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Maitre T, Camuset J, Faure M, Cracco C, Maalouf G, Allenbach Y, Barral M, Fekkar A, Giol M, Parrot A, Cadranel J. Enhancing antifungal treatment for chronic cavitary pulmonary aspergillosis through the addition of endobronchial valve therapy. Respir Med Case Rep 2024; 52:102106. [PMID: 39364341 PMCID: PMC11447398 DOI: 10.1016/j.rmcr.2024.102106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 06/06/2024] [Accepted: 08/09/2024] [Indexed: 10/05/2024] Open
Abstract
A 62-year-old male experienced anti-MDA5 dermatomyositis with lung involvement, treated with immunosuppressive therapy leading to chronic cavitary pulmonary aspergillosis in left upper lobe. Patient's history was complicated by complete left pneumothorax due to alveolar-pleural fistula occurring because of the rupture of the pulmonary cavitation. Left lung failed to re-expand despite a four-week period of pleural drainage. In addition to antifungal therapy, patient received endobronchial valve therapy in the anterior segmental bronchus of the left upper lobe leading to air leak cessation, left lung re expansion and aspergillosis cavitation closure.
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Affiliation(s)
- Thomas Maitre
- Service de Pneumologie et d’Oncologie Thoracique et Centre Constitutifs Maladies Pulmonaires Rares, Hôpital Tenon, APHP Sorbonne Université, Paris, France
- Centre d’Immunologie et des Maladies Infectieuses (Cimi Paris), INSERM U1135, Sorbonne Université, Paris, France
| | - Juliette Camuset
- Service de Chirurgie Thoracique, Hôpital Tenon, APHP Sorbonne Université, Paris, France
| | - Morgane Faure
- APHP-6 Sorbonne Université, Site Pitié Salpêtrière, Service de Pneumologie (Département R3S), Paris, France
| | - Christophe Cracco
- APHP-6 Sorbonne Université, Site Pitié Salpêtrière, Service de Pneumologie (Département R3S), Paris, France
| | - Georgina Maalouf
- Service de Médecine Interne, Hôpital Pitié Salpêtrière, APHP Sorbonne Université, Paris, France
| | - Yves Allenbach
- Service de Médecine Interne, Hôpital Pitié Salpêtrière, APHP Sorbonne Université, Paris, France
| | - Matthias Barral
- Service de Radiologie, Hôpital Tenon, APHP Sorbonne Université, Paris, France
| | - Arnaud Fekkar
- Laboratoire de Parasitologie, Hôpital Pitié Salpêtrière, APHP Sorbonne Université, Paris, France
| | - Mihaela Giol
- Service de Chirurgie Thoracique, Hôpital Tenon, APHP Sorbonne Université, Paris, France
| | - Antoine Parrot
- Service de Pneumologie et d’Oncologie Thoracique et Centre Constitutifs Maladies Pulmonaires Rares, Hôpital Tenon, APHP Sorbonne Université, Paris, France
| | - Jacques Cadranel
- Service de Pneumologie et d’Oncologie Thoracique et Centre Constitutifs Maladies Pulmonaires Rares, Hôpital Tenon, APHP Sorbonne Université, Paris, France
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Podder S, Khan M, Sink Z, Verga S, Kurman JS, Malsin E. Bronchoscopic Lung Volume Reduction: A Review. Semin Respir Crit Care Med 2024. [PMID: 39025124 DOI: 10.1055/s-0044-1787876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2024]
Abstract
Bronchoscopic lung volume reduction (BLVR) is an established treatment modality for the management of advanced chronic obstructive pulmonary disease complicated by severe emphysema and hyperinflation refractory to other therapies. BLVR aims to reduce hyperinflation and residual volume, thereby improving pulmonary function, symptom control, and quality of life. Multiple distinct devices and technologies, including endobronchial coils, thermal vapor ablation, bio-lung volume reduction, and airway bypass stenting, have been developed to achieve lung volume reduction with varying degrees of accessibility and evidence. The most promising BLVR treatment modality to date has been the placement of one-way endobronchial valves (EBVs), with more than 25,000 cases performed worldwide. Identifying symptomatic patients who would benefit from BLVR is challenging and can be time and resource intensive, and candidacy may be limited by physiologic parameters. Additional new technologies may be able to improve the identification and evaluation of candidates as well as increase the portion of evaluated patients who ultimately qualify for BLVR. In this review, we aim to provide historical context to BLVR, summarize the available evidence regarding its use, discuss potential complications, and provide readers with a clear guide to patient selection and referral for BLVR, with a focus on EBV placement. In addition, we will highlight potential future directions for the field.
