Endobronchial Therapy for Persistent Air Leak

Abstract

Persistent air leak (PAL) after intercostal drain insertion delays lung reexpantion, increases complications, and results in longer hospital stays and higher treatment costs. A proportion of patients will have comorbid disease or severe underlying lung disease, precluding surgery. We aimed to review the current available endobronchial treatments for PAL and the evidence for their use. The Watanabe spigot had success rates of 57% in early reports. There are numerous case reports and series evaluating endobronchial and intrabronchial valves in the management of PAL. Success rates range from 57 to 95%. Complications were generally minimal and non-fatal. To date, there are no published randomised trials, but one is underway. Endobronchial therapy seems to be a viable and safe alternative for the management of PAL in non-surgical candidates. There is to date no high-level evidence, and our most current practices are based on observational data and expert opinion.