Safety and outcomes of bronchoscopic lung volume reduction with endobronchial valves under moderate sedation

Chronic obstructive pulmonary disease (COPD) remains a leading cause of morbidity and mortality worldwide. Bronchoscopic lung volume reduction (BLVR) using endobronchial valves (EBV) offers a minimally invasive treatment for severe emphysema. Traditionally performed under general anesthesia (GA), this study evaluates whether BLVR performed under moderate sedation (MS) potentially has less adverse events as compared to ones done under GA.

This retrospective analysis included 65 patients who underwent BLVR with EBV placement at the University of Florida between January 2020 and June 2022. All procedures were performed under MS. Primary outcomes assessed included the incidence of pneumothorax (PTX), while secondary outcomes comprised valve removal rates, need for revision bronchoscopy, and other procedural complications.

The incidence of PTX was 16.9%, lower than the previously reported rate of 26% in studies combining GA and MS. No major complications or deaths were reported. Procedures were successfully completed in all patients, with valves deployed as planned. Revision bronchoscopy was required in 21.5% of cases.

BLVR under MS is demonstrated to be safe and feasible, with a lower rate of complications compared to GA. These findings suggest that MS may be a preferred sedation method for BLVR, though further research is warranted to confirm these results and explore the long-term outcomes and cost implications.