Intrabronchial valves for persistent air-leaks: what’s the verdict?

Lerner, Andrew D.; Yarmus, Lonny; Gorden, Jed A.; Gilbert, Christopher R.

doi:10.1080/17476348.2016.1240036

Cited by 2 publications

(4 citation statements)

References 15 publications

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“…Consistent with other published series (3)(4)(5)(6)(7)(8)(9)(10)(11), the valves were removed in 65% of cases and left in place in the remaining 35% of patients without any problem. The safety of this strategy is supported by other studies, in which valves were placed permanently for emphysema or for prolonged periods for other medical conditions (13)(14)(15)(16)(17).…”

Section: Discussionmentioning

confidence: 68%

“…All patients were treated with Zephyr EBV (Zephyr, Pulmonx Corporation-Redwood City, CA, USA). In Europe, CE Mark cleared the use of EBVs for the treatment of emphysematous patients, and for damaged lung resulting in air-leaks (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14). Thus, no specific approval by Institutional Review Board (IRB) was needed.…”

Section: Methodsmentioning

confidence: 99%

“…In 2001 an American College of Chest Physicians (ACCP) consensus statement did not recommend bronchoscopy for the treatment of PAL (1,2). However, in the last two decades encouraging results have been reported in small case series (3)(4)(5)(6)(7)(8)(9)(10)(11)(12) and review articles (13,14) by the use of bronchial valves, originally designed for management of emphysema. There are currently 2 commercially available types of bronchial valves; the Zephyr endobronchial valve (EBV) (Zephyr, Pulmonx Corporation-Redwood City, CA, USA) and Spiration intra bronchial valves (IBV) (Olympus Respiratory America-Redmond, WA, USA).…”

Section: Introductionmentioning

confidence: 99%

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Unidirectional endobronchial valves for management of persistent air-leaks: results of a multicenter study

Fiorelli¹,

D’Andrilli²,

Cascone³

et al. 2018

J. Thorac. Dis

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Background: To evaluate the efficacy of Endo-Bronchial Valves in the management of persistent air-leaks (PALs) and the procedural cost. Methods: It was a retrospective multicenter study including consecutive patients with PALs for alveolar pleural fistula (APF) undergoing valve treatment. We assessed the efficacy and the cost of the procedure. Results: Seventy-four patients with persistent air leaks due to various etiologies were included in the analysis. In all cases the air leaks were severe and refractory to standard treatments. Sixty-seven (91%) patients underwent valve treatment obtaining a complete resolution of air-leaks in 59 (88%) patients; a reduction of air-leaks in 6 (9%); and no benefits in 2 (3%). The comparison of data before and after valve treatment showed a significant reduction of air-leak duration (16.2±8.8 versus 5.0±1.7 days; P<0.0001); chest tube removal (16.2±8.8 versus 7.3±2.7 days; P<0.0001); and length of hospital stay (LOS) (16.2±8.8 versus 9.7±2.8 days; P=0.004). Seven patients not undergoing valve treatment underwent pneumo-peritoneum with pleurodesis (n=6) or only pleurodesis (n=1). In only 1 (14%) patient, the chest drainage was removed 23 days later while the remaining 6 (86%) were discharged with a domiciliary chest drainage removed after 157±41 days. No significant difference was found in health cost before and after endobronchial valve (EBV) implant (P=0.3). Conclusions: Valve treatment for persistent air leaks is an effective procedure. The reduction of hospitalization costs related to early resolution of air-leaks could overcome the procedural cost.

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Section: Discussionmentioning

confidence: 68%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Unidirectional endobronchial valves for management of persistent air-leaks: results of a multicenter study

Fiorelli¹,

D’Andrilli²,

Cascone³

et al. 2018

J. Thorac. Dis

View full text Add to dashboard Cite

show abstract

“…There remains a lack of evidence-based data to support the best therapeutic approach. However, unlike post-surgical PAL, pleurodesis is often not needed for iatrogenic pleural cases since these typically resolve with watchful waiting alone (14).…”

mentioning

confidence: 99%

Managing complications of pleural procedures

Williams¹,

Lerner²

2021

J Thorac Dis

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Pleural disease is common and often requires procedural intervention. Given this prevalence, pleural procedures are performed by a wide range of providers with varying skill level in both medical and surgical specialties. Even though the overall complication rate of pleural procedures is low, the proximity to vital organs and blood vessels can lead to serious complications which if left unrecognized can be life threatening. As a result, it is of the utmost importance for the provider to have a firm grasp of the local anatomy both conceptually when preparing for the procedure and physically, via physical exam and the use of a real time imaging modality such as ultrasound, when performing the procedure. With this in mind, anyone who wishes to safely perform pleural procedures should be able to appropriately anticipate, quickly identify, and efficiently manage any potential complication including not only those seen with many procedures such as pain, bleeding, and infection but also those specific to procedures performed in the thorax such as pneumothorax, re-expansional pulmonary edema, and regional organ injury. In this article, we will review the basic approach to most pleural procedures along with essential local anatomy most often encountered during these procedures. This will lay the foundation for the remainder of the article where we will discuss clinical manifestations and management of various pleural procedure complications.

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Intrabronchial valves for persistent air-leaks: what’s the verdict?

Cited by 2 publications

References 15 publications

Unidirectional endobronchial valves for management of persistent air-leaks: results of a multicenter study

Unidirectional endobronchial valves for management of persistent air-leaks: results of a multicenter study

Managing complications of pleural procedures

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