Olivia Giddings1, Judit Kuhn, Jason Akulian. 1. aDivision of Pulmonary and Critical Care Medicine, University of North Carolina at Chapel Hill School of Medicine bUniversity of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
Abstract
PURPOSE OF REVIEW: Bronchopleural fistula is a cause of increased morbidity and mortality. Patients who develop bronchopleural fistula after lung resection or spontaneous pneumothorax often have multiple co-morbidities making them poor candidates for repeated surgical intervention. Previous nonsurgical treatments for bronchopleural fistula have had limited success. Endobronchial valves, originally designed for bronchoscopic lung volume reduction, have been used under a humanitarian use exception for the treatment of bronchopleural fistula. Numerous case series and reports have been published; however, guidelines for the use of endobronchial valves specifically for bronchopleural fistula have yet to be developed. RECENT FINDINGS: A number of case series and reports have described the use of one-way endobronchial valves for the treatment of bronchopleural fistula, after spontaneous pneumothorax, lung resection and complication of suppurative lung disease. In the largest series reported (40 patients), 93% of patients experienced improvement in air leak, with 48% having complete resolution. Other series have shown similar success. Complications are rare and include pneumonia, expectoration or migration of valves, and bacterial colonization. SUMMARY: The use of endobronchial valves for the treatment of bronchopleural fistula is well tolerated and effective. Controlled clinical trials are needed to further evaluate their efficacy and identify ideal patient populations for their use.
PURPOSE OF REVIEW: Bronchopleural fistula is a cause of increased morbidity and mortality. Patients who develop bronchopleural fistula after lung resection or spontaneous pneumothorax often have multiple co-morbidities making them poor candidates for repeated surgical intervention. Previous nonsurgical treatments for bronchopleural fistula have had limited success. Endobronchial valves, originally designed for bronchoscopic lung volume reduction, have been used under a humanitarian use exception for the treatment of bronchopleural fistula. Numerous case series and reports have been published; however, guidelines for the use of endobronchial valves specifically for bronchopleural fistula have yet to be developed. RECENT FINDINGS: A number of case series and reports have described the use of one-way endobronchial valves for the treatment of bronchopleural fistula, after spontaneous pneumothorax, lung resection and complication of suppurative lung disease. In the largest series reported (40 patients), 93% of patients experienced improvement in air leak, with 48% having complete resolution. Other series have shown similar success. Complications are rare and include pneumonia, expectoration or migration of valves, and bacterial colonization. SUMMARY: The use of endobronchial valves for the treatment of bronchopleural fistula is well tolerated and effective. Controlled clinical trials are needed to further evaluate their efficacy and identify ideal patient populations for their use.