Treatment Of Persistent Air Leak Research Articles

Endobronchial Valves in Treatment of Persistent Air Leak: European Case-Series Study and Best Practice Recommendations - From an Expert Panel.

Persistent air leak (PAL) is associated with prolonged hospitalization, high morbidity and increased treatment costs. Conservative treatment consists of observation, chest tube drainage, and pleurodesis. Guidelines recommend surgical evaluation if air leak does not respond after 3-5 days. One-way endobronchial valves (EBV) have been proposed as a treatment option for patients with PAL in which surgical treatment is not feasible, high risk or has failed. We aimed to provide a comprehensive overview of reported EBV use for PAL and issue best practice recommendations based on multicenter experience. We conducted a retrospective observational case-series study at four different European academic hospitals and provided best practice recommendations based on our experience. A systematic literature review was performed to summarize the current knowledge on EBV in PAL. We enrolled 66 patients, male (66.7%), median age 59.5 years. The most common underlying lung disease was chronic obstructive pulmonary disease (39.4%) and lung cancer (33.3%). The median time between pneumothorax and valve placement was 24.5 days (interquartile range: 14.0-54.3). Air leak resolved in 40/66 patients (60.6%) within 30 days after EBV treatment. Concerning safety outcome, no procedure-related mortality was reported and complication rate was low (6.1%). Five patients (7.6%) died in the first 30 days after intervention. EBV placement is a treatment option in patients with PAL. In this multicenter case-series of high-risk patients not eligible for lung surgery, we show that EBV placement resulted in air leak resolution in 6 out of 10 patients with a low complication rate. Considering the minimally invasive nature of EBV to treat PAL as opposed to surgery, further research should investigate if EBV treatment should be expanded in low to intermediate risk PAL patients.

The Efficacy and Safety of Autologous Blood Patch for Persistent Air Leaks: A Systematic Review and Meta-Analysis.

Persistent air leaks (PALs) are associated with prolonged hospital stays, contaminationand sustained infection of the pleural space, and significant morbidity. A fistulous tract between the alveoli and the pleural space is referred to as analveolar-pleural fistula (APF), whereas a fistulous tract between the bronchiole and the pleural space is referred to as a bronchopleural fistula (BPF). There is no consensus on the treatment, and multiple modalities exist for the management of persistent air leak (PAL). Autologous blood patch (ABP) is a relatively safe and inexpensive method that has been used for many years for the treatment of PALs. We conducted an electronic database search between 08/24/2022 and 08/27/2022 in PubMed, Embase, and Cochrane using keywords. The following keywords were used: "Blood patch" OR "Autologous blood patch" AND "pleurodesis."Our study included all original studies with the prime focus on the etiology of PALs, clinical characteristics, procedural details of ABP, and outcomes of the proposed treatment. The primary outcomes that were the focus of our study were the time to seal the air leak, the time to remove the chest tube after air leak cessation, and the time to discharge from the hospital. To determine the safety of ABP, we also evaluated the procedural outcomes. Our findings suggest a statistically significant decrease in the time to air leak cessation when compared to the control group (mean difference of -3.75 {95% CI: -5.65 to -1.85; P=0.001}) with considerable heterogeneity of I2=85% and P=0.001. However, the difference was not statistically significant when a lower dose of ABP (50 mL) was compared to a higher dose (100 mL) (mean difference of 1.48 {95% CI: -0.07 to 3.02; P=0.06}) and considerable heterogeneity of I2=80% and P=0.03. There was no statistically significant difference in the time to discharge when compared to the control group (mean difference of -2.12 {95% CI: -4.83 to 0.59; P=0.13}) and considerable heterogeneity (I2=95% and P<0.001). When compared to the control group, ABP did not provide any statistically significant difference in the risk ratio for infection (1.18 {95% CI: 0.52 to 2.65; P=0.70} and moderate heterogeneity {I2=33% and P=0.20}), pain (1.18 {95% CI: 0.52 to 2.65; P=0.70} and moderate heterogeneity {I2=33% and P=0.20}), and fever (0.54 {95% CI: 0.27 to 1.10; P=0.09} and no heterogeneity {I2=0% and P=0.50}). Our study concludes that using ABP caused a statistically significant decrease in the time to air leak cessation when compared to the control group. However, the procedure does not provide a statistically significant difference in the time to discharge from the hospital when compared to conservative treatment. Similarly, there was no statistically significant difference in the risk ratio for complications such as infection, pain, and fever when compared to conservative management. More studies need to be conducted to fully understand the efficacy and safety of ABP in the management of PALs.

