Complications after bronchoscopic lung volume reduction

Franzen, Daniel; Straub, Gilles; Freitag, Lutz

doi:10.21037/jtd.2018.06.66

Cited by 12 publications

(6 citation statements)

References 22 publications

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“…A recent meta-analysis identified the following risk ratios (RRs) ( 32 The most common adverse event is pneumothorax, which is more likely with complete lobar atelectasis, especially when it occurs rapidly. Pneumothorax occurs because of compensatory over-expansion of the ipsilateral untreated lobe(s) (33). In both the EMPROVE and LIBERATE trials, the majority of pneumothoraces occurred within the first 72 hours, so close observation in the hospital is recommended for at least 3 days postoperatively (24)(25)(26).…”

Section: Management Of Complicationsmentioning

confidence: 99%

Bronchoscopic lung volume reduction: who, what, where, when?

Kurman¹,

Hogarth²

2021

Shanghai Chest

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Chronic obstructive pulmonary disease (COPD) is a significant source of morbidity and mortality globally. The number of afflicted individuals is expected to increase for the foreseeable future. Endoscopic lung volume reduction (ELVR) modalities have recently been introduced as an alternative to more invasive lung volume reduction surgery (LVRS) for severe emphysema. Endoscopic tools include one-way valves, coils, thermal vapor ablation, and sealant. These devices are broadly classified as "block" and "non-block" strategies. They differ in terms of the requirement for fissure integrity, whether they are applied at the lobar or segmental level, their reversibility, and whether they are applicable for homogenous and/or heterogenous disease. Endobronchial valves (EBVs) are now being used outside of clinical trials and are supported by multiple guidelines. These valves reduce hyperinflation by promoting lobar atelectasis in the absence of collateral ventilation (CV), which can now be quantified using specialized software and intra-procedural analysis. Patient selection criteria continue to be refined as more data become available. Pneumothorax is the most common adverse event but does not appear to affect outcomes if it is appropriately managed. Multiple ongoing trials are investigating the impact of different devices and strategies in order to improve long-term outcomes. Other modalities for ELVR are under development. Herein, we review the impact of COPD on population health and discuss the role of endobronchial procedural interventions in its management.

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Section: Management Of Complicationsmentioning

confidence: 99%

Bronchoscopic lung volume reduction: who, what, where, when?

Kurman¹,

Hogarth²

2021

Shanghai Chest

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“…This is self-limiting in most patients and in this case no further evaluation is required. However, during follow-up hemoptysis is reported in 1.5-5.6% of treated patients [5,6,9,47]. In most cases, the cause of hemoptysis is granulation tissue at the site of the valves or mucosal damage/ulceration due to valve movements ( Figure 10), and might be more prevalent in patients on systemic anticoagulation.…”

Section: Hemoptysismentioning

confidence: 99%

Endobronchial valve therapy for severe emphysema: an overview of valve-related complications and its management

Koster

Klooster

Hacken

et al. 2020

Expert Review of Respiratory Medicine

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Introduction: Bronchoscopic lung volume reduction treatment with one-way valves is an effective guideline treatment option for patients with severe emphysema. However, important challenges and adverse reactions may occur after treatment. Areas covered: This review summarizes the complications after endobronchial and intrabronchial valve treatment that have been described by the currently published randomized controlled trials and other relevant papers regarding the complications and its management. In case there was no relevant literature regarding these subjects, recommendations are based on expert opinion. Complications include pneumothorax, post-obstruction pneumonia and hemoptysis. Also, the treatment may not be effective due to the presence of collateral ventilation or misplaced valves. Furthermore, an initial beneficial effect may vanish due to granulation tissue formation, valve dysfunction or valve migration. Careful follow-up after treatment with valves is important. Evaluation with a CT-scan and/or bronchoscopy is needed if there is no improvement after treatment, loss of benefit, or occurrence of important adverse events during follow-up. Expert opinion: Treating severe emphysema patients with one-way valves requires continuous dedication and expertise, especially to achieve an optimal outcome and elegantly deal with the various complications after treatment.

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“…It is usually observed in the first few days after the procedure. It may cause respiratory insufficiency, and in such cases, the coil should be removed thoracoscopically [34]. It is unclear whether this complication develops due to the proximity of the coils to the pleura; therefore, thoracic surgeons should be informed about the complication.…”

Section: Bronchopleural Fistula and Penetration Into Pleural Spacementioning

confidence: 99%

Bronchoscopic Lung Volume Reduction Using Coil Therapy: Complications and Management

Gülşen

2020

Advances in Respiratory Medicine

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Nonsurgical approaches involving bronchoscopic lung volume reduction (BLVR) have been developed in the last decade. One of these, the BLVR coil procedure, is a treatment option for patients with homogeneous and heterogeneous end-stage emphysema and a forced expiratory volume in 1 second (FEV1) of 15–45%. This treatment decreases hyperinflation and improves lung function, the quality of life, and exercise capacity. It is very important to prepare patients for treatment, premedications, anesthesia applications, intubation, post-procedure follow-up and treatments. Further, it has been observed that various complications can develop during and after the procedure. Generally, the observed and reported complications are chronic obstructive pulmonary disease (COPD) exacerbation, chest pain, mild bleeding, pneumonia, pneumothorax, and respiratory failure. Rarely, aspergillus cavitation (coil-related aspergilloma), bronchopleural fistula and penetration into the pleural space, bronchiectasis, coil-associated inflammatory response and opacities, and hiccups are observed. Common complications are usually mild or moderate, while the rare ones can be life-threatening (except hiccup), so early diagnosis and treatment are necessary. However, patients treated with BLVR have lower mortality rates than untreated patients with similar morbidity. Based on the findings of this review, we can estimate that premedication one day before and just before the procedure may reduce potential complications. Some medical centers apply and recommend 30-day macrolide treatment after the procedure. New generation supraglottic devices may be preferred to avoid complications due to endotracheal intubation. Moreover, further research is needed to identify risk factors, prevent potential complications, and a common consensus is required for routine preventive treatment.

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Complications after bronchoscopic lung volume reduction

Cited by 12 publications

References 22 publications

Bronchoscopic lung volume reduction: who, what, where, when?

Bronchoscopic lung volume reduction: who, what, where, when?

Endobronchial valve therapy for severe emphysema: an overview of valve-related complications and its management

Bronchoscopic Lung Volume Reduction Using Coil Therapy: Complications and Management

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