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Hance JM, Martin JT, Mullett TW. Endobronchial Valves in the Treatment of Persistent Air Leaks. Ann Thorac Surg 2015; 100:1780-5; discussion 1785-6. [DOI: 10.1016/j.athoracsur.2015.05.073] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2014] [Revised: 05/11/2015] [Accepted: 05/15/2015] [Indexed: 10/23/2022]
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Abstract
BACKGROUND Prolonged air leaks may result in increased morbidity and mortality. Endobronchial valves have been used as a nonoperative treatment. We evaluated the efficacy of endobronchial valves at achieving chest tube removal and hospital discharge for air leaks resulting from varied etiologies. METHODS All consecutive patients undergoing endobronchial valve placement for persistent air leak were evaluated by a multidisciplinary team at a single institution. Those receiving valves underwent bronchoscopy with balloon occlusion to identify airways contributing to the leak. After airway sizing, unidirectional endobronchial valves were deployed. RESULTS During an 18-month period, 21 patients underwent 24 valve placement procedures; 88 valves were placed (median, 3; mean, 3.6; range, 1 to 12). Patient age range was 16 months to 70 years. The underlying cause of persistent air leak was postoperative (n = 8), pneumothorax (n = 11), cavitary lung infection (n = 3), and postpneumonectomy bronchopleural fistula (n = 2). There were no valve-related complications during placement, dwell time, or removal. Three patients died as a result of their underlying disease, unrelated to valves. Of those with chest tubes who survived and were discharged, all had successful removal of their chest tubes. Median duration to chest tube removal after initial valve placement was 15 days (mean, 21 days; range, 0 to 86 days). Median length of stay after final valve placement was 5 days (mean, 15 days; range, 0 to 196 days). CONCLUSIONS Challenging air leaks often occur in medically compromised patients. They may persist despite multiple interventions. Endobronchial valves offer minimally invasive management. Time to chest tube removal and length of stay are variable, frequently because of clinical status and underlying disease.
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Affiliation(s)
- Michael F Reed
- Department of Surgery, Division of Thoracic Surgery, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania.
| | - Christopher R Gilbert
- Department of Medicine, Division of Pulmonary, Allergy, and Critical Care, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Matthew D Taylor
- Department of Surgery, Division of Thoracic Surgery, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Jennifer W Toth
- Department of Medicine, Division of Pulmonary, Allergy, and Critical Care, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
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Podgaetz E, Andrade RS, Zamora F, Gibson H, Dincer HE. Endobronchial Treatment of Bronchopleural Fistulas by Using Intrabronchial Valve System: A Case Series. Semin Thorac Cardiovasc Surg 2015; 27:218-22. [PMID: 26686450 DOI: 10.1053/j.semtcvs.2015.06.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2015] [Indexed: 11/11/2022]
Abstract
Air leaks, alveolopleural or bronchopleural fistulas, either spontaneous, iatrogenic, or postsurgical, can be difficult to treat, and if prolonged in spite of proper chest tube thoracostomy they may require surgical or chemical pleurodesis with variable success. Intrabronchial valve (IBV) treatment is minimally invasive and has a potential to shorten the duration of air leaks in well-selected patients with ongoing air leaks. The study included 19 patients with prolonged air leaks treated with IBVs spiration, with a total of 71 valves placed at a tertiary university hospital. Internal Board Review approval was obtained to use IBVs for off-label indication. IBVs were placed in desired airways with 100% accuracy in patients with air leaks without complications, including self-migration. All 19 patients with air leaks were initially treated with chest tube thoracostomy and in addition chemical pleurodesis in 2 and blood patch in a patient without success. After IBV placement, all patients but one with air leak had successful resolution of the air leak and removal of chest tube in a median of 3 days (range: 2-45 days). In conclusion, the use of IBVs for prolonged air leaks in various etiologies is effective and safe.
