Endobronchial Valves for Management of Persistent Air Leaks in Patients With Chronic Lung Disease

Persistent air leak (PAL) is a challenging problem in patients with spontaneous pneumothorax and chronic lung disease who are poor surgical candidates. Conventional management consists of long-term thoracostomy tube placement; however, in some cases, patients are unable to leave the hospital because of the need for continuous negative pressure. We investigated the application of endobronchial valves (EBVs) in the management of patients with air leak for whom surgical intervention was contraindicated.

EBVs were placed in patients with PALs arising from nonoperative causes. Successful outcomes were defined as the ability to remove the thoracostomy tube from suction, resolution of air leak, and removal of chest tube.

Seventeen patients with PAL requiring negative pressure suction were treated with EBVs. The overall complete successful outcome rate was 82.4%. There was a statistically significant reduction in length of stay after valve placement in the success group compared with the failure group (8.9 days vs 61.7 days; P = .0097).

EBVs are a valid option for patients who are not surgical candidates and have failed to respond to conventional management of PAL. This experimental use of EBVs leads to high success rates and shorter length of stay when it is successful.