Endobronchial one-way valves for treatment of persistent air leaks: a systematic review

Abstract

Persistent air leak (PAL) is associated with significant morbidity and mortality, prolonged hospitalization and increased health-care costs. It can arise from a number of conditions, including pneumothorax, necrotizing infection, trauma, malignancies, procedural interventions and complications after thoracic surgery. Numerous therapeutic options, including noninvasive and invasive techniques, are available to treat PALs. Recently, endobronchial one-way valves have been used to treat PAL. We conducted a systematic review based on studies retrieved from PubMed, EMbase and Cochrane library. We also did a hand-search in the bibliographies of relevant articles for additional studies. 34 case reports and 10 case series comprising 208 patients were included in our review. Only 4 patients were children, most of the patients were males. The most common underlying disease was COPD, emphysema and cancer. The most remarkable cause was pneumothorax. The upper lobes were the most frequent locations of air leaks. Complete resolution was gained within less than 24 h in majority of patients. Complications were migration or expectoration of valves, moderate oxygen desaturation and infection of related lung. No death related to endobronchial one-way valves implantation has been found. The use of endobronchial one-way valve adds to the armamentarium for non-invasive treatments of challenging PAL, especially those with difficulties of anesthesia, poor condition and high morbidity. Nevertheless, prospective randomized control trials with large sample should be needed to further evaluate the effects and safety of endobronchial one-way valve implantation in the treatment of PAL.

Treatment of Persistent Air Leak with Endobronchial Valves

“…Pulmonary air leaks arise when there is an abnormal communication between the bronchial or alveolar spaces and the pleura through a bronchopleural or alveolar-pleural fistula [1]. A pulmonary air leak is deemed persistent when it lasts for more than 5 to 7 days postoperatively [2].…”

“…Persistent air leaks are usually treated conservatively with prolonged thoracostomy tube drainage [1,2,5]. In case this approach fails, surgical revision used to be the only option.…”

Endobronchial valves for persistent air leak all-cause mortality and financial impact: US trend from 2012–2016

“…PAL has higher morbidity, prolonged ICU stay, and complications, including pneumonia and pulmonary embolism [16]. The first successful use of EBV for PAL was described in 2006, and since then there have been numerous similar studies [17,18]. PAL has been defined inconsistently in the literature, but most studies label an ongoing air leak for 5 to 7 days despite constant drainage of the thoracic cavity as PAL [19][20][21][22].…”

“…EBV migration or expulsion, related infections, and post-deployment desaturation, in addition to its cost, are currently significant concerns related to EBV use [18,28,29]. Like any developing new field in medicine, EBV is surrounded by many unanswered questions.…”

Successful long-term treatment of persistent pulmonary air leak in pneumocystis jirovecii pneumonia by unidirectional endobronchial valves

“…However, in most previous case reports, EBVs were removed four to eight weeks after resolution of the PAL in order to minimise the risk of side effects [1]. None of these case series report long-term follow-up results.…”