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Affiliation(s)
- Eitan Podgaetz
- Division of Cardiothoracic Surgery, Section of Thoracic and Foregut Surgery, University of Minnesota, Minneapolis, Minnesota.
| | - Rafael S Andrade
- Division of Cardiothoracic Surgery, Section of Thoracic and Foregut Surgery, University of Minnesota, Minneapolis, Minnesota
| | - Felix Zamora
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Heidi Gibson
- Cardiopulmonary Service, University of Minnesota, Minneapolis, Minnesota
| | - H Erhan Dincer
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, University of Minnesota, Minneapolis, Minnesota
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Digital quantification of air leak to identify the location of an alveolopleural fistula. Ann Am Thorac Soc 2015; 11:1152-4. [PMID: 25237995 DOI: 10.1513/annalsats.201404-176cc] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Musani AI, Dutau H. Management of alveolar-pleural fistula: a complex medical and surgical problem. Chest 2015; 147:590-592. [PMID: 25732439 DOI: 10.1378/chest.14-2202] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Ali I Musani
- Division of Pulmonary, Critical Care and Sleep Medicine, Thoracic Oncology, Pleural Diseases and Interventional Pulmonology Department, North University Hospital, Marseille, France.
| | - Hervé Dutau
- National Jewish Health, Thoracic Endoscopy Unit, Thoracic Oncology, Pleural Diseases and Interventional Pulmonology Department, North University Hospital, Marseille, France
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Gkegkes ID, Mourtarakos S, Gakidis I. Endobronchial valves in treatment of persistent air leaks: a systematic review of clinical evidence. Med Sci Monit 2015; 21:432-8. [PMID: 25660145 PMCID: PMC4332267 DOI: 10.12659/msm.891320] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background Persistent air leak is one of the most common complications of lung diseases and pulmonary resections. Prolonged hospitalization, increased morbidity, and increased overall treatment costs arise from persistent air leaks. The use of endobronchial valves (EBVs) in the management of air leaks is an important alternative, especially for patients who are not candidates for surgical treatment. Material/Methods We retrieved the included studies by performing a systematic search in PubMed and Scopus databases. The references of the included studies were also hand-searched. Results We retrieved 25 case reports and 3 case series from our literature search. The most common cause of persisting air leaks was spontaneous secondary pneumothorax (12/39, 31%). The left upper lobe (13/39, 33%) and right upper lobe (14/39, 36%) were the most frequent locations of air leaks. Most air leaks treated with EBVs ceased in less than 24 h. Three recurrences of air leak were reported and 2 cases of EBV migration were described. No deaths were reported in correlation with EBVs. Conclusions EBVs are a minimally invasive therapeutical option that may be suitable for the treatment of persistent air leaks regardless of the initial cause, especially in high-risk patients. Nevertheless, studies with better methodological quality are essential to standardize this technique and to provide more evidence on EBV safety issues.
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Affiliation(s)
- Ioannis D Gkegkes
- Department of Thoracic Surgery, General Hospital of Attica "KAT", Athens, Greece
| | | | - Ioannis Gakidis
- Department of Thoracic Surgery, General Hospital of Attica "KAT", Athens, Greece
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Toth JW, Podany AB, Reed MF, Rocourt DV, Gilbert CR, Santos MC, Cilley RE, Dillon PW. Endobronchial occlusion with one-way endobronchial valves: a novel technique for persistent air leaks in children. J Pediatr Surg 2015; 50:82-5. [PMID: 25598099 DOI: 10.1016/j.jpedsurg.2014.10.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2014] [Accepted: 10/06/2014] [Indexed: 01/29/2023]
Abstract
PURPOSE In children, persistent air leaks can result from pulmonary infection or barotrauma. Management strategies include surgery, prolonged pleural drainage, ventilator manipulation, and extracorporeal membrane oxygenation (ECMO). We report the use of endobronchial valve placement as an effective minimally invasive intervention for persistent air leaks in children. METHODS Children with refractory prolonged air leaks were evaluated by a multidisciplinary team (pediatric surgery, interventional pulmonology, pediatric intensive care, and thoracic surgery) for endobronchial valve placement. Flexible bronchoscopy was performed, and air leak location was isolated with balloon occlusion. Retrievable one-way endobronchial valves were placed. RESULTS Four children (16 months to 16 years) had prolonged air leaks following necrotizing pneumonia (2), lobectomy (1), and pneumatocele (1). Patients had 1-4 valves placed. Average time to air leak resolution was 12 days (range 0-39). Average duration to chest tube removal was 25 days (range 7-39). All four children had complete resolution of air leaks. All were discharged from the hospital. None required additional surgical interventions. CONCLUSION Endobronchial valve placement for prolonged air leaks owing to a variety of etiologies was effective in these children for treating air leaks, and their use may result in resolution of fistulae and avoidance of the morbidity of pulmonary surgery.
