Off-label use of intrabronchial valves for persistent air leak is safe and effective: a retrospective case analysis

Journal of Thoracic Disease

article

Harpreet Singh¹  Jonathan S. Kurman¹  Chinmay Jani²  Mohammed Abdalla¹  Brandon DePaul⁴  Bryan S. Benn¹ 

[1] Department of Pulmonary and Critical Care, Medical College of Wisconsin;Department of Medicine, Mount Auburn Hospital;Harvard Medical School;Department of Medicine, Medical College of Wisconsin

关键词: Persistent air leak (PAL);    endobronchial valves;    airway valves;    bronchoscopy;    pneumothorax;   

DOI  :  10.21037/jtd-22-824

学科分类：呼吸医学

来源: Pioneer Bioscience Publishing Company

【 摘 要 】

Background: Persistent air leak (PAL) is a challenging clinical problem associated with prolonged hospital stay and increased morbidity. Historically, treatment options were limited to thoracostomy tube drainage, pleurodesis, and surgical repair. The development of one-way airway valves has represented a paradigm shift in PAL management. We present our experience using intrabronchial valves (IBVs) for PAL management looking at both on-label (post-thoracic surgery) and off-label (all other) indications. Methods: We performed a retrospective review of our single-center experience. Data collected included demographics, primary pathology leading to PAL, comorbidities, time to chest tube removal, complications, mortality, need for any additional procedure, and time to IBV removal. Results: During the study period, 15 patients underwent IBV insertion for PAL. The on-label cohort contained three patients (post lobectomy or segmentectomy). The off-label cohort had 12 patients (6 empyema, 4 secondary spontaneous pneumothorax, 1 penetrating trauma, and 1 post percutaneous lung nodule biopsy). In the on-label cohort, chest tube was removed after a mean duration of 4.0±1.0 days for all patients. In the off-label cohort, 83.3% (10/12) had chest tube removal 16.2±5.7 days (P=0.396) after IBV placement. One patient developed hypoxic respiratory failure shortly after IBV insertion, necessitating removal of 2 out of 5 valves. Conclusions: IBVs are a minimally invasive, well tolerated treatment modality for patients with PAL and a viable alternative to invasive surgical interventions. Procedure or valve-related complications are uncommon. Valves can be removed and do not preclude surgical intervention. Updated guidelines are necessary to formalize PAL management.

【 授权许可】

Unknown