Closure of persisting air leaks in patients with severe pleural empyema — use of endoscopic one-way endobronchial valve☆

Abstract

Parapneumonic pleural empyema is a critical illness with mortality up to 20%. Patients often have severe comorbidity and are not always suitable for major thoracic surgery. Peripheral bronchopleural fistula adds further difficulty. This may result in a situation where recovery is impossible. Therefore, we developed a combination of minimally invasive surgical debridement and closure of the air leak with a bronchoscopic one-way endobronchial valve. Thus far, two patients received the combined treatment. Both patients suffered from a pleural empyema and because of severe comorbidity were not fit for major thoracic surgery. First, minimally invasive surgical debridement of the pleural cavity was performed. In both patients, a persisting peripheral bronchopleural fistula occurred. Via bronchoscopy the leak could be localized in both cases in the lower lobe segment 8. In each case, we implanted an endobronchial one-way valve designed for the treatment of lung emphysema. After the bronchoscopic valve implantation, the leakage ceased in both cases and healing of the pleural empyema was achieved. The valves were subsequently removed via bronchoscopy. Successful closure of peripheral air leaks in patients with pleural empyema using an endoscopic one-way valve is feasible. It is a treatment option in patients who are not fit for major thoracic surgery.

Bronchoscopic management of bronchopleural fistula

“…They closed a large peripheral BPF with a one-way valve, by positioning it in small segmental bronchi that was proved to be connected with the fistula. After that first report, other similar case reports with the same results were published [26,27]. In 2015 two series with valves were published.…”

Endobronchial Valves for Challenging Air Leaks

“…Their efficacy for management of postoperative air leak was later defined [1,9,11,12]. Other case reports have defined additional clinical scenarios in which EBVs were effectively used for elimination of airflow to specific regions of the lung [11,14,[16][17][18][19][20].…”

Surgery for parapneumonic pleural empyema – What influence does the rising prevalence of multimorbidity and advanced age has on the current outcome?

“…Our technique has already previously been described in detail. 20 The crucial point is to identify the origin of the fistula within the bronchial tree. During rigid bronchoscopy in general anesthesia methylene blue solution is inserted via the chest tubes.…”