Endobronchial fibrin sealant and autologous blood patch for treatment of persistent air leak in a mechanically ventilated patient: a case report

Background: Persistent air leaks (PALs) are associated with high morbidity. There are multiple endobronchial therapies used to treat PALs, although no single modality has been identified as superior and even fewer used successfully in mechanically ventilated patients.

Variation in incidence, prevention and treatment of persistent air leak after lung cancer surgery.

OBJECTIVESPersistent air leak (PAL; >5 days after surgery) is the most common complication after pulmonary resection and associated with prolonged hospital stay and increased morbidity. Literature is contradictory about the prevention and treatment of PAL. Variation is therefore hypothesized. The aim of this study is to understand the variation in the incidence, preventive management and treatment of PAL.METHODSData from the Dutch Lung Cancer Audit for Surgery were combined with results of an online survey among Dutch thoracic surgeons. The national incidence of PAL and case-mix corrected between-hospital variation were calculated in patients who underwent an oncological (bi)lobectomy or segmentectomy between January 2012 and December 2018. By multivariable logistic regression, factors associated with PAL were assessed. A survey was designed to assess variation in (preventive) management and analysed using descriptive statistics. Hospital-level associations between management strategies and PAL were assessed by univariable linear regression.RESULTSOf 12 382 included patients, 9.0% had PAL, with a between-hospital range of 2.6–19.3%. Factors associated with PAL were male sex, poor lung function, low body mass index, high American Society of Anesthesiologists (ASA) score, pulmonary comorbidity, upper lobe resection, (bi)lobectomy (vs segmentectomy), right-sided tumour and robotic-assisted thoracic surgery. Perioperative (preventive) management of PAL differed widely between hospitals. When using water seal compared to suction drainage, the average incidence of PAL decreased 2.9%.CONCLUSIONSIn the Netherlands, incidence and perioperative (preventive) management of PAL vary widely. Using water seal instead of suction drainage and increasing awareness are potential measures to reduce this variation.

Pleurodesis with an Autologous Blood Patch in the Treatment of Persistent Air Leak after Lung Resection

Objective To evaluate the efficacy and risks of autologous blood patch pleurodesis in patients with persistent air leak(PAL)after lung resection. Methods A total of 97 patients with PAL after lung resection in Beijing Shijitan Hospital from October 2014 to October 2019 were retrospectively reviewed,including 53 treated by autologous blood patch pleurodesis and 44 by the conventional way.The therapeutic effect,adverse reactions and complications were analyzed. Results All the patients with PAL were cured with autologous blood patch pleurodesis.Most air leaks(81.1%)ceased within 48 hours after treatment,and the left 18.9% patients got cured after a repeat.The mean tube retention time and the mean in-hospital stay were 8.4 days and 10.0 days in the autologous blood patch pleurodesis group and 13.5 days and 15.3 days in the conventional treatment group.A prolonged drainage time(P=0.00)and in-hospital stay(P=0.00)were observed in the conventional treatment group.No severe complications were observed except two patients developed slight fever and cutaneous emphysema. Conclusion In our experience,the autologous blood patch pleurodesis is an effective way with low risk of adverse reactions in the treatment of PAL.

