Modifying Post-Operative Medical Care after EBV Implant May Reduce Pneumothorax Incidence

Abstract

ObjectiveEndoscopic lung volume reduction (ELVR) with valves has been shown to improve COPD patients with severe emphysema. However, a major complication is pneumothoraces, occurring typically soon after valve implantation, with severe consequences if not managed promptly. Based on the knowledge that strain activity is related to a higher risk of pneumothoraces, we asked whether modifying post-operative medical care with the inclusion of strict short-term limitation of strain activity is associated with a lower incidence of pneumothorax.MethodsSeventy-two (72) emphysematous patients without collateral ventilation were treated with bronchial valves and included in the study. Thirty-two (32) patients received standard post-implantation medical management (Standard Medical Care (SMC)), and 40 patients received a modified medical care that included an additional bed rest for 48 hours and cough suppression, as needed (Modified Medical Care (MMC)).ResultsThe baseline characteristics were similar for the two groups, except there were more males in the SMC cohort. Overall, ten pneumothoraces occurred up to four days after ELVR, eight pneumothoraces in the SMC, and only two in the MMC cohorts (p=0.02). Complicated pneumothoraces and pneumothoraces after upper lobe treatment were significantly lower in MMC (p=0.02). Major clinical outcomes showed no significant differences between the two cohorts.ConclusionsIn conclusion, modifying post-operative medical care to include bed rest for 48 hours after ELVR and cough suppression, if needed, might reduce the incidence of pneumothoraces. Prospective randomized studies with larger numbers of well-matched patients are needed to confirm the data.

Reducción de volumen pulmonar endoscópica en enfisema pulmonar avanzado: Casos clínicos

“…En estudios posteriores de carácter observacional a largo plazo, se reporta que la incidencia de neumotórax llega hasta 23%, por lo que se recomienda manejar a estos pacientes con monitorización por 48-72 h y utilizar con inhibidores de la tos [14][15][16] . En un estudio retrospectivo, de 429 pacientes, 25 de ellos (5,9%) presentó neumotoráx, siendo mayor a 7 días en 68%.…”

Endoscopic lung volume reduction in chronic obstructive airway disease using one-way valves

“…In particular, pneumothorax has been of high importance, since in the recent years a significant increase in its incidence has been observed, Figure 5. While in the VENT study a pneumothorax rate of only 4.2% was recorded, in the follow-up studies the pneumothorax rates were between 8-25% [20,29]. The cause of this increasing incidence is the optimized patient selection: a complete fissure seems not only to be a predictor of a successful valve therapy, but also a predictor of pneumothorax occurrence.…”

“…Because the pneumothorax occurs in 76% of cases within the first three days after valve implantation, a stationary monitoring 48-72 hours is advised [32]. A 48-hour postinterventional bed-rest seems to minimize the risk of pneumothorax [29]. In this recent study von Herzog et.al, 72 consecutive COPD patients with severe homogeneous or heterogeneous emphysema and negative collateral ventilation status assessed by the Chartis console, were treated with EBV.…”

Status of and prospects for bronchoscopic lung volume reduction for patients with severe emphysema

“…Patients with pneumothorax benefit more from receiving EBVs. However, pneumothorax is a serious complication of EBV implantation, patients must be closely monitored for pneumothorax within 72-96 hours of the procedure; patients should be placed on bed rest for 48 hours and be given a cough suppressant since pneumothorax often occurs 4 days after EBV implantation (56). Experts in the treatment of postoperative pneumothorax have reached a consensus: all patients need to be closely observed, and patients with an expanding pneumothorax will need immediate insertion of a chest drain (57).…”