Management of Prolonged Pulmonary Air Leaks with Endobronchial Valve Placement
Charles Bakhos, Peter Doelken, Stevan Pupovac, Tom Fabian, Albany Medical Center, Albany, NY USA.
Objective: Prolonged pulmonary air leaks (PAL) are associated with increased morbidity and extended hospital stay. Our goal is to investigate if the bronchoscopic placement of one-way valves can help treat this condition.
Methods: We queried a prospectively maintained database of all patients with PAL lasting more than 7 days at a single 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 2012 until 2015. 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 male, mean age 65 ±15) underwent bronchoscopic valve deployment. Eight patients had postoperative PAL and 3 had a secondary spontaneous pneumothorax. The mean duration of air leak prior to valve deployment was 16 ±12 days, and the mean number of implanted valves 1.9 (mode=2, median=2). Median duration of hospital stay before and after valve deployment was 12 and 7 days, respectively (p=0.05). Digital monitoring demonstrated a mean drop in air leak flow of 1200 ml/min after valve deployment. There were no procedural complications related to deployment or removal of the valves. (Figure SA14-1)
Conclusions: Ronchoscopic placement of one way valves is a safe procedure that can help manage patients with prolonged PAL and shorten the hospital stay. A prospective randomized trial with cost-efficiency analysis is necessary to better demonstrate the role of this minimally invasive modality.
Figure 1 – Digital air leak monitoring guiding the placement of a single endobronchial valve in a Patient with interstitial lung disease after a thoracoscopic wedge resection of an adenocarcinoma of the RML (right middle lobe) (a: balloon occlusion of right upper lobe bronchus; b: balloon occlusion of right lower lobe bronchus)