Incidence and outcomes for post-bronchoscopic lung volume reduction (BLVR) pneumothoraces stratified by target lobe...

Bronchoscopic lung volume reduction (BLVR) is a minimally invasive procedure used to improve shortness of breath in some patients with hyperinflation secondary to emphysema. Treatment with BLVR involves placement of small, one-way endobronchial valves (EBV) into airways to induce lobar atelectasis. Patients treated with BLVR show an improvement in forced expiratory volume at 1 s (FEV1), 6-min walk distance (6MWD), and an improvement in St. George's Respiratory Questionnaire (SGRQ) scores. The most common complication following BLVR is pneumothorax. The incidence of a pneumothorax is 25.4 percent.

This retrospective analysis describes a single institution's incidence of post-BLVR pneumothorax stratified by target lobe. Clinical outcomes, chest tube days, homogeneous versus heterogeneous disease, and need for EBV removal due to unresolving PAL are also described. Data was collected on patients from an internal quality database and the Epic (Epic System Corporation, Verone, WI) electronic medical record (EMR) between July 1st, 2019 and November 1st, 2024. Inclusion criteria used were patients with underlying emphysema undergoing BLVR complicated by a post-procedural pneumothorax. Data was analyzed for all pneumothoraces that occurred following BLVR. Pneumothoraces were then stratified based on the target lobe treated with EBVs. Patient's demographics were summarized using descriptive statistics. Chi-square test or Fisher's Exact test when appropriate was used to compare the incidence of pneumothorax following BLVR based on lobe treated with that of the overall population. SAS Version 9.4 (SAS Ins., Cary, NC) was used for analysis. p-value <0.05 was considered statistically significant.

Between July 1st, 2019 and November 1st, 2024, 167 BLVR procedures were performed. A total of 42 procedures were complicated by a post-BLVR pneumothorax (25 percent) requiring chest tube placement. Out of the 42 post-BLVR pneumothoraces, 24 occurred after treatment of the left upper lobe (40 percent), 10 occurred after the treatment of the right upper lobe and right middle lobe (28 percent), 4 occurred after treatment of the RUL (21 percent), 3 occurred after treatment of the left lower lobe (5 percent), 1 occurred after treatment of the right lower lobe (5 percent) and 0 occurred after treatment of the right middle lobe alone. Incidence of pneumothorax when treating the left upper lobe was found to be statistically significant compared to the overall incidence of pneumothorax in other lobes. Twenty-six procedures complicated by pneumothorax (62 percent) were performed in homogeneous patterns of disease in the treated lung, while 16 (38 percent) were performed in heterogeneous patterns of disease.

The incidence of pneumothorax following BLVR varies depending on the target lobe treated. Development of a pneumothorax following BLVR of the left upper lobe carried an incidence of 40 %, which was statistically significant different to the overall incidence (p = 0.03).