PSU3 OUTCOME IMPROVEMENT AND HOSPITAL STAY REDUCTION IN LUNG REDUCTION SURGERIES

One of the most common complications after a lung reduction surgery is prolonged air leak. This study reports the routine use of Heimlich valve and its impact on total hospital stay and a re-operation for a persistent leak. This article evaluates electronic health records to assess the impact of this treatment and the results also show a prospective algorithm for treatment of persistent air leaks. From September 2005, through November 2011, 150 patients were operated for elective pulmonary resection, which had a heterogenous pattern of lung disease, with post-operative mortality of 4 patients and average duration of total length of hospital stay of 10.61 days. Bilateral Heimlich valves were applied to 18 patients, and unilateral Heimlich valves in 132 patients. Use of Heimlich valve was done irrespective of size of air leak. X-rays were obtained in patients after Heimlich valve was placed which showed minimal size of air leak. Mean number of postoperative days to placement of the Heimlich valve was 7.2 ± 2.4. The mean number of days to postoperative discharge was 8.1 ± 1.6(range5 to 16) and the mean number of days after discharge until removal of the chest tubes and the Heimlich valves was 3.61 ± 1.4(range 0, to 26). Almost all patient tolerated Heimlich valve well after discharge. The average hospital stay was shortened by 56% with the use of Heimlich valve in patients who underwent lung reduction surgery, considering the fact that all these patients would have stayed in the hospital, till the removal of their chest tube. The reduced hospital stay has certainly been caused by the use of Heimlich valve. This eventually helps in providing better patient care.The algorithm to predict the severity of air leak clinically was found to be effective in determining the course of decision making.

Combined intrapleural and intrabronchial injection of fibrin glue for closing alveolar pleural fistula: a case report

BackgroundThe treatment of persistent air leak is a challenge. Herein, we reported the combined intrabronchial and intrapleural injection of fibrin glue using fiber bronchoscopy to seal off an alveolar pleura fistula developed following necrotizing pneumonia in high-risk patient.Case presentationA 74-year-old man was intubated in emergency for acute ischemic stroke. Percutaneous dilatational tracheostomy was then performed, and 15 days later patient returned to spontaneous breathing. However, he developed alveolar pleural fistula following necrotizing pneumonia with persistent air leaks. The intrabronchial and intrapleural injection of fibrin glue using fiber bronchoscopy sealed off the alveolar pleura fistula after that other endoscopic treatments as bronchial valve and intrabronchial fibrin glue application had failed.ConclusionsOur strategy is safe and easy to reproduce. It represents an additional method in the armamentarium of the physicians for the management of PAL when all standard strategies are unfeasible or fail.

Endoscopic one-way endobronchial valves in the treatment of persistent air leak with empyema

Background: Persistent air leak complicated by empyema is a life-threatening condition especially in patients with pulmonary emphysema. Surgical approaches are often disappointing and demolitive surgery is often needed. Endobronchial valves have been successfully applied for persistent air leak but their use in case of concurrent empyema has been reported in very few cases. We present a case series of six consecutive patients with persistent air leak and empyema, successfully treated by endobronchial valves. Methods: Bronchoscopic procedures included preliminary identification of the area of air leakage by bronchial occlusion using a balloon catheter. The nitinol and silicon valves (Pulmonx ® ) were inserted by means of flexible bronchoscopy in all cases. Chest drain was removed after negativity of microbiological essay from pleural liquid. Results: Four patients had severe emphysema with chronic respiratory failure and smoking history. One patient was affected by rheumatoid arthritis and one had chronic heart failure and diabetes. Four cases were postoperative air leakage after lung resection and two cases were due persistent spontaneous pneumothorax. Empyema was mainly due to Acinetobacter baumannii or Pseudomonas aeruginosa or staphylococcus aureus. Procedures were successful in every case. Air-leaks stopped in the first 24 hours after procedure in two patients and within 7 days in the remaining cases. All patients were discharged within 3 weeks without complications. Conclusions: Insertion of endobronchial valves is a safe and effective method for treating persistent air leak even during empyema in selected cases and especially for patient unfit for surgery.

