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Endobronchial occlusion with one-way endobronchial valves: a novel technique for persistent air leaks in children

Jennifer W Toth1, Abigail B Podany2, Michael F Reed3

  • 1Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA.

Journal of Pediatric Surgery
|January 20, 2015
PubMed

Insights

Endobronchial valve placement effectively treated persistent air leaks in children, offering a minimally invasive alternative to surgery. This approach resolved air leaks, leading to successful hospital discharge for all patients.

Area of Science:

  • Pediatric Pulmonology
  • Interventional Pulmonology
  • Thoracic Surgery

Background:

  • Persistent air leaks in children often stem from pulmonary infections or barotrauma.
  • Current management includes surgery, prolonged pleural drainage, ventilator adjustments, and ECMO, each with potential morbidities.

Purpose of the Study:

  • To evaluate the efficacy of endobronchial valve (EBV) placement as a minimally invasive intervention for persistent air leaks in pediatric patients.
  • To assess EBV placement as an alternative to surgical intervention for refractory prolonged air leaks.

Main Methods:

  • A multidisciplinary team evaluated pediatric patients with refractory prolonged air leaks for EBV placement.
  • Flexible bronchoscopy was used to locate air leaks, which were isolated using balloon occlusion.
  • Retrievable, one-way endobronchial valves were subsequently placed.

Main Results:

  • Four pediatric patients (16 months to 16 years) with prolonged air leaks (due to necrotizing pneumonia, lobectomy, or pneumatocele) were treated.
  • An average of 12 days was required for air leak resolution, with chest tubes removed after an average of 25 days.
  • All patients experienced complete air leak resolution, were discharged, and did not require further surgical procedures.

Conclusions:

  • Endobronchial valve placement is an effective treatment for prolonged air leaks in children across various etiologies.
  • This minimally invasive approach can lead to fistula resolution and potentially avoid the complications associated with pulmonary surgery.
Abstract

Keywords:
Air leakBronchopleural fistulaBronchoscopyEndobronchial valve

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