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Affiliation(s)
- Shreya Podder
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Marium Khan
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Zane Sink
- Jerry M. Wallace School of Osteopathic Medicine, Campbell University, Lillington, North Carolina
| | - Steven Verga
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
- Froedtert Memorial Lutheran Hospital, Milwaukee, Wisconsin
| | - Jonathan S Kurman
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
- Froedtert Memorial Lutheran Hospital, Milwaukee, Wisconsin
| | - Elizabeth Malsin
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
- Froedtert Memorial Lutheran Hospital, Milwaukee, Wisconsin
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Mskhaladze T, Tchkonia D, Vacharadze K, Kiria N, Chkonia M. Closure of TB pulmonary cavern using endobronchial valve placement. Oxf Med Case Reports 2024; 2024:omae022. [PMID: 38532759 PMCID: PMC10962235 DOI: 10.1093/omcr/omae022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 02/08/2024] [Accepted: 02/20/2024] [Indexed: 03/28/2024] Open
Abstract
INTRODUCTION Enhancing the efficacy of treatment for Multi-Drug Resistant (MDR) and Extensively Drug Resistant (XDR) Tuberculosis has prompted exploration into adjunctive therapies, such as Endobronchial Valve Placement (EVP) in addition to pharmacological interventions. MATERIALS AND METHODS EVP was performed utilizing a combination of rigid and flexible bronchoscopes to address airway hemorrhage and facilitate closure of TB cavities. The procedure involved the deployment of large valves (12 mm and 17 mm), necessitating the utilization of a rigid bronchoscope. RESULTS Sputum conversion was confirmed through culture analysis after one month, and chest CT scans revealed complete closure of the tuberculous cavity five months post the EVP procedure. CONCLUSION We posit that when used in conjunction with anti-TB chemotherapy, this method holds promise for shortening treatment duration and improving overall efficacy.
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Affiliation(s)
- Teona Mskhaladze
- Phthysiatry-Pulmonology, Tbilisi State Medical University, Tbilisi, Georgia
| | - David Tchkonia
- Internal Medicine, European University, Tbilisi, Georgia
| | - Kakha Vacharadze
- Phthysiatry-Pulmonology, Tbilisi State Medical University, Tbilisi, Georgia
| | - Nana Kiria
- Phthysiatry-Pulmonology, National Center for Tuberculosis and Lung Diseases, Tbilisi, Georgia
| | - Mikolay Chkonia
- Medical School, David Tvildiani Medical University, Tbilisi, Georgia
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Welling JBA, Koster TD, Slebos DJ. From plugging air leaks to reducing lung volume: a review of the many uses of endobronchial valves. Expert Rev Med Devices 2023; 20:721-727. [PMID: 37409351 DOI: 10.1080/17434440.2023.2233435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 07/03/2023] [Indexed: 07/07/2023]
Abstract
INTRODUCTION One-way endobronchial valve treatment improves lung function, exercise capacity, and quality of live in patients with severe emphysema and hyperinflation. Other areas of therapeutic application include treatment of persistent air leak (PAL), giant emphysematous bullae, native lung hyperinflation, hemoptysis, and tuberculosis. AREAS COVERED In this review, we will assess the clinical evidence and safety of the different applications of one-way endobronchial valves (EBV). EXPERT OPINION There is solid clinical evidence for the use of one-way EBV for lung volume reduction in emphysema. Treatment with one-way EBV can be considered for the treatment of PAL. The application of one-way EBV for giant bullae, post lung transplant native lung hyperinflation, hemoptysis, and tuberculosis is under investigation and more research is required to investigate the efficacy and safety of these applications.
