title: Endobronchial Valves for Challenging Air Leaks.
abstract: BACKGROUND
  Prolonged air leaks may result in increased morbidity and mortality. Endobronchial valves have been used as a nonoperative treatment. We evaluated the efficacy of endobronchial valves at achieving chest tube removal and hospital discharge for air leaks resulting from varied etiologies.
  
  
  METHODS
  All consecutive patients undergoing endobronchial valve placement for persistent air leak were evaluated by a multidisciplinary team at a single institution. Those receiving valves underwent bronchoscopy with balloon occlusion to identify airways contributing to the leak. After airway sizing, unidirectional endobronchial valves were deployed.
  
  
  RESULTS
  During an 18-month period, 21 patients underwent 24 valve placement procedures; 88 valves were placed (median, 3; mean, 3.6; range, 1 to 12). Patient age range was 16 months to 70 years. The underlying cause of persistent air leak was postoperative (n = 8), pneumothorax (n = 11), cavitary lung infection (n = 3), and postpneumonectomy bronchopleural fistula (n = 2). There were no valve-related complications during placement, dwell time, or removal. Three patients died as a result of their underlying disease, unrelated to valves. Of those with chest tubes who survived and were discharged, all had successful removal of their chest tubes. Median duration to chest tube removal after initial valve placement was 15 days (mean, 21 days; range, 0 to 86 days). Median length of stay after final valve placement was 5 days (mean, 15 days; range, 0 to 196 days).
  
  
  CONCLUSIONS
  Challenging air leaks often occur in medically compromised patients. They may persist despite multiple interventions. Endobronchial valves offer minimally invasive management. Time to chest tube removal and length of stay are variable, frequently because of clinical status and underlying disease.
authors.affiliation: Department of Surgery, Division of Thoracic Surgery, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania. Electronic address: mreed@psu.edu.
authors.forename: Michael F
authors.initials: MF
authors.lastname: Reed
authors.affiliation: Department of Medicine, Division of Pulmonary, Allergy, and Critical Care, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania.
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Gilbert
authors.affiliation: Department of Surgery, Division of Thoracic Surgery, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania.
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Taylor
authors.affiliation: Department of Medicine, Division of Pulmonary, Allergy, and Critical Care, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania.
authors.forename: Jennifer W
authors.initials: JW
authors.lastname: Toth
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001999:Bronchoscopy / Q000379:methods; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D011030:Pneumothorax / Q000601:surgery*; D019736:Prostheses and Implants; D011474:Prosthesis Design; D019919:Prosthesis Implantation; D016156:Respiratory Tract Fistula / Q000628:therapy; D020775:Thoracic Surgery, Video-Assisted; D055815:Young Adult