Bronchoscopic management in persistent air leak: a narrative review

Area of Science:

• Pulmonology
• Thoracic Surgery
• Interventional Pulmonology

Background:

• Persistent air leak (PAL) is a significant complication following lung injury or surgery, characterized by prolonged air leakage into the pleural space.
• Common causes include spontaneous pneumothorax, pneumonia, mechanical ventilation barotrauma, chest trauma, and post-operative fistulas.
• Failure of conventional drainage necessitates advanced management strategies to prevent complications like respiratory distress and increased morbidity.

Purpose of the Study:

• To provide a comprehensive narrative review of persistent air leak (PAL).
• To explore the diverse etiologies, clinical implications, and diagnostic approaches for PAL.
• To examine the evolving landscape and efficacy of bronchoscopic treatment options for refractory PAL.

Main Methods:

• A literature search was conducted across PubMed/MEDLINE and Scopus databases.
• Included studies published up to August 28, 2023, focusing on PAL causes, diagnosis, and management.
• Keywords encompassed bronchoscopic management, bronchopleural fistula, endobronchial valves, sealants, and autologous blood patch pleurodesis.

Main Results:

• PAL arises from various conditions, including pneumonia, barotrauma, trauma, and post-surgical complications.
• Conventional drainage is insufficient for PAL, diagnosed when air leak persists beyond 5-7 days.
• Bronchoscopic techniques like endobronchial valves (EBVs), sealants, and autologous blood patch (ABP) offer minimally invasive, targeted solutions for refractory cases.

Conclusions:

• Persistent air leak presents a clinical challenge requiring individualized management based on etiology and severity.
• Bronchoscopic interventions demonstrate significant efficacy in managing refractory PAL.
• Optimizing patient outcomes necessitates early recognition, multidisciplinary collaboration, and personalized treatment planning.