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Affiliation(s)
- Jennifer W Toth
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA
| | - Abigail B Podany
- Division of Pediatric Surgery, Department of Surgery, Penn State Milton S. Hershey Medical Center, Hershey, PA.
| | - Michael F Reed
- Division of Cardiothoracic Surgery, Department of Surgery, Penn State Milton S. Hershey Medical Center, Hershey, PA
| | - Dorothy V Rocourt
- Division of Pediatric Surgery, Department of Surgery, Penn State Milton S. Hershey Medical Center, Hershey, PA
| | - Christopher R Gilbert
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA
| | - Mary C Santos
- Division of Pediatric Surgery, Department of Surgery, Penn State Milton S. Hershey Medical Center, Hershey, PA
| | - Robert E Cilley
- Division of Pediatric Surgery, Department of Surgery, Penn State Milton S. Hershey Medical Center, Hershey, PA
| | - Peter W Dillon
- Division of Pediatric Surgery, Department of Surgery, Penn State Milton S. Hershey Medical Center, Hershey, PA
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Rescue therapy using an endobronchial valve and digital air leak monitoring in Invasive Pulmonary Aspergillosis. Respir Med Case Rep 2014; 14:27-9. [PMID: 26029572 PMCID: PMC4356032 DOI: 10.1016/j.rmcr.2014.12.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
In this case report, we describe the utilisation of two recently developed technologies for the successful management of a persistent air leak (PAL) in a critically ill patient in whom cardiothoracic surgical intervention was not possible. We report the case of a young leukaemic woman with a PAL complicating Invasive Pulmonary Aspergillosis (IPA), who was effectively managed using an Endobronchial Valve, supplemented by objective, digital air leak data provided by a Thopaz® device (Medela, Switzerland).
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Gudbjartsson T, Helgadottir S, Ek L. One-way endobronchial valve for bronchopleural fistula after necrotizing pneumonia. Asian Cardiovasc Thorac Ann 2014; 21:498-9. [PMID: 24570548 DOI: 10.1177/0218492313480052] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Tomas Gudbjartsson
- Department of Cardiothoracic Surgery, Landspitali University Hospital, Reykjavik, Iceland
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Abstract
There are limited therapies for severe emphysema. Bronchoscopic treatments of emphysema were introduced to achieve the beneficial physiological changes seen in surgical lung volume reduction; however, at the present time these treatments are mostly aimed at improving quality of life and functional status in patients with emphysema. At this time, none of these minimally invasive approaches have been approved in the United States for treatment of emphysema; however, several novel interventions have demonstrated potential in early-phase clinical trials. We performed a systematic evaluation of the relevant medical literature and present herein an evidence-based review of bronchoscopic treatments for emphysema, with a focus on the current status of this technology in the United States as compared with Europe.
