Endobronchial Valves in Treatment of Persistent Air Leak: European Case-Series Study and Best Practice Recommendations - From an Expert Panel.

IF 3.5 3区医学 Q2 RESPIRATORY SYSTEM Respiration Pub Date : 2024-01-01 Epub Date: 2024-06-13 DOI:10.1159/000539573

Illaa Smesseim, Louis-Vincent Morin-Thibault, Felix J F Herth, James Tonkin, Pallav L Shah, Dirk-Jan Slebos, David T Koster, Chris Dickhoff, Johannes Marlene Andreas Daniels, Jouke Annema, Peter Bonta

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Abstract

Introduction: Persistent air leak (PAL) is associated with prolonged hospitalization, high morbidity and increased treatment costs. Conservative treatment consists of observation, chest tube drainage, and pleurodesis. Guidelines recommend surgical evaluation if air leak does not respond after 3-5 days. One-way endobronchial valves (EBV) have been proposed as a treatment option for patients with PAL in which surgical treatment is not feasible, high risk or has failed. We aimed to provide a comprehensive overview of reported EBV use for PAL and issue best practice recommendations based on multicenter experience.

Methods: We conducted a retrospective observational case-series study at four different European academic hospitals and provided best practice recommendations based on our experience. A systematic literature review was performed to summarize the current knowledge on EBV in PAL.

Results: We enrolled 66 patients, male (66.7%), median age 59.5 years. The most common underlying lung disease was chronic obstructive pulmonary disease (39.4%) and lung cancer (33.3%). The median time between pneumothorax and valve placement was 24.5 days (interquartile range: 14.0-54.3). Air leak resolved in 40/66 patients (60.6%) within 30 days after EBV treatment. Concerning safety outcome, no procedure-related mortality was reported and complication rate was low (6.1%). Five patients (7.6%) died in the first 30 days after intervention.

Conclusion: EBV placement is a treatment option in patients with PAL. In this multicenter case-series of high-risk patients not eligible for lung surgery, we show that EBV placement resulted in air leak resolution in 6 out of 10 patients with a low complication rate. Considering the minimally invasive nature of EBV to treat PAL as opposed to surgery, further research should investigate if EBV treatment should be expanded in low to intermediate risk PAL patients.

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治疗持续性漏气的支气管内瓣膜：欧洲病例系列研究和最佳实践建议 - 来自专家小组。

导言：持续性气漏（PAL）与住院时间长、发病率高和治疗费用增加有关。保守治疗包括观察、胸腔管引流和胸膜穿刺术。如果气漏在 3-5 天后仍无反应，指南建议进行手术评估。单向支气管内瓣膜（EBV）已被提议作为一种治疗方案，用于手术治疗不可行、高风险或失败的 PAL 患者。我们的目的是全面概述 EBV 用于 PAL 的报道，并根据多中心经验提出最佳实践建议。方法我们在四家不同的欧洲学术医院开展了一项回顾性观察病例系列研究，并根据我们的经验提出了最佳实践建议。我们还进行了系统的文献综述，总结了目前有关 PAL 中 EBV 的知识。结果我们共招募了 66 名患者，男性（66.7%），中位年龄为 59.5 岁。最常见的肺部疾病是慢性阻塞性肺病（39.4%）和肺癌（33.3%）。气胸与瓣膜置入之间的中位时间为 24.5 天（IQR：14.0-54.3）。40/66的患者（60.6%）在接受支气管内瓣膜治疗后30天内解决了漏气问题。在安全性方面，没有与手术相关的死亡率报告，并发症发生率较低（6.1%）。5 名患者（7.6%）在介入治疗后 30 天内死亡。结论 EBV 置入术是治疗持续性气漏 (PAL) 患者的一种选择。在这一多中心病例系列中，我们对不符合肺部手术条件的高风险患者进行了研究，结果显示，10 名患者中有 6 名通过 EBV 置入术解决了气漏问题，且并发症发生率较低。考虑到 EBV 治疗 PAL 的微创性优于手术，进一步的研究应探讨是否应将 EBV 治疗扩大到中低风险的 PAL 患者。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Respiration 医学-呼吸系统

CiteScore

7.30

自引率

5.40%

发文量

审稿时长

4-8 weeks

期刊介绍： ''Respiration'' brings together the results of both clinical and experimental investigations on all aspects of the respiratory system in health and disease. Clinical improvements in the diagnosis and treatment of chest and lung diseases are covered, as are the latest findings in physiology, biochemistry, pathology, immunology and pharmacology. The journal includes classic features such as editorials that accompany original articles in clinical and basic science research, reviews and letters to the editor. Further sections are: Technical Notes, The Eye Catcher, What’s Your Diagnosis?, The Opinion Corner, New Drugs in Respiratory Medicine, New Insights from Clinical Practice and Guidelines. ''Respiration'' is the official journal of the Swiss Society for Pneumology (SGP) and also home to the European Association for Bronchology and Interventional Pulmonology (EABIP), which occupies a dedicated section on Interventional Pulmonology in the journal. This modern mix of different features and a stringent peer-review process by a dedicated editorial board make ''Respiration'' a complete guide to progress in thoracic medicine.