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Affiliation(s)
- Jorrit B A Welling
- Department of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Groningen Research Institute for Asthma and COPD, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - T David Koster
- Department of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Groningen Research Institute for Asthma and COPD, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Dirk-Jan Slebos
- Department of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Groningen Research Institute for Asthma and COPD, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Endobronchial Valve Treatment of Tuberculous Cavities in Patients with Multidrug-Resistant Pulmonary Tuberculosis: A Randomized Clinical Study. Pathogens 2022; 11:pathogens11080899. [PMID: 36015021 PMCID: PMC9414730 DOI: 10.3390/pathogens11080899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 08/05/2022] [Accepted: 08/08/2022] [Indexed: 11/26/2022] Open
Abstract
Background: Multidrug-resistant pulmonary tuberculosis (MDR-PTB) has become a major cause of high morbidity and mortality related to TB. Conventional drug regimens are ineffective for the treatment of MDR-PTB patients with cavities. This study aimed to evaluate the clinical efficacy and safety of one-way endobronchial valves (EBVs) for the treatment of cavities in MDR-PTB patients. Methods: MDR-PTB patients with positive sputum cultures, sputum smears, and cavities were treated with EBVs in the drainage bronchus of the pulmonary cavity between November 2013 and March 2018. The participants comprised those who had failed previous anti-tuberculosis therapy, as determined by drug susceptibility testing. Results: Thirty-five MDR-PTB patients were included, three of whom were lost during follow-up. The size of the lung cavity was reduced in all of the patients after EBV implantation, including the three lost to follow-up. In the remaining 32 patients, the sputum culture conversion (SCC) rate reached 100%, and the cavity closure rate was 68.8%. There were no significant differences in the cavity closure rate between patients aged ≤40 and >40 years, between the upper and lower lobes, or between the use and non-use of linezolid groups (p > 0.05). Interestingly, the cavity closure rate was higher in women than in men (p = 0.005). Moreover, the cavity closure rate correlated with the time to SCC (correlation coefficient, 0.8933; p < 0.0001). There were no severe adverse events in the patients treated with EBV implantation. Conclusion: EBV installation is effective and safe for the treatment of cavities in MDR-PTB patients. The efficacy of EBV treatment may not be affected by age, disease course, or the location of the lung lobe in the cavity.
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Mondoni M, Saderi L, Sotgiu G. Novel treatments in multidrug-resistant tuberculosis. Curr Opin Pharmacol 2021; 59:103-115. [PMID: 34186381 DOI: 10.1016/j.coph.2021.05.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 05/17/2021] [Accepted: 05/25/2021] [Indexed: 02/07/2023]
Abstract
The management of multidrug-resistant tuberculosis (TB) is associated with low treatment success, high mortality and failure rates. New drugs and novel short-therapeutic regimens have only recently helped overcome these obstacles. We carried out a narrative literature review aimed at summarizing the scientific evidence on the recent therapeutic advances in the field of drug-resistant TB. Experimental and observational studies on novel (i.e. bedaquiline, delamanid, pretomanid) drugs and novel regimens and the main pharmacological characteristics of the newest compounds are described. We also highlight the main scientific evidence on therapeutic strategies complementary to standard chemotherapy (i.e. new approaches to drug delivery, host-directed therapy, surgery, new collapse therapy, rehabilitation, and palliative care).
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Affiliation(s)
- Michele Mondoni
- Respiratory Unit, ASST Santi Paolo e Carlo, San Paolo Hospital, Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - Laura Saderi
- Clinical Epidemiology and Medical Statistics Unit, Dept of Medical, Surgical and Experimental Medicine, University of Sassari, Sassari, Italy
| | - Giovanni Sotgiu
- Clinical Epidemiology and Medical Statistics Unit, Dept of Medical, Surgical and Experimental Medicine, University of Sassari, Sassari, Italy.
