John M Hance1, Jeremiah T Martin2, Timothy W Mullett1. 1. Department of Surgery, Division of Cardiothoracic Surgery, University of Kentucky, Lexington, Kentucky. 2. Department of Surgery, Division of Cardiothoracic Surgery, University of Kentucky, Lexington, Kentucky. Electronic address: j.martin@uky.edu.
Abstract
BACKGROUND: Endobronchial valves (EBVs) are a useful adjunct in the management algorithm of patients with persistent pulmonary air leaks. They are increasingly used in the management of postsurgical parenchymal air leaks and carry a humanitarian use device exemption for this purpose. We report our experience with EBVs in the management of patients with bronchopleural fistula secondary to postsurgical intervention and spontaneous pneumothorax from medical comorbidities. METHODS: An institutional review board-approved retrospective review was conducted of our single-center EBV experience. Patients were categorized as postsurgical versus medical. Data collected included demographic characteristics, indication for and number of valves placed, and chest tube duration before and after valve placement to evaluate overall resolution of air leak. Success was defined as resolution of air leak. RESULTS: A total of 14 valve placement procedures were performed. Mean age was 60 years and 10 patients were men. Eight represented prolonged leaks secondary to postsurgical complications and six were secondary to medical comorbidities. Indications for placement of valves in medical patients included persistent leak secondary to lung biopsy, ruptured bleb disease, and pneumothorax after cardiopulmonary resuscitation. Postsurgical indications included leaks secondary to lung biopsy, lobectomy, and ruptured bleb disease. A median of two valves were placed per procedure. A postprocedure median length of stay of 14.5 days was observed in the surgical group compared with 15 days in the medical group. Overall success rate was 57% (surgical group, 62.5%; medical group, 50%). CONCLUSIONS: EBVs are a useful adjunct in the management of persistent pulmonary air leaks, particularly when conventional interventions are contraindicated or not ideal. EBVs are well tolerated in the critically ill, have few known complications, are removable, and do not preclude future surgical intervention. Future studies should evaluate EBV efficacy versus the natural course of persistent pulmonary air leaks and their impact on cost and length of stay.
BACKGROUND: Endobronchial valves (EBVs) are a useful adjunct in the management algorithm of patients with persistent pulmonary air leaks. They are increasingly used in the management of postsurgical parenchymal air leaks and carry a humanitarian use device exemption for this purpose. We report our experience with EBVs in the management of patients with bronchopleural fistula secondary to postsurgical intervention and spontaneous pneumothorax from medical comorbidities. METHODS: An institutional review board-approved retrospective review was conducted of our single-center EBV experience. Patients were categorized as postsurgical versus medical. Data collected included demographic characteristics, indication for and number of valves placed, and chest tube duration before and after valve placement to evaluate overall resolution of air leak. Success was defined as resolution of air leak. RESULTS: A total of 14 valve placement procedures were performed. Mean age was 60 years and 10 patients were men. Eight represented prolonged leaks secondary to postsurgical complications and six were secondary to medical comorbidities. Indications for placement of valves in medical patients included persistent leak secondary to lung biopsy, ruptured bleb disease, and pneumothorax after cardiopulmonary resuscitation. Postsurgical indications included leaks secondary to lung biopsy, lobectomy, and ruptured bleb disease. A median of two valves were placed per procedure. A postprocedure median length of stay of 14.5 days was observed in the surgical group compared with 15 days in the medical group. Overall success rate was 57% (surgical group, 62.5%; medical group, 50%). CONCLUSIONS:EBVs are a useful adjunct in the management of persistent pulmonary air leaks, particularly when conventional interventions are contraindicated or not ideal. EBVs are well tolerated in the critically ill, have few known complications, are removable, and do not preclude future surgical intervention. Future studies should evaluate EBV efficacy versus the natural course of persistent pulmonary air leaks and their impact on cost and length of stay.
Authors: Muhanned Abu-Hijleh; Kim Styrvoky; Vikram Anand; Fernando Woll; Lonny Yarmus; Michael S Machuzak; Daniel A Nader; Timothy W Mullett; D Kyle Hogarth; Jennifer W Toth; Ghazwan Acash; Roberto F Casal; Stephen Hazelrigg; Douglas E Wood Journal: Lung Date: 2019-08-28 Impact factor: 2.584
Authors: Alfonso Fiorelli; Antonio D'Andrilli; Roberto Cascone; Luisa Occhiati; Marco Anile; Daniele Diso; Francesco Cassiano; Camilla Poggi; Mohsen Ibrahim; Giacomo Cusumano; Alberto Terminella; Giuseppe Failla; Alba La Sala; Michela Bezzi; Margherita Innocenti; Elena Torricelli; Federico Venuta; Erino Angelo Rendina; Giovanni Vicidomini; Mario Santini; Claudio Andreetti Journal: J Thorac Dis Date: 2018-11 Impact factor: 2.895
Authors: Irsa S Hasan; Mark S Allen; Stephen D Cassivi; William S Harmsen; Nandita Mahajan; Francis C Nichols; Janani Reisenauer; Robert K Shen; Dennis A Wigle; Shanda H Blackmon Journal: J Thorac Dis Date: 2021-06 Impact factor: 2.895
Authors: Kenneth K Sakata; Janani S Reisenauer; Ryan M Kern; David E Midthun; James P Utz; Shanda H Blackmon; John J Mullon; Dennis A Wigle Journal: Respir Med Case Rep Date: 2018-09-13