PURPOSE: Prolonged air leaks (PAL) from the lung are an infrequent but difficult clinical problem. A bronchoscopic approach to treatment of an air leak requires identification of which airway(s) are feeding the air leak. The IBV(r) Valve System (Spiration, Redmond WA) is an approved bronchoscopic device for treatment of certain post-surgical PAL and uses a balloon catheter to localize the leak. We summarize the use of balloon occlusion as a method.
METHODS: Information from physicians was obtained from PAL treatments in the United States, and the European Union. Sedation or general anesthesia was used for anesthesia prior to flexible bronchoscopy. A balloon catheter (Olympus 5B-2C) was prepared by replacing air with saline. The catheter was passed into an airway and the balloon was inflated while observing the water seal chamber for a decrease in the air leakage. Usually a lobar bronchus was initially identified, and then a segmental or subsegmental airway was identified, sized (same balloon), and valve treated.
RESULTS: Air leak localization using the balloon catheter was successful in 37 of 41 (90%) PAL treatments. In 3 of 4 procedures without localization no valve treatment took place. In the other procedure without localization the physician had prior knowledge from surgery and proceeded with valve treatment. In one case the localization was not possible because of limited ventilation around the bronchoscope passing through an endotracheal tube. There have also been 2 cases where SPECT scanning before the procedure provided guidance to help localize and then confirm with balloon occlusion. Proper localization with balloon occlusion was likely since 95% of the treated air leaks had clinical resolution after valve placements.
CONCLUSION: Balloon occlusion is a good technique for localization of air leaks. Airway localization may not be possible in some complex cases.
CLINICAL IMPLICATIONS: Airway balloon occlusion for localization is a very promising approach to treat prolonged air leaks with bronchial valves.
DISCLOSURE: Daniel Nader, Employee Drs. Springmeyer and Gonzalez are employees and shareholders in Spiration, Inc.; No Product/Research Disclosure Information