscopy* / instrumentation
  • Bronchoscopy* / methods
  • Chest Tubes
  • Databases, Factual
  • Female
  • Follow-Up Studies
  • Humans
  • Length of Stay
  • Male
  • Middle Aged
  • Pneumonectomy*
  • Pneumothorax / etiology
  • Pneumothorax / therapy*
  • Postoperative Complications / therapy*
  • Prostheses and Implants*
  • Treatment Outcome