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Riskiyev A, Ciobanu A, Hovhannesyan A, Akopyan K, Gadoev J, Parpieva N. Characteristics and Treatment Outcomes of Patients with Tuberculosis Receiving Adjunctive Surgery in Uzbekistan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18126541. [PMID: 34204519 PMCID: PMC8296362 DOI: 10.3390/ijerph18126541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 05/11/2021] [Accepted: 05/18/2021] [Indexed: 11/19/2022]
Abstract
Surgical interventions are performed as an adjunct to pharmacological treatment in Uzbekistan in 10–12% of diagnosed tuberculosis (TB) patients. In this study among patients with respiratory TB who had surgical interventions in Republican Specialized Scientific-Practical Medical Centre of Phthisiology and Pulmonology of Uzbekistan (RSSPMCPP) from January to May 2017, we describe (i) reasons and types of surgical intervention, (ii) post-surgical complications, (iii) histological diagnosis before and after surgery, and (iv) treatment outcomes. There were 101 patients included in the analysis (mean age 36 years; 51% male; 71% lived in rural areas). The main indications for surgical intervention included pulmonary tuberculoma (40%), fibrocavitary, or cavernous pulmonary TB (23%) and massive hemoptysis (20%). Pulmonary resections were the most frequent surgical procedures: segmentectomy (41%), lobectomy or bilobectomy (19%), and combined resection (17%). Ten patients (9%) suffered post-surgery complications. According to histological examination after surgery, TB was confirmed in 81 (80%) patients. For the other 20 patients, the confirmed diagnoses were: lung cancer (n = 6), echinococcosis (n = 5), post-TB fibrosis (n = 5), non-tuberculous pleurisy (n = 2), hamartoma (n = 1), and pneumonia (n = 1). The majority of patients (94%), who underwent surgery, were considered successfully treated. In conclusion, adjunctive surgical therapy can be an option for TB treatment, especially in cases of complicated TB.
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Affiliation(s)
- Anvar Riskiyev
- Republican Specialized Scientific-Practical Medical Centre of Phthisiology and Pulmonology, 1 Alimov Street, Tashkent City 100086, Uzbekistan;
- Correspondence: ; Tel.: +998-97-710-6070
| | - Ana Ciobanu
- World Health Organization Regional Office for Europe, UN City, Marmorvej 51, DK-2100 Copenhagen, Denmark; (A.C.); (A.H.); (K.A.)
| | - Arax Hovhannesyan
- World Health Organization Regional Office for Europe, UN City, Marmorvej 51, DK-2100 Copenhagen, Denmark; (A.C.); (A.H.); (K.A.)
| | - Kristina Akopyan
- World Health Organization Regional Office for Europe, UN City, Marmorvej 51, DK-2100 Copenhagen, Denmark; (A.C.); (A.H.); (K.A.)
- Tuberculosis Research and Prevention Centre NGO, Yerevan 0070, Armenia
| | - Jamshid Gadoev
- World Health Organization Country Office in Uzbekistan, 16 Tarobiy Street, Tashkent City 100100, Uzbekistan;
| | - Nargiza Parpieva
- Republican Specialized Scientific-Practical Medical Centre of Phthisiology and Pulmonology, 1 Alimov Street, Tashkent City 100086, Uzbekistan;
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Flora AS, Aragaki-Nakahodo A, Benzaquen S. Endobronchial Valve Placement for Persistent Air Leaks Secondary to Pulmonary Infections. J Bronchology Interv Pulmonol 2021; 28:47-52. [PMID: 32452981 DOI: 10.1097/lbr.0000000000000689] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 04/27/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Pneumothoraces associated with infectious diseases have a higher rate of treatment failure and longer length of hospital stay than those associated with obstructive lung diseases and malignancy. Little is mentioned in the medical literature concerning the use of endobronchial 1-way valves in treating alveolar-pleural fistulae (APF) caused by pulmonary infections. METHODS A 7-year, single-center, retrospective analysis of patients consented for exempted off-label use of the Olympus Spiration Implantable Endobronchial Valve system to control prolonged air leaks at the University of Cincinnati Medical Center. RESULTS Nineteen consecutive patients had 22 separate APF events from pulmonary infections during which a total of 101 valves were placed over 23 procedures (average 4.4±2.8 valves per procedure). The average time from the first chest tube placement to valve placement was 23.4±20.8 days (range, 2 to 84 d). Chest tubes were successfully removed in 19 (86.4%) of 22 APF events without further intervention. In events not including chest tubes remaining solely for empyema treatment after cessation of air leak (n=14), the average time from valve placement to the removal of all chest tubes was 12.8±20.2 days (1 to 81 d). Thirty and ninety day all-cause mortality was 15.8%. On average, valves were removed 64.1±27.1 days (range, 38 to 135 d) after placement. CONCLUSION Based on our institutional experience, endobronchial valves may be a treatment option for select patients with persistent air leaks caused by pulmonary infections. Further standardized and comparative studies are required to fully understand the risks and benefits of this treatment.
