Abstract
Persistent air leak (PAL) is associated with significant morbidity and mortality, prolonged hospitalization and increased health-care costs. It can arise from a number of conditions, including pneumothorax, necrotizing infection, trauma, malignancies, procedural interventions and complications after thoracic surgery. Numerous therapeutic options, including noninvasive and invasive techniques, are available to treat PALs. Recently, endobronchial one-way valves have been used to treat PAL. We conducted a systematic review based on studies retrieved from PubMed, EMbase and Cochrane library. We also did a hand-search in the bibliographies of relevant articles for additional studies. 34 case reports and 10 case series comprising 208 patients were included in our review. Only 4 patients were children, most of the patients were males. The most common underlying disease was COPD, emphysema and cancer. The most remarkable cause was pneumothorax. The upper lobes were the most frequent locations of air leaks. Complete resolution was gained within less than 24 h in majority of patients. Complications were migration or expectoration of valves, moderate oxygen desaturation and infection of related lung. No death related to endobronchial one-way valves implantation has been found. The use of endobronchial one-way valve adds to the armamentarium for non-invasive treatments of challenging PAL, especially those with difficulties of anesthesia, poor condition and high morbidity. Nevertheless, prospective randomized control trials with large sample should be needed to further evaluate the effects and safety of endobronchial one-way valve implantation in the treatment of PAL.
Highlights
Pulmonary air leak is a common clinical problem which can be resulted from both bronchopleural fistulas (BPFs) and alveolar-pleural fistulas (APFs)
Lung resections carry significant risks of Persistent air leak (PAL), with an incidence ranging from 8% after a sublobar resection to 45% after lung volume reduction surgery (LVRS)
Literature search strategy A search was conducted on PubMed, EMbase and Cochrane library for original studies published from 2005 to April 2017 on endobronchial one-way valves placement for treating PAL, using the keywords as “valve” AND “air leak” OR “bronchopleural fistula” OR “alveolar-pleural fistula”
Summary
Pulmonary air leak is a common clinical problem which can be resulted from both bronchopleural fistulas (BPFs) and alveolar-pleural fistulas (APFs). The presence of PAL is associated with significant morbidity and mortality, prolonged hospitalization and increased health-care costs [4]. Air leak, both BPF and APF, can arise from a number of conditions, including, but not limited to, pneumothorax, necrotizing infection, trauma, malignancies, procedural interventions (biopsy, CPR, radiofrequency ablation of lung tumors, etc) and complications after thoracic surgery [5,6,7]. Lung resections carry significant risks of PALs, with an incidence ranging from 8% after a sublobar resection to 45% after lung volume reduction surgery (LVRS). The incidence of postoperative air leak ranges from 28% to 60% immediately after surgery, 26% to 48% on postoperative day 1, 22% to 24% on
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