Endobronchial valve placement for a severe pneumothorax in a child on ECLS

Interventional Bronchus Occlusion Using Amplatzer Devices – A Promising Treatment Option for Children with Persistent Air Leak

“…The two largest published studies supporting the use of EBV for PAL are retrospective analyses in adults reporting success rates of over 90 % [30,31]. One case series including four children and two single case reports have demonstrated that IBO using EBVs is also applicable even in critically ill children [12,21,22]. An obstacle to the use of EBVs in younger children is the large diameter of the application system, which has to be passed through the working channel of the bronchoscope and requires a minimum diameter of 2,1 mm.…”

“…Unfortunately, no data on mortality rates in children exists, but mortality from PAL ranges from 16% -72% in adult patients 8 9 . Chest tube placement is the current standard of care 10 11 but is not always sufficient to achieve adequate expansion of the affected lung and sustained contact of the visceral pleura to the parietal pleura, which is a precondition for the healing of the defect 12 . Furthermore, continuous suction through chest tubes, often applied in patients with PALs to evacuate the pleural space, may prevent spontaneous healing due to continuous flow of air through the lesion.…”

Interventional bronchoscopy in children: Planning the path ahead

“…23,24 Endobronchial valves have been used in the management of children with persistent air leak. 25,26 Given multiple techniques are already being used, moving forward, the field of interventional pediatric bronchoscopy will need to define the optimal use of each technique in children. To determine this for any individual technique the indications, feasibility, yield, and safety all need to be considered.…”

“…In adult interventional bronchoscopy national level registries have helped generate evidence to inform clinical practice. [32][33][34] In paediatrics, the registry should be open internationally given that the case series reported this far have come from India, 2,22,[35][36][37] China, 23 United States of America, 24,25,38 the Netherlands, 26 Germany, 3 and Australia. 3,39 Establishment of such a registry likely represents the most pragmatic way to generate evidence regarding the use of the different interventional bronchoscopy techniques.…”

“…Cryoprobes have been used in the investigation of childhood ILD, as well as for the removal of foreign body . Endobronchial valves have been used in the management of children with persistent air leak …”