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Affiliation(s)
- Arjan S Flora
- Interventional Pulmonology Service, Division of Pulmonary, Critical Care, and Sleep Medicine, University of Cincinnati Medical Center, Cincinnati, OH
| | - Alejandro Aragaki-Nakahodo
- Interventional Pulmonology Service, Division of Pulmonary, Critical Care, and Sleep Medicine, University of Cincinnati Medical Center, Cincinnati, OH
| | - Sadia Benzaquen
- Division of Pulmonary, Critical Care, and Sleep Medicine, Einstein Medical Center, Philadelphia, PA
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Mondoni M, Centanni S, Sotgiu G. New perspectives on difficult-to-treat tuberculosis based on old therapeutic approaches. Int J Infect Dis 2020; 92S:S91-S99. [PMID: 32114204 DOI: 10.1016/j.ijid.2020.02.039] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Revised: 02/18/2020] [Accepted: 02/19/2020] [Indexed: 12/11/2022] Open
Abstract
Tuberculosis (TB) is an important clinical and public health issue worldwide. Despite improved treatment success rates following the introduction of antibiotics in daily clinical practice, the expected decline in incidence has been hampered by HIV epidemics and multi- and extensively drug-resistant TB. During the pre-antibiotic era, TB therapies were mainly based on improving hygiene conditions, strengthening the immune system, and targeting the rest of the affected lungs with invasive techniques. Detailed knowledge of old non-pharmacological therapies might support physicians and researchers in the identification of new solutions for difficult-to-treat patients. We performed a narrative literature review on the main old therapeutic options prescribed for patients with TB. The main recommendations and contraindications of sanatorium therapies (i.e., bed rest, fresh air, sunlight) and pulmonary collapse techniques are reviewed, evaluating their physiological basis and their impact on patient outcomes. We report studies describing new interventional pulmonary and surgical techniques and assess new perspectives based on old medical and surgical treatments, whose potential implementation could help complicated patients.
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Affiliation(s)
- Michele Mondoni
- Respiratory Unit, ASST Santi Paolo e Carlo, San Paolo Hospital, Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - Stefano Centanni
- Respiratory Unit, ASST Santi Paolo e Carlo, San Paolo Hospital, Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - Giovanni Sotgiu
- Clinical Epidemiology and Medical Statistics Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy.
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Intrathoracic negative pressure therapy and/or endobronchial valve for pleural empyema minimal invasive management: case series of thirteen patients and review of the literature. Wideochir Inne Tech Maloinwazyjne 2020; 15:588-595. [PMID: 33294074 PMCID: PMC7687666 DOI: 10.5114/wiitm.2020.93210] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 01/20/2020] [Indexed: 01/11/2023] Open
Abstract
Introduction Intrathoracic negative pressure therapy is an adjunct to standard methods of complex empyema management in debilitated patients. Nevertheless, the use of endoscopic one-way endobronchial valves to successfully close large bronchopleural fistulas in patients with advanced pleural empyema has been described in only a few case reports. Aim To present our experience in managing complex pleural empyema using thoracostomy with intrathoracic negative pressure therapy and/or endobronchial valve implantation. Material and methods We retrospectively analyzed data from 13 consecutive patients (11 men, mean age: 56 years, range: 38–80 years) who were treated for pleural empyema using thoracostomy with intrathoracic negative pressure therapy and/or endobronchial valve implantation between October 2015 and November 2017. Results The control of empyema was satisfactory in 12 patients; however, 1 patient died from sepsis-related multiorgan failure despite complete cessation of air leak on day 9 after endobronchial valve implantation. The overall success rate for the final closure of the chest wall was 9/12 patients (75%): in 5 patients, the wall closed spontaneously, and in 4, the wall was closed using thoracomyoplasty. Conclusions Thoracostomy with intrathoracic negative pressure therapy, endobronchial valve implantation with tube drainage, and a combination of the two could adequately manage patients with pleural empyema with or without a persistent air leakage fistula.
