Endoscopic treatment with endobronchial valves of Persistent Air Leak (PAL)

Abstract

Introduction: Persistent air leak is defined as prolonged (>5 days) need for a chest drain after pneumothorax, chest trauma or lung resection (28% to 60%). Standard treatment consists in maintaining the chest tube with or without suction. Pleurodesis, pleural decortication or surgical resection are further options. PAL occurrence extends the average hospital stay and increases costs. Aims and objectives: We evaluated safety and efficacy of endoscopic treatment of PAL with endobronchial valves. Methods: We reviewed the files of all patients treated for PAL during 6 years in 2 Italian Interventional Pulmonology Center. Results: Since September 2011 25 patients underwent endoscopic treatment of PAL due to: lung resection (9, 7 cancer), pneumothorax (11, 6 spontaneous-5 iatrogenic) or pleural empyema (5). Treatment was performed 17.5±10 days after chest tube insertion through flexible (92%) or rigid bronchoscopy (2 pt). Air leaks were located at a segmental (11pt) or lobar (12 pt) level using an Olympus balloon; in 2 patients 2 adjacent lobes were excluded. We used Zephyr Endo Bronchial Valves (6 pt) or Olympus Spiration Valve System (17 pt) or both (2 pt). Bronchoscopies lasted 28.6±11.5 minutes, air leak resolved immediately in 23 pt out of 25 (92%). No severe complications were described and pneumothorax never recurred. Conclusions: This retrospective study suggests that bronchoscopic treatment of PAL with bronchial valves is a minimally invasive procedure, effective and safe, regardless of its cause. Future prospective studies should focus of cost/effectiveness compared to conventional treatment.