title: Modifying Post-Operative Medical Care after EBV Implant May Reduce Pneumothorax Incidence.
abstract: OBJECTIVE
  Endoscopic lung volume reduction (ELVR) with valves has been shown to improve COPD patients with severe emphysema. However, a major complication is pneumothoraces, occurring typically soon after valve implantation, with severe consequences if not managed promptly. Based on the knowledge that strain activity is related to a higher risk of pneumothoraces, we asked whether modifying post-operative medical care with the inclusion of strict short-term limitation of strain activity is associated with a lower incidence of pneumothorax.
  
  
  METHODS
  Seventy-two (72) emphysematous patients without collateral ventilation were treated with bronchial valves and included in the study. Thirty-two (32) patients received standard post-implantation medical management (Standard Medical Care (SMC)), and 40 patients received a modified medical care that included an additional bed rest for 48 hours and cough suppression, as needed (Modified Medical Care (MMC)).
  
  
  RESULTS
  The baseline characteristics were similar for the two groups, except there were more males in the SMC cohort. Overall, ten pneumothoraces occurred up to four days after ELVR, eight pneumothoraces in the SMC, and only two in the MMC cohorts (p=0.02). Complicated pneumothoraces and pneumothoraces after upper lobe treatment were significantly lower in MMC (p=0.02). Major clinical outcomes showed no significant differences between the two cohorts.
  
  
  CONCLUSIONS
  In conclusion, modifying post-operative medical care to include bed rest for 48 hours after ELVR and cough suppression, if needed, might reduce the incidence of pneumothoraces. Prospective randomized studies with larger numbers of well-matched patients are needed to confirm the data.
authors.affiliation: Department of Internal Medicine/Infectious Diseases and Respiratory Medicine, Charité -Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
authors.forename: Dominik
authors.initials: D
authors.lastname: Herzog
authors.affiliation: Institute of Radiology, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Poellinger
authors.affiliation: Institute of Radiology, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
authors.forename: Felix
authors.initials: F
authors.lastname: Doellinger
authors.affiliation: Department of Internal Medicine/Infectious Diseases and Respiratory Medicine, Charité -Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
authors.forename: Dirk
authors.initials: D
authors.lastname: Schuermann
authors.affiliation: Department of Internal Medicine/Infectious Diseases and Respiratory Medicine, Charité -Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
authors.forename: Bettina
authors.initials: B
authors.lastname: Temmesfeld-Wollbrueck
authors.affiliation: Department of Nuclear Medicine, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13553, Berlin, Germany.
authors.forename: Vera
authors.initials: V
authors.lastname: Froeling
authors.affiliation: Institute of Radiology, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
authors.forename: Nils F
authors.initials: NF
authors.lastname: Schreiter
authors.affiliation: Institute for Biometry and Clinical Epidemiology, Charité -Universitätsmedizin Berlin, Hindenburgdamm 30, 12203, Berlin, Germany.
authors.forename: Konrad
authors.initials: K
authors.lastname: Neumann
authors.affiliation: Department of Internal Medicine/Infectious Diseases and Respiratory Medicine, Charité -Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Hippenstiel
authors.affiliation: Department of Internal Medicine/Infectious Diseases and Respiratory Medicine, Charité -Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
authors.forename: Norbert
authors.initials: N
authors.lastname: Suttorp
authors.affiliation: Department of Internal Medicine/Infectious Diseases and Respiratory Medicine, Charité -Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
authors.forename: Ralf-Harto
authors.initials: RH
authors.lastname: Hubner
mesh_terms: D000368:Aged; D000996:Antitussive Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D001510:Bed Rest; D005260:Female; D006350:Heart Valve Prosthesis / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D008297:Male; D011013:Pneumonectomy / Q000009:adverse effects; D011030:Pneumothorax / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D011182:Postoperative Care / Q000379:methods*; D011656:Pulmonary Emphysema / Q000601:surgery / Q000628:therapy*; D012189:Retrospective Studies
chemical_list: D000996:Antitussive Agents