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Disorders of the Pleura |

Treatment of Prolonged Air Leak After Pulmonary Resection: The Role of Endobronchial Valves: Two Case Reports FREE TO VIEW

Maria Rodríguez, MD; María Teresa Gómez Hernández, MD; Aldo Torracchi, MD; Nuria María Novoa Valentín, PhD; Rosa Cordovilla, PhD; Jose Luis Aranda Alcaide, PhD; Marcelo Fernando Jiménez López, PhD; Gonzalo Varela Simó, PhD
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Salamanca University Hospital, Salamanca, Spain


Chest. 2014;145(3_MeetingAbstracts):262A. doi:10.1378/chest.1823445
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Abstract

SESSION TITLE: Pleural Case Report Posters

SESSION TYPE: Case Report Poster

PRESENTED ON: Sunday, March 23, 2014 at 01:15 PM - 02:15 PM

INTRODUCTION: Prolonged air leak (PAL) is the most common complication after pulmonary resection. In our settings PAL is defined as a postoperative persistent air leak of at least 5 days. We described 2 cases of PAL treated using endobronchial valves (EBV) placement. We have performed a retrospective review of 13 patients presenting with PAL after any type of pulmonary resection between January 2012 and August 2013. Data were obtained from our prospectively recorded database. Two of these patients were treated using EBV (Table 1). We describe patients’ characteristics, clinical course, type of valves, complications and final outcome.

CASE PRESENTATION: The first patient was a 74 year old man with COPD (GOLD 2) who was admitted for a left upper lobectomy in our department due to NSCLC. He presented an immediate postoperative acute myocardial infarction that required prolonged invasive mechanical ventilation, as well as a pacemaker insertion. Postoperative course was also complicated with PAL of 22 days. On the postoperative day 23, he had an EBV (Olympus® IBV 7 mm) placed in segment 8 left to control the air leak, which was solved 15 days later. Mechanical ventilation was stopped on day 33. Non complications were recorded related to the EBV. Finally, the patient recovered and 1 month after leak resolution the valve was removed without complications and before discharge. The patient is doing well 4 months later. The second patient was a 69 year old male, with COPD emphysema (GOLD 2) admitted to our department for surgical treatment of a recurrent right spontaneous pneumothorax. After surgical procedure, no air leak was observed. But on day 5, he presented with a massive air leak and acute respiratory failure. In an emergency basis, he had two EBV (Zemphir® 4mm) placed on postoperative day 6 on segments 1 and 3 right. This management controlled his respiratory symptoms and the air leak on day 11th after the procedure. No dislodgements or other type of complications of the valves were observed. Two days after air-leak resolution the patient was discharged with a residual basal pneumothorax. One month after placement, both EBV were removed without complications. The patient is doing well, with complete pneumothorax resolution, 4 months after removal.

DISCUSSION: The use of EBV has been described as a new strategy to treat PAL. Published series are still short, but EBV should be taken into account for those patients not suitable for surgical treatment of their air leak or with a high postoperative risk due to their cardio-respiratory morbidity.

CONCLUSIONS: Although our experience with PAL treatment after pulmonary resection using EBV is very limited, it has been feasible, safe and effective to control this complication even in an acute respiratory failure and mechanical ventilation settings

Reference #1: Dooms CA, De Leyn PR, Yserbyt J, Decaluwe H, Ninane V. Endobronchial valves for persistent postoperative pulmonary air leak: accurate monitoring and functional implications. Respiration. 2012;84:329-33.

Reference #2: Kovitz KL, French KD. Endobronchial valve placement and balloon occlusion for persistent air leak: procedure overview and new current procedural terminology codes for 2013. Chest. 2013.144:661-5.

Reference #3: Venuta F, Rendina EA, De Giacomo T, Coloni GF. Postoperative strategies to treat permanent air leaks. Thorac Surg Clin. 2010. 20:391-7. Review

DISCLOSURE: The following authors have nothing to disclose: Maria Rodríguez, María Teresa Gómez Hernández, Aldo Torracchi, Nuria María Novoa Valentín, Rosa Cordovilla, Jose Luis Aranda Alcaide, Marcelo Fernando Jiménez López, Gonzalo Varela Simó

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