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Perch M, Riise GC, Hogarth K, Musani AI, Springmeyer SC, Gonzalez X, Iversen M. Endoscopic treatment of native lung hyperinflation using endobronchial valves in single-lung transplant patients: a multinational experience. CLINICAL RESPIRATORY JOURNAL 2014; 9:104-10. [PMID: 24506317 DOI: 10.1111/crj.12116] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2013] [Revised: 01/08/2014] [Accepted: 01/25/2014] [Indexed: 12/29/2022]
Abstract
BACKGROUND Hyperinflation of the native lung (NLH) is a known complication to single-lung transplantation for emphysema. The hyperinflation can lead to compression of the graft and cause respiratory failure. Endobronchial valves have been used to block airflow in specific parts of the native lung, reducing the native lung volume and relieving the graft. OBJECTIVE We report short-term follow-up and safety from 14 single-lung transplant patients with NLH treated with bronchoscopic lung volume reduction using endobronchial valves. METHODS Retrospective clinical information related to endobronchial valve treatment was obtained from four centres. All patients were treated with IBV(TM) Valve System (Spiration, Olympus Respiratory America, Redmond, WA, USA). All patients had evidence of severe NLH with mediastinal displacement. RESULTS A total of 74 IBV valves were placed in 14 patients, with an average of 5.3 (range 2-10). Five patients had two procedures with staged treatment. Eleven patients reported symptom relief, and nine had lung function improvements. There was a significant increase in forced expiratory volume in 1 s of 9% (P = 0.013) and forced vital capacity of 15% (P = 0.034) within the first months after treatment. There were no reported device-related adverse events nor reports of migration. Two patients had pneumothorax. One patient had pneumonia in the location of the valve placement, and another had infection within days. Three other patients were hospitalised with infection 2 months after treatment. CONCLUSIONS Treating NLH with IBV endobronchial valves leads to clinical improvement in the majority of patients, and the treatment has an acceptable safety.
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Affiliation(s)
- Michael Perch
- Department of Cardiology, Section for Lung Transplantation, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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63
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Akulian J, Feller-Kopman D, Lee H, Yarmus L. Advances in interventional pulmonology. Expert Rev Respir Med 2014; 8:191-208. [PMID: 24450415 DOI: 10.1586/17476348.2014.880053] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Interventional pulmonology (IP) remains a rapidly expanding and evolving subspecialty focused on the diagnosis and treatment of complex diseases of the thorax. As the field continues to push the leading edge of medical technology, new procedures allow for novel minimally invasive approaches to old diseases including asthma, chronic obstructive pulmonary disease and metastatic or primary lung malignancy. In addition to technologic advances, IP has matured into a defined subspecialty, requiring formal training necessary to perform the advanced procedures. This need for advanced training has led to the need for standardization of training and the institution of a subspecialty board examination. In this review, we will discuss the dynamic field of IP as well as novel technologies being investigated or employed in the treatment of thoracic disease.
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Affiliation(s)
- Jason Akulian
- University of North Carolina, Pulmonary and Critical Care, Chapel Hill, CA, USA
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64
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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 2014; 144:661-665. [PMID: 23918110 DOI: 10.1378/chest.12-2746] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Unidirectional endobronchial valves, originally studied for potential treatment of emphysema, have emerged as a useful intervention for patients with persistent air leak from the lung. The procedure is accomplished via bronchoscopy in a patient who already has a chest tube in place for management of the air leak. It uses an occluding balloon to determine the specific airway(s) leading to the leak by impact on airflow and subsequent placement of removable valve(s) in one or more segment or subsegments to decrease flow across the leak to allow for healing of the fistula. Specific US Food and Drug Administration-approved criteria for placement and removal of these valves via a Humanitarian Device Exemption are discussed along with reported outcomes. Current Procedural Terminology codes effective for 2013 that are specific to the procedure are reviewed.
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Affiliation(s)
- Kevin L Kovitz
- Division of Pulmonary, Critical Care, Sleep and Allergy, University of Illinois Hospital & Health Sciences System, Chicago; Chicago Chest Center, Elk Grove Village, IL.