Assessment of Fissure Integrity in Patients With Intrabronchial Valves for Treatment of Prolonged Air Leak

Intrabronchial valves (IBVs) are a treatment alternative for persistent air leak (PAL). However, there is a paucity of evidence regarding whether the absence of collateral ventilation (CV) can predict successful treatment of PAL with IBV placement. We assessed whether absence of CV measured by fissure integrity could predict successful resolution of PAL with IBV placement. A multicenter, retrospective study was performed. Patients who underwent IBV placement for PAL were identified. Chest computed tomography analysis via VIDA Diagnostics was used to assess CV. CV was present if the treated lobe was adjacent to a fissure that was <90% complete. A total of 81 valves were placed in 26 patients (median, 3 per patient). A total of 16 patients without CV underwent IBV placement: 14 patients had complete resolution of PAL with a median time from IBV placement to air leak resolution of 4.5 days and 2 patients required subsequent procedures to manage the PAL. In a subset of patients without CV who underwent complete lobar occlusion with IBV (n= 8), median time to PAL resolution was 3 days, whereas in patients without CV who underwent incomplete lobar occlusion with IBV (n= 6), median time PAL resolution was 6.5 days (p= 0.045). All 10 patients with CV underwent IBV placement and complete lobar occlusion: 4 patients had complete PAL resolution with a median time from IBV placement to PAL resolution of 17.5 days and 6 patients required subsequent procedures to manage their PAL. PAL treatment with IBV is more successful in patients without CV, especially when complete lobar occlusion with IBV is achieved.

Endobronchial valve for treatment of persistent air leak complicating spontaneous pneumothorax.

Endobronchial one-way valves have been proposed as treatment for persistent air leak complicating spontaneous pneumothorax in which surgical intervention is not feasible. However, published data on efficacy, safety, and factors associated with success are scanty. This is a retrospective study of 37 patients at a general hospital from 2008 to 2016. The impact of endobronchial valve implantation on the time to air-leak cessation after bronchoscopy was evaluated. The median patient age was 71 years. The majority of patients were males (92%), were ever-smokers (83%), had at least one co-morbidity (97%), and had secondary spontaneous pneumothorax (89%). Nineteen patients (51%) had a mean of 2.6 endobronchial valves implanted (range, 1-6). The air leak ceased within 72 hours for only eight patients (22% of the complete cohort), with immediate air-leak cessation after completion of endobronchial valve implantation. All six successful cases that had computed tomographic data of the thorax were shown to have bilateral intact interlobar fissures. The median (interquartile range) Charlson co-morbidity index was 1 (0.25-1) and 2 (1-3) for the success group and failure group, respectively (P=0.029). All patients in the no-endobronchial valve group survived, whereas three patients in the endobronchial valve group died within 30 days of endobronchial valve implantation. Only a small proportion of cases of endobronchial valve implantation for air leak complicating pneumothorax had unequivocal success. Intact bilateral interlobar fissures appear to be a necessary, though not sufficient, condition for success. Patients with fewer medical co-morbidities and immediate air-leak cessation after endobronchial valve implantation have a higher likelihood of success.

Bronchoscopic valve placement for the treatment of persistent air leaks.

Persistent air leaks (PALs) are associated with increased morbidity, prolonged hospital stay, and increased treatment costs. Endobronchial 1-way valves have been recently used as a potential less invasive treatment option. We sought to investigate the effects of valve therapy in treating this condition. The patients with evidence of continuous air leak flow whose chest tubes remained in place for more than 7 days were treated with bronchoscopic closure using 1-way valves. The source of the air leak was identified by the Chartis system.A total of 11 patients (1 woman, 10 men; mean age, 68 years) who underwent valve placement were eligible to be enrolled from January 2015 through January 2017. Six patients had postoperative PAL, and 5 had a secondary spontaneous pneumothorax. The number of used valves varied from 1 to 3 (median 1). The resolution of the leak was complete in 8 patients (72.7%), whose mean duration of air leak before and after valve deployment was 58.5 and 4.5 days, respectively. There were no complications related to the valve deployment.Bronchoscopic placement of 1-way valves is a safe procedure that could help manage patients with prolonged PALs. 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.

