Isolation of persistent air leaks and placement of intrabronchial valves

Abstract

Objectives Alveolar-pleural fistulas causing persistent air leaks are conditions associated with prolonged hospital courses, high morbidity, and possibly increased mortality. Intrabronchial valves serve as a noninvasive therapeutic option for the closure of alveolar-pleural fistulas. Methods The present review describes a brief history of, and indications for, the placement of intrabronchial valves in patients with persistent air leaks. The essential steps necessary for placement are air leak isolation, airway sizing, and valve deployment. Additionally, the indications and methods for intrabronchial valve removal, along with the potential complications from intrabronchial valve placement, are described. Conclusions The increased use of intrabronchial valves in the treatment of persistent air leaks requires bronchoscopists and clinicians to understand the procedural steps and techniques necessary for intrabronchial valve placement.

ERS task force statement: diagnosis and treatment of primary spontaneous pneumothorax

“…SAKAMOTO et al [166] showed in a retrospective study that coverage of stapling with absorbable mesh after bullectomy seems to improve the success rate of definitive management of PSP. An endobronchial approach using valves to control localised air leaks might offer a promising future treatment [167].…”

Endobronchial Valve Placement as Destination Therapy for Recurrent Pneumothorax in the Setting of Advanced Malignancy

“…1 Endobronchial valve placement remains the only endobronchial intervention available, with documented literature supporting use in air leaks. [2][3][4] Although other interventions such as glue and coiling have been reported, the American College of Chest Physicians' statement on prolonged air leaks in pneumothorax suggest avoidance of these endobronchial interventions. 5 Our multidisciplinary team pursued endobronchial valve placement in this patient with a persistent air leak after recurrent pneumothorax in the setting of an advanced refractory malignancy.…”

“…4 Re- ports of off-label endobronchial valve use continue to increase and have been documented in numerous situations at this point, including a heterogeneous case series of persistent air leaks. 2 In patients in whom the leak can be isolated to an anatomic area (subsegmental, segmental, or lobar bronchi), endobronchial valve use provides a nonsurgical approach to the treatment of prolonged air leaks.…”

“…4 Endobronchial valve removal was performed secondary to the known pneumonia risk related to endobronchial valve placement 2,3 in an attempt to minimize potential complications in this immunocompromised patient. However, after evidence of recurrence and plans for hospice referral, destination therapy appeared quite appropriate.…”

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

“…General anesthesia and moderate sedation have both been used, though we favor the former with an endotracheal tube to allow for an airtight system. If general anesthesia is used a size 8.5 or larger endotracheal tube are recommended to prevent decrease of the air leak because of decreased ventilation around the bronchoscope within a smaller sized tube (78). Air leak isolation is completed as described above.…”