SESSION TITLE: Pleural
SESSION TYPE: Slide Presentations
PRESENTED ON: Sunday, March 23, 2014 at 04:15 PM - 05:15 PM
PURPOSE: Prolonged pulmonary air leaks (PAL), after lung surgery or any causes of pneumothorax, are a source of significant morbidity and resource utilization. Usual approaches include prolonged thoracostomy tube drainage, pleurodesis or open surgical repair. Bronchoscopic techniques using various agents and devices have been essayed but with only anecdotal benefits reported. The use of endobronchial valves (EBV) is a minimal invasive method that may be effective for the treatment of a PAL.
METHODS: The study reviews 6 patients treated with EBV due to PAL from November 2010 - March 2013. Data was extracted from a prospective clinical database and is presented descriptively. Flexible bronchoscopy was performed either through an endobronchial tube under general anesthesia or through the mouth under conscious sedation with spontaneous breathing and local anesthesia. Bronchoscopy with balloon occlusion was used to identify the leaking airways to be treated with EBV. Air leak improvement was defined with Cerfolio classification, or complete cessation of the air leak.
RESULTS: In 2 of the 6 patients EBV was indicated for postoperative PAL, in the other 4 the indication was PAL secondary to pneumothorax. Series includes 5 men with an average age of 62.8 (range 28-85), all of them severe COPD patients. Air leak was identified in all lobes except in RLL and ML. Most of the valves employed were Olympus (Zemphyr valve was used in one case), the average of EBV used was 2 (range 1-4). No complications during the procedure were reported. Treatment was successful in 4 out of the 6 cases (67%). Average time to remove the chest tube was 12.5 days after its insertion. Surgical treatment was required in two patients. Removal of valves had no complications: mean time of 44,8 days (range 19-720 days).
CONCLUSIONS: The use of endobronchial valves is an effective, safe and minimally invasive intervention for prolonged pulmonary air leaks. Endobronchial valves represent an option for the management of PAL in patients who are not eligible for surgical procedures.
CLINICAL IMPLICATIONS: Treatment of PAL
DISCLOSURE: The following authors have nothing to disclose: Aldo Torracchi, Rosa Cordovilla, Gonzalo Varela Simó, Marcelo Fernando Jiménez López, Nuria María Novoa Valentín, Maria Rodríguez, María Teresa Gómez Hernández, Jose Luis Aranda
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