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65
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Ambrosino N, Ribechini A, Allidi F, Gabbrielli L. Use of endobronchial valves in persistent air leaks: a case report and review of the literature. Expert Rev Respir Med 2014; 7:85-90. [DOI: 10.1586/ers.12.76] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Endobronchial valves for treatment of bronchopleural fistula in granulomatous polyangitis: a longitudinal case report. J Bronchology Interv Pulmonol 2013; 20:186-8. [PMID: 23609260 DOI: 10.1097/lbr.0b013e3182917513] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Bronchopleural fistula (BPF) is an abnormal communication between the bronchus and the pleural space, commonly occurring after pulmonary resection or due to a spontaneous pneumothorax secondary to an underlying lung disease. We present a case of BPF in the setting of granulomatous polyangitis treated with endobronchial valves (EBV) with a longitudinal follow-up. These 1-way valves allow air and mucus to exit the diseased segment of lung during expiration, but prevent the reentry of air upon inspiration. The targeted segment may undergo atelectasis, achieving nonsurgical lung volume reduction, and allowing the remaining lung to compensate for the loss of volume. The use of these valves has shown to decrease hospitalization, morbidity, and mortality in these patients. In this case, the patient endured a prolonged hospitalization (82 d) and was able to be discharged only 7 days after EBV placement. This facilitated engagement in a pulmonary rehabilitation program, increased physical activity, and ultimately resumption of normal activity for the patient. To our knowledge, this is the first case of EBV used to treat BPF in the setting of underlying granulomatous polyangitis. This underscores the point that in appropriate settings, EBVs can decrease morbidity and mortality, and significantly improve the quality of life.
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Fielding DI, Bashirzadeh F, Deller D, Douglas A, Boots R, Hopkins P. Life-saving closure of a pulmonary cavity by endobronchial valve placement. Am J Respir Crit Care Med 2013; 187:1145-6. [PMID: 23675725 DOI: 10.1164/rccm.201210-1833le] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Pastis NJ, Silvestri GA, Shepherd RW. Quality-of-life improvement and cost-effectiveness of interventional pulmonary procedures. Clin Chest Med 2013; 34:593-603. [PMID: 23993826 DOI: 10.1016/j.ccm.2013.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Most interventional pulmonology studies focus on the technical success of procedures without measuring validated quality-of-life (QoL) outcomes. Studies are now incorporating end points that include QoL measurements and there are examples of interventional procedures that likely improve QoL. It is vital for the interventional pulmonary literature to incorporate cost-effectiveness when introducing new technology. While not uniformly analyzed in a rigorous manner in all studies, there are examples of interventional pulmonary studies that analyze cost-effectiveness through avoidance of more expensive procedures, cost savings per day free of emergency room visit, or cost savings per day not requiring intensive care unit care.
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Affiliation(s)
- Nicholas J Pastis
- Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, Medical University of South Carolina, Charleston, SC 29425, USA.
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Endobronchial Oxygen Insufflation: A Novel Technique for Localization of Occult Bronchopleural Fistulas. Ann Am Thorac Soc 2013; 10:157-9. [DOI: 10.1513/annalsats.201212-126ot] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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71
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Mahajan AK, Doeing DC, Hogarth DK. Isolation of persistent air leaks and placement of intrabronchial valves. J Thorac Cardiovasc Surg 2013; 145:626-30. [PMID: 23312104 DOI: 10.1016/j.jtcvs.2012.12.003] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2012] [Revised: 11/20/2012] [Accepted: 12/03/2012] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Alveolar-pleural fistulas causing persistent air leaks are conditions associated with prolonged hospital courses, high morbidity, and possibly increased mortality. Intrabronchial valves serve as a noninvasive therapeutic option for the closure of alveolar-pleural fistulas. METHODS The present review describes a brief history of, and indications for, the placement of intrabronchial valves in patients with persistent air leaks. The essential steps necessary for placement are air leak isolation, airway sizing, and valve deployment. Additionally, the indications and methods for intrabronchial valve removal, along with the potential complications from intrabronchial valve placement, are described. CONCLUSIONS The increased use of intrabronchial valves in the treatment of persistent air leaks requires bronchoscopists and clinicians to understand the procedural steps and techniques necessary for intrabronchial valve placement.