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Mukhtar O, Khalid M, Shrestha B, Alhafdh O, Pata R, Bakhiet M, Quist J, Enriquez D, Shostak E, Schmidt F. Endobronchial valves for persistent air leak all-cause mortality and financial impact: US trend from 2012-2016. J Community Hosp Intern Med Perspect 2019; 9:397-402. [PMID: 31723383 PMCID: PMC6830260 DOI: 10.1080/20009666.2019.1675229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 09/27/2019] [Indexed: 12/02/2022] Open
Abstract
Background: Endobronchial valves (EBV) are considered an innovation in the management of the persistent air leak (PAL). They offer a minimally invasive alternative to the traditional approach of pleurodesis and surgical intervention. We examined trends in mortality, length of stay (LOS), and resources utilization in patients who underwent EBV placement for PAL in the US. Methods: We utilized discharge data from the Nationwide Inpatient Sample (NIS) for five years (2012–2016). We included adults diagnosed with a pneumothorax who underwent EBV insertion at ≥ 3 days from the day of chest tube placement; or following invasive thoracic procedure. We analyzed all-cause mortality, LOS, and resources utilization in the study population. Results: A total of 1,885 cases met our inclusion criteria. Patients were mostly middle-aged, males, whites, and had significant comorbidities. The average LOS was 21.8 ± 20.5 days, the mean time for chest tube placement was 3.8 ± 5.9 days, and the mean time for EBV insertion was 10.5 ± 10.3 days. Pleurodesis was performed before and after EBV placement and in 9% and 6%, respectively. Conclusions: Our study showed that the all-cause mortality rate fluctuated throughout the years at around 10%. Despite EBV being a minimally invasive alternative, its use has not trended up significantly during the study period. EBVs are also being used off-label in the US for spontaneous pneumothorax. This study shall provide more data to the scarce literature about EBV for PAL.
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Affiliation(s)
- Osama Mukhtar
- Pulmonary Division, Interfaith Medical Center, Brooklyn, NY, USA
| | - Mazin Khalid
- Department of Medicine, Interfaith Medical Center, Brooklyn, NY, USA
| | - Binav Shrestha
- Department of Medicine, Interfaith Medical Center, Brooklyn, NY, USA
| | - Oday Alhafdh
- Pulmonary Division, Interfaith Medical Center, Brooklyn, NY, USA
| | - Ramakanth Pata
- Department of Medicine, Interfaith Medical Center, Brooklyn, NY, USA
| | - Manal Bakhiet
- Department of Medicine, Interfaith Medical Center, Brooklyn, NY, USA
| | - Joseph Quist
- Pulmonary Division, Interfaith Medical Center, Brooklyn, NY, USA
| | - Danilo Enriquez
- Pulmonary Division, Interfaith Medical Center, Brooklyn, NY, USA
| | - Eugene Shostak
- Department of Cardiothoracic Surgery, Weill-Cornell Medicine, New York, NY, USA
| | - Frances Schmidt
- Pulmonary Division, Interfaith Medical Center, Brooklyn, NY, USA
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12
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Hartman JE, Vanfleteren LEGW, van Rikxoort EM, Klooster K, Slebos DJ. Endobronchial valves for severe emphysema. Eur Respir Rev 2019; 28:28/152/180121. [PMID: 30996040 DOI: 10.1183/16000617.0121-2018] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 03/08/2019] [Indexed: 11/05/2022] Open
Abstract
The results of the randomised controlled trials investigating the bronchoscopic lung volume reduction treatment using endobronchial valves (EBV) are promising, and have led to their inclusion in treatment guidelines, US Food and Drug Administration approval and inclusion in routine care in an increasing number of countries. The one-way valve treatment has advanced and is now a regular treatment option. However, this new phase will lead to new challenges in terms of implementation. We believe that key issues in future research concern advanced patient selection, improved methods for target lobe selection, increased knowledge on the predictive risk of a pneumothorax, positioning of pulmonary rehabilitation in conjunction with the EBV treatment, the positioning of lung volume reduction surgery versus EBV treatment, and the long-term efficacy, adverse events, impact on exacerbations and hospitalisations, costs and survival. Hopefully, the increasing number of patients treated, the setup of (inter)national registries and future research efforts will further optimise all aspects of this treatment.