Management of Persistent Air Leaks with Intrabronchial Valves.

Persistent air leaks (PALs) are regarded as a frequent complication after thoracic surgery resulting in prolonged hospitalization and increased morbidity. Several more or less invasive therapeutic approaches are available for treatment of PAL with varying degrees of success. The endoscopic placement of one-way intrabronchial valves in the segment(s) in which the air leak has been located offers a highly effective and well-tolerated minimal invasive option for patients with PAL.

Bronchoscopic valves for prolonged air leak: current status and technique.

Unidirectional airway valves are devices used for the treatment of persistent air leaks (PALs) secondary to alveolar-pleural fistulas (APF) or bronchopleural fistulas (BPFs). These valves were originally developed as a non-surgical alternative to lung volume reduction surgery (LVRS) for patients with chronic obstructive pulmonary disease (COPD). Randomized trials investigating the use of valves for bronchoscopic LVRS did not lead to the Federal Drug Administration (FDA) approval, but stemming from these studies a Humanitarian Device Exemption (HDE) was granted to Spiration intrabronchial valves (IBVs) for the treatment of PALs. These valves are being increasingly utilized due to the effectiveness of IBVSs in reducing PALs, thus shortening duration of hospitalizations and minimizing the risk of hospital associated complications. The literature supporting the use of unidirectional airway valves for the bronchoscopic treatment of PALs is grounded primarily in case reports. While the current body of literature available to justify the use of unidirectional valves is limited to case series, current multicenter, randomized trials should provide further guidance regarding patient selection and effectiveness.

Editorial: the movement towards airway valves for the treatment of persistent air leaks

Alveolar-pleural fistulas (APF) are pathologic communications between the alveoli and pleural space. These communications can occur from pneumothoraces, pulmonary infections, trauma, malignancies, and complications of thoracic surgery. Development of an APF may result in a persistent airleak (PAL), which allows air entering the lungs to continuously pass into the pleural space. The presence of an APF or a PAL is associated with significant morbidity, increased mortality, and prolonged hospitalizations (1-3).

PUB148 Efficacy of Heimlich Valve in Preventing Air Leaks

One of the most common complications after a lung reduction surgery is prolonged air leak. This is a prospective study, which reports the routine use of Hiemlich valve and its impact on total hospital stay and a reoperation for a persistent leak. This article evaluates a type of treatment for air leaks using Hiemlich valves; the results also show a prospective algorithm for treatment of persistent air leaks. From September 2005, through November 2011, 150 patients were operated for elective pulmonary resection, which had a heterogenous pattern of lung disease, with post-operative mortality of 4 patients and average duration of total length of hospital stay of 10.61 days. Bilateral Hiemlich valves were applied to 18 patients, and unilateral Hiemlich valves in 132 patients. Dyspnea increased in 10 patients after switching to Heimlich valve and they were resumped on chest drainage with suction.Use of Heimlich valve was done irrespective of size of air leak. Grading of air leak was done as small defined if an occasional bubble was seen; moderate when frequent bubbles were seen or large if the bubbles were continuous in the water seal chamber. X-rays were obtained in patients after Hiemlich valve was placed which showed minimal size of air leak. Patients did not develop dyspnea after placement of Hiemlich valve. Follow up x-rays in all of the cases after removal of Hiemlich valve showed completely resolved apical air spaces. Mean number of postoperative days to placement of the Hiemlich valve was 7.2 ± 2.4. The mean number of days to postoperative discharge was 8.1 ± 1.6(range5 to 16) and the mean number of days after discharge until removal of the chest tubes and the Hiemlich valves was 3.61 ± 1.4(range 0, to 26). Almost all patient tolerated Hiemlich valve well after discharge. The average hospital stay was shortened by 56% with the use of Hiemlich valve in patients who underwent lung reduction surgery, considering the fact that all these patients would have stayed in the hospital, till the removal of their chest tube. The mean length of hospital stay was 11 days. The reduced hospital stay has certainly been caused by the use of Hiemlich valve. It is advisable to put chest drainage system to Hiemlich valves, as early as the third post-operative day. This eventually helps in providing better patient care.