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Affiliation(s)
- Amit K Mahajan
- University of Chicago Medical Center, Chicago, IL 60637, USA.
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Dooms CA, De Leyn PR, Yserbyt J, Decaluwe H, Ninane V. Endobronchial valves for persistent postoperative pulmonary air leak: accurate monitoring and functional implications. ACTA ACUST UNITED AC 2012; 84:329-33. [PMID: 22889916 DOI: 10.1159/000339411] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2012] [Accepted: 05/07/2012] [Indexed: 11/19/2022]
Abstract
An alveolar-pleural fistula is a communication between the pulmonary parenchyma distal to a segmental bronchus and the pleural space. A postoperative pulmonary expiratory air leak after an anatomic pulmonary resection is usually managed conservatively. The use of endobronchial valves is a minimal invasive method that may be effective for the treatment of a persistent postoperative pulmonary air leak. We present and discuss the advantages of a digital thoracic drainage system for the accurate, objective and reproducible air leak assessment during endobronchial valve placement. Our case also illustrates that, even after lobectomy, lobar exclusion with valves allows air leak resolution without atelectasis and with moderate functional alteration. We discuss the anatomic and physiologic changes induced by valves placed for air leak closure.
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Affiliation(s)
- Christophe A Dooms
- Department of Pulmonology, University Hospitals Leuven, Leuven, Belgium.
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Brichon PY, Poquet C, Arvieux C, Pison C. Successful treatment of a life-threatening air leakage, complicating severe abdominal sepsis, with a one-way endobronchial valve. Interact Cardiovasc Thorac Surg 2012; 15:779-80. [PMID: 22761125 DOI: 10.1093/icvts/ivs258] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
A 41-year-old woman had a jeopardizing air leak from an alveolar-pleural and transdiaphragmatic fistula with pulmonary cavitation, secondary to a severe postoperative abdominal sepsis. Her condition dramatically improved by introduction, in the lower bronchus, of a one-way endobronchial valve, leading to immediate cessation of air leakage and removal of extracorporeal membrane oxygenation, and thus avoiding a lower left lobectomy with myoplasty. Furthermore, removal of the valve nine weeks later led to near-complete recovery of the left lower lobe.
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Affiliation(s)
- Pierre-Yves Brichon
- Department of Thoracic Surgery, University Hospital of Grenoble, Grenoble, France.
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Abstract
Pneumothorax in critically ill patients remains a common problem in the ICU, occurring in 4% to 15% of patients. Pneumothorax should be considered a medical emergency and requires a high index of suspicion, prompt recognition, and intervention. The diagnosis of pneumothorax in the critically ill patient can be made by physical examination findings or radiographic studies including chest radiographs, ultrasonography, or CT scanning. Ultrasonography is emerging as the diagnostic procedure of choice for the diagnosis and management guidance and management of pneumothoraces, if expertise is available. Pneumothoraces in unstable, critically ill patients or in those on mechanical ventilation should be managed with tube thoracostomy. If there is suspicion for tension pneumothorax, immediate decompression and drainage should be performed. With widespread use of CT scanning, there have been more occult pneumothoraces diagnosed, and the most recent literature suggests that drainage is preferred. In patients with a persistent air leak or failure of the lung to expand, current guidelines suggest that an early thoracic surgical consultation be requested within 3 to 5 days.
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Affiliation(s)
- Lonny Yarmus
- Interventional Pulmonology, Division of Pulmonary and Critical Care Medicine, The Johns Hopkins Hospital, Baltimore, MD.
| | - David Feller-Kopman
- Interventional Pulmonology, Division of Pulmonary and Critical Care Medicine, The Johns Hopkins Hospital, Baltimore, MD
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El-Sameed Y, Waness A, Al Shamsi I, Mehta AC. Endobronchial Valves in the Management of Broncho-Pleural and Alveolo-Pleural Fistulae. Lung 2012; 190:347-51. [DOI: 10.1007/s00408-011-9369-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2011] [Accepted: 12/29/2011] [Indexed: 01/06/2023]
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