title: Intrabronchial valves: a case series describing a minimally invasive approach to bronchopleural fistulas in medical intensive care unit patients.
abstract: BACKGROUND
  Bronchopleural fistulas (BPF) are conditions associated with prolonged hospital course, high morbidity, and possibly increased mortality. The presence of BPFs in critically ill patients may cause difficulty in ventilation and increased oxygen requirements. Intrabronchial valves (Spiration IBV) serve as a noninvasive therapeutic option for the closure of BPFs.
  
  
  METHODS
  This report is a retrospective description of 3 patients transferred to our medical intensive care unit (ICU) with BPFs and persistent air leaks (PAL). One patient required high levels of oxygen supplementation through a nonrebreather face mask, whereas 2 required mechanical ventilation because of respiratory failure. IBVs were placed in each patient with the intention of closing their BPF and weaning them from respiratory support.
  
  
  RESULTS
  The use of IBVs in ICU patients with BPFs and PALs resulted in 1 patient being weaned from the persistent need for a nonrebreather face mask to room air and also aided in the liberation from mechanical ventilation of 2 patients who had been failing spontaneous breathing trials.
  
  
  CONCLUSIONS
  The use of IBVs is safe and well tolerated in ICU patients with BPFs and PALs. The placement of IBVs results in significant clinical improvement, allowing for either weaning from high levels of oxygen support or liberation from mechanical ventilation.
authors.affiliation: University of Chicago Medical Center, 5841 S. Maryland Ave, Chicago, IL 60637, USA. amit.mahajan@uchospitals.edu
authors.forename: Amit Kumar
authors.initials: AK
authors.lastname: Mahajan
authors.forename: Philip
authors.initials: P
authors.lastname: Verhoef
authors.forename: Shruti B
authors.initials: SB
authors.lastname: Patel
authors.forename: Gordon
authors.initials: G
authors.lastname: Carr
authors.forename: Douglas
authors.initials: D
authors.lastname: Kyle Hogarth
mesh_terms: D000368:Aged; D001983:Bronchial Fistula / Q000150:complications / Q000628:therapy*; D003422:Critical Care; D016638:Critical Illness; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010995:Pleural Diseases / Q000150:complications / Q000628:therapy*; D019736:Prostheses and Implants; D016156:Respiratory Tract Fistula / Q000150:complications / Q000628:therapy*; D012189:Retrospective Studies; D015300:Ventilator Weaning / Q000295:instrumentation