A Novel Technique to Treat Air Leak Following Lobectomy: Intrapleural Infusion of Plasma.

BackgroundPersistent air leak following pulmonary lobectomy can be very difficult to treat and results in prolonged hospitalization. We aimed to evaluate the efficacy of a new method of postoperative air leak management using intrapleurally infused fresh frozen plasma via the chest tube.Material/MethodsBetween June 2008 and June 2014, we retrospectively reviewed 98 consecutive patients who underwent lobectomy for lung cancer and postoperatively developed persistent air leak treated with intrapleural instillation of fresh frozen plasma.ResultsThe study identified 89 men and 9 women, with a median age of 65.5 years (range 48–77 years), with persistent postoperative air leak. Intrapleural infusion of fresh frozen plasma was successful in stopping air leaks in 90 patients (92%) within 24 hours, and in 96 patients (98%) within 48 hours, following resumption of the procedure. In the remaining 2, air leak ceased at 14 and 19 days.ConclusionsIntrapleural infusion of fresh frozen plasma is a safe, inexpensive, and remarkably effective method for treatment of persistent air leak following lobectomy for lung cancer.

Endobronchial Valves in the Treatment of Persistent Air Leaks

Endobronchial valves (EBVs) are a useful adjunct in the management algorithm of patients with persistent pulmonary air leaks. They are increasingly used in the management of postsurgical parenchymal air leaks and carry a humanitarian use device exemption for this purpose. We report our experience with EBVs in the management of patients with bronchopleural fistula secondary to postsurgical intervention and spontaneous pneumothorax from medical comorbidities. An institutional review board-approved retrospective review was conducted of our single-center EBV experience. Patients were categorized as postsurgical versus medical. Data collected included demographic characteristics, indication for and number of valves placed, and chest tube duration before and after valve placement to evaluate overall resolution of air leak. Success was defined as resolution of air leak. A total of 14 valve placement procedures were performed. Mean age was 60 years and 10 patients were men. Eight represented prolonged leaks secondary to postsurgical complications and six were secondary to medical comorbidities. Indications for placement of valves in medical patients included persistent leak secondary to lung biopsy, ruptured bleb disease, and pneumothorax after cardiopulmonary resuscitation. Postsurgical indications included leaks secondary to lung biopsy, lobectomy, and ruptured bleb disease. A median of two valves were placed per procedure. A postprocedure median length of stay of 14.5 days was observed in the surgical group compared with 15 days in the medical group. Overall success rate was 57% (surgical group, 62.5%; medical group, 50%). EBVs are a useful adjunct in the management of persistent pulmonary air leaks, particularly when conventional interventions are contraindicated or not ideal. EBVs are well tolerated in the critically ill, have few known complications, are removable, and do not preclude future surgical intervention. Future studies should evaluate EBV efficacy versus the natural course of persistent pulmonary air leaks and their impact on cost and length of stay.

Endobronchial valves in treatment of persistent air leaks: a systematic review of clinical evidence.

