Endoscopic One-Way Valve Implantation in Patients With Prolonged Air Leak and the Use of Digital Air Leak Monitoring

Firlinger, Irene; Stubenberger, Elisabeth; Müller, Michael; Burghuber, Otto Chris; Valipour, Arschang

doi:10.1016/j.athoracsur.2012.12.036

Cited by 63 publications

(57 citation statements)

References 21 publications

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“…Our study conclusions support the earlier retrospective series suggesting that bronchial valve therapy using the IBV Valve System for prolonged air leak has an acceptable safety and efficacy for the treatment of a prolonged pulmonary air leak [6,7]. Accordingly, in 2008, the US Food and Drug Administration (FDA) approved the IBV Valve System for use in the treatment of prolonged air leaks of the lung, or significant air leaks that are likely to become prolonged air leaks following lobectomy, segmentectomy or lung volume reduction surgery [11].…”

Section: Discussionsupporting

confidence: 81%

“…We clearly demonstrated an uneventful valve removal 3 weeks after valve placement in all patients. TABLE 6 Comparison of published studies on bronchial valve treatment for persistent pulmonary air leak GILLESPIE et al [6] F IRLINGER et al [7] Current study Decreased FEV1 suggests that respiratory compromise associated with airway closure may be a potential side-effect of air-leak treatment with IBVs, in particular when this leak complicates lobectomy. This drawback seems limited, as the initial diagnostic balloon occlusion test may allow for exclusion of the more disabled patients and, thereby, limit the number of respiratory failures.…”

Section: Discussionmentioning

confidence: 99%

“…The use of bronchial valves was first considered a potential effective salvage procedure for the treatment of a persistent pulmonary air leak in patients who were not suitable candidates for any other surgical treatment [4,5]. Retrospective case series provided scientific evidence that removable bronchial valves are a safe and effective intervention for alveolar-pleural fistula with persistent pulmonary air leak [6,7]. Limitations of reported case studies and series are their retrospective nature, chest tube monitoring mainly based on a subjective assessment of the air leak reduction, and heterogeneity of disorders causing the persistent air leak.…”

Section: Introductionmentioning

confidence: 99%

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Bronchial valve treatment for pulmonary air leak after anatomical lung resection for cancer

Dooms

Decaluwé²,

Yserbyt

et al. 2013

European Respiratory Journal

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A persistent post-operative pulmonary expiratory air leak after an anatomical pulmonary resection is usually managed conservatively, but can be associated with significant morbidity and increased costs. The use of bronchial valves is a minimally invasive method that may be an effective and safe treatment in this setting.In a prospective study, the clinical efficacy of intrabronchial valve treatment in patients with a prolonged persistent pulmonary air leak after anatomical surgical resection for cancer was investigated.10 out of 277 patients with anatomical pulmonary resection for cancer were included, and 90% were scheduled for valve treatment. We demonstrated an air leak cessation at a median of 2 days after valve placement, which resulted in chest tube removal at a median of 4 days after valve placement. Elective removal of the intrabronchial valves could be safely planned 3 weeks after valve implantation. Lung function alteration associated with airway occlusion by valves was limited.Intrabronchial valve treatment with the aid of a digital thoracic drainage system is an effective and safe therapy for patients with a prolonged pulmonary air leak after anatomical lung resection for cancer. @ERSpublications Bronchial valve placement is an effective and safe treatment for a pulmonary air leak after lung resection

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Section: Discussionsupporting

confidence: 81%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Bronchial valve treatment for pulmonary air leak after anatomical lung resection for cancer

Dooms

Decaluwé²,

Yserbyt

et al. 2013

European Respiratory Journal

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“…Notably, recent case series have demonstrated the efficacy of valve insertion in reducing and eliminating air leaks [24,25]. Thus, valve insertion in targeted airways leading to the region of parenchymal air leakage might be a potential alternative treatment approach if isolation of the ‘responsible' airways is feasible.…”

Section: Prolonged Air Leakage After Pneumothoraxmentioning

confidence: 99%

Expert Statement: Pneumothorax Associated with Endoscopic Valve Therapy for Emphysema - Potential Mechanisms, Treatment Algorithm, and Case Examples

et al. 2014

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The use of endoscopically placed unidirectional valves for the treatment of emphysema is increasing. With better patient selection, there is also an increased likelihood of complications associated with the procedure, such as postprocedural pneumothorax. There is, however, little evidence of pneumothorax management in patients with severe COPD and emphysema. This report describes an expert recommendation that has been developed to outline pneumothorax management after valve placement to inform physicians and patients of the risk-benefit profile and to assist them in decision making. Skilled and aggressive pneumothorax management is necessary in this patient population, and by following these recommendations traumatic scenarios, prolonged drainage, extended hospitalizations, and/or surgery might be avoided in many cases.

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“…Combining bronchoscopic valve placement with digital measurement of the degree of air leak shows great promise for streamlining the management process. The ability to quantify the amount of air leak may allow rapid identification of responders to valve placement after the procedure, facilitating earlier chest tube removal and reducing hospital length of stay in these patients (76,77). In addition, during bronchoscopy, these digital flow monitoring systems can help us more accurately recognize partial response after selective balloon occlusion that can be missed when only looking at the degree of "bubbling".…”

Section: Bronchoscopically Placed One-way Valvesmentioning

confidence: 99%

Persistent air leaks: a review with an emphasis on bronchoscopic management

Lazarus

Casal

2017

J. Thorac. Dis.

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Persistent air leak (PAL) is a cause of significant morbidity in patients who have undergone lung surgery and those with significant parenchymal lung disease suffering from a pneumothorax. Its management can be complex and challenging. Although conservative treatment with chest drain and observation is usually effective, other invasive techniques are needed when conservative treatment fails. Surgical management and medical pleurodesis have long been the usual treatments for PAL. More recently numerous bronchoscopic procedures have been introduced to treat PAL in those patients who are poor candidates for surgery or who decline surgery. These techniques include bronchoscopic use of sealants, sclerosants, and various types of implanted devices. Recently, removable one-way valves have been developed that are able to be placed bronchoscopically in the affected airways, ameliorating air-leaks in patients who are not candidates for surgery. Future comparative trials are needed to refine our understanding of the indications, effectiveness, and complications of bronchoscopic techniques for treating PAL. The following article will review the basic principles of management of PAL particularly focusing on bronchoscopic techniques.

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Endoscopic One-Way Valve Implantation in Patients With Prolonged Air Leak and the Use of Digital Air Leak Monitoring

Cited by 63 publications

References 21 publications

Bronchial valve treatment for pulmonary air leak after anatomical lung resection for cancer

Bronchial valve treatment for pulmonary air leak after anatomical lung resection for cancer

Expert Statement: Pneumothorax Associated with Endoscopic Valve Therapy for Emphysema - Potential Mechanisms, Treatment Algorithm, and Case Examples

Persistent air leaks: a review with an emphasis on bronchoscopic management

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