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Affiliation(s)
- Jorine E Hartman
- Dept of Pulmonary diseases, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands .,Groningen Research Institute for Asthma and COPD, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Lowie E G W Vanfleteren
- COPD Centre, Sahlgrenska University Hospital and Institute of Medicine, Gothenburg University, Gothenburg, Sweden.,Dept of Development and Education, CIRO+, Centre of Expertise for Chronic Organ Failure, Horn, The Netherlands.,Dept of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
| | - Eva M van Rikxoort
- Depat of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Karin Klooster
- Dept of Pulmonary diseases, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands.,Groningen Research Institute for Asthma and COPD, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Dirk-Jan Slebos
- Dept of Pulmonary diseases, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands.,Groningen Research Institute for Asthma and COPD, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
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Marfina GY, Vladimirov KB, Avetisian AO, Starshinova AA, Kudriashov GG, Sokolovich EG, Yablonskii PK. Bilateral cavitary multidrug- or extensively drug-resistant tuberculosis: role of surgery†. Eur J Cardiothorac Surg 2017; 53:618-624. [DOI: 10.1093/ejcts/ezx350] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Accepted: 08/16/2017] [Indexed: 12/20/2022] Open
Affiliation(s)
- Galina Yu Marfina
- Department of Pulmonary TB Thoracic Surgery, St. Petersburg State Scientific and Research Institute of Phthisiopulmonology, St. Petersburg, Russia
| | - Kirill B Vladimirov
- Department of Phthisiopulmonology and Thoracic Surgery, I.I. Mechnikov’ North-West State Medical University, St. Petersburg, Russia
| | - Armen O Avetisian
- Department of Pulmonary TB Thoracic Surgery, St. Petersburg State Scientific and Research Institute of Phthisiopulmonology, St. Petersburg, Russia
| | - Anna A Starshinova
- Department of Pulmonary TB Thoracic Surgery, St. Petersburg State Scientific and Research Institute of Phthisiopulmonology, St. Petersburg, Russia
| | - Grigorii G Kudriashov
- Department of Pulmonary TB Thoracic Surgery, St. Petersburg State Scientific and Research Institute of Phthisiopulmonology, St. Petersburg, Russia
| | - Evgenii G Sokolovich
- Department of Pulmonary TB Thoracic Surgery, St. Petersburg State Scientific and Research Institute of Phthisiopulmonology, St. Petersburg, Russia
| | - Piotr K Yablonskii
- Department of Pulmonary TB Thoracic Surgery, St. Petersburg State Scientific and Research Institute of Phthisiopulmonology, St. Petersburg, Russia
- Faculty of Medicine, St. Petersburg State University, St. Petersburg, Russia
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Yablonskii P, Kudriashov G, Vasilev I, Avetisyan A, Sokolova O. Robot-assisted surgery in complex treatment of the pulmonary tuberculosis. J Vis Surg 2017; 3:18. [PMID: 29078581 DOI: 10.21037/jovs.2016.12.09] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Accepted: 12/02/2016] [Indexed: 11/06/2022]
Abstract
Surgery of pulmonary tuberculosis associated with open thoracotomy due to dense pleural and vascular adhesions. These reasons limited the use of video-assisted thoracoscopic surgery (VATS) in these cases. Robotic surgical system aimed to performing successfully minimally invasive operations for pulmonary tuberculosis. This paper showed 3-year experience of one chest center in this area. The results of this work are recommendations that facilitate the implementation of robot-assisted lung resection in complex treatment of pulmonary tuberculosis.
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Affiliation(s)
- Piotr Yablonskii
- Department of Thoracic Surgery, St. Petersburg State Research Institute of Phthisiopulmonology, St. Petersburg, Russian.,Medical Faculty, St. Petersburg, Russian
| | - Grigorii Kudriashov
- Department of Thoracic Surgery, St. Petersburg State Research Institute of Phthisiopulmonology, St. Petersburg, Russian
| | - Igor Vasilev
- Department of Thoracic Surgery, St. Petersburg State Research Institute of Phthisiopulmonology, St. Petersburg, Russian
| | - Armen Avetisyan
- Department of Thoracic Surgery, St. Petersburg State Research Institute of Phthisiopulmonology, St. Petersburg, Russian
| | - Olga Sokolova
- Department of Thoracic Surgery, St. Petersburg State Research Institute of Phthisiopulmonology, St. Petersburg, Russian
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