BackgroundPersistent air leak is one of the most common complications of lung diseases and pulmonary resections. Prolonged hospitalization, increased morbidity, and increased overall treatment costs arise from persistent air leaks. The use of endobronchial valves (EBVs) in the management of air leaks is an important alternative, especially for patients who are not candidates for surgical treatment.Material/MethodsWe retrieved the included studies by performing a systematic search in PubMed and Scopus databases. The references of the included studies were also hand-searched.ResultsWe retrieved 25 case reports and 3 case series from our literature search. The most common cause of persisting air leaks was spontaneous secondary pneumothorax (12/39, 31%). The left upper lobe (13/39, 33%) and right upper lobe (14/39, 36%) were the most frequent locations of air leaks. Most air leaks treated with EBVs ceased in less than 24 h. Three recurrences of air leak were reported and 2 cases of EBV migration were described. No deaths were reported in correlation with EBVs.ConclusionsEBVs are a minimally invasive therapeutical option that may be suitable for the treatment of persistent air leaks regardless of the initial cause, especially in high-risk patients. Nevertheless, studies with better methodological quality are essential to standardize this technique and to provide more evidence on EBV safety issues.

Endobronchial Valve Therapy in Prolonged Air Leak

Persistent air leak (PAL) is the most common complication following lung resection.1,2 It lengthens hospital stay and increases post-surgical morbidity and mortality due to the increased risk of empyema, fever or pneumonia.4 It can contribute to respiratory failure, limit activity, increase the time and costs of hospitalization and add to the risk of hospital-acquired infections.1 PAL is defined as prolonged air leak caused by an alveolopleural fistula lasting more than 7 days.1 Although the length of evolution described in the literature varies, the finding of air leak on day 5 post-surgery is considered as a “significant air leak”. If the air leak is continuous or occurs during inhalation or exhalation and presents with subcutaneous emphysema or respiratory failure, it normally becomes persistent.1,5 An alveolopleural fistula is the abnormal communication between the pulmonary parenchyma distal to a segmentary bronchus and the pleural space.3 After surgery, it may be caused by delayed healing of the lung surface, due mainly to underlying parenchymal disease.1 For this reason, PAL is more common after surgery for secondary spontaneous pneumothorax than after primary pneumothorax. An incidence of around 20% has been reported.1 Standard treatment of PAL is generally conservative, with continuous chest drainage. If the condition prolongs over time, surgical reintervention can be considered as a second option. This procedure can be burdensome in terms of morbidity, does not always guarantee a solution, and in some cases the problem may even be aggravated if the already diseased parenchyma is exposed to more injury.1 The most common surgical techniques currently available for treating this disease are further resection of the lung parenchyma at the site of the anatomical defect, reinforcement of sutures with bovine pericardium, pleurectomy, pleurodesis with autologous blood patches or other chemical agents such as fibrin sealant, sponges, ethanol, trichloroacetic acid, bronchial blockers or cautery using a fiberoptic bronchoscope.2 The wide range of therapeutic options indicate that no single approach is fully effective, and this has led to the introduction of less invasive approaches such as endobronchial valves, which provide shorter recovery

Endobronchial Valves in the Treatment of Persistent Air Leak, an Alternative to Surgery

IntroductionPersistent air leak is frustrating for both patients and physicians, above all leaks with a high risk of surgery. Insertion of endobronchial valves could be an alternative to surgery. The aim of this study is to describe our experience in these valves and analyze their efficacy in a series of patients with persistent air leaks. Materials and methodsThe valves are inserted by means of flexible bronchoscopy under conscious sedation and local anesthesia. A preliminary bronchoscopy identifies the air leak by bronchial occlusion using a balloon catheter. A successful outcome is defined as complete disappearance of the leak following removal of the chest drain, without the need for further surgery. ResultsFrom November 2010 to December 2013, 8 patients with persistent air leaks were treated with endobronchial valves. The number of valves used ranged from 1 to 4 (median 2), with a median duration of air leak prior to placement of 15.5 days. There were no complications and the resolution of the leak was complete in 6 of 8 patients (75%). The median duration of drainage after insertion of the valves was 13 days and the median time to removal of 52.5 days. ConclusionsInsertion of endobronchial valves is a safe and effective method for treating persistent air leaks, and a valid alternative to surgery.