title: Use of One-Way Intrabronchial Valves in Air Leak Management After Tube Thoracostomy Drainage.
abstract: BACKGROUND
  A persistent air leak represents significant clinical management problems, potentially affecting morbidity, mortality, and health care costs. In 2008, a unidirectional, intrabronchial valve received humanitarian device exemption for use in managing prolonged air leak after pulmonary resection. Since its introduction, numerous reports exist but no large series describe current utilization or outcomes. Our aim was to report current use of intrabronchial valves for air leaks and review outcome data associated with its utilization.
  
  
  METHODS
  A multicenter, retrospective review of intrabronchial valve utilization from January 2013 to August 2014 was performed at eight centers. Data regarding demographics, valve utilization, and outcomes were analyzed.
  
  
  RESULTS
  We identified 112 patients undergoing evaluation for intrabronchial valve placement, with 67% (75 of 112) undergoing valve implantation. Nearly three quarters of patients underwent valve placement for off-label usage (53 of 75). A total of 195 valves were placed in 75 patients (mean 2.6 per patient; range, 1 to 8) with median time to air leak resolution of 16 days (range, 2 to 156).
  
  
  CONCLUSIONS
  We present the largest, multicenter study of patients undergoing evaluation for intrabronchial valve use for air leak management. Our data suggest the majority of intrabronchial valve placements are occurring for off-label indications. Although the use of intrabronchial valves are a minimally invasive intervention for air leak management, the lack of rigorously designed studies demonstrating efficacy remains concerning. Prospective randomized controlled studies remain warranted.
authors.affiliation: Division of Pulmonary, Allergy, and Critical Care Medicine, Penn State College of Medicine-Milton S. Hershey Medical Center, Hershey, Pennsylvania. Electronic address: christopher.gilbert@swedish.org.
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Gilbert
authors.affiliation: Section of Pulmonary and Critical Care Medicine, Baylor College of Medicine, Houston, Texas.
authors.forename: Roberto F
authors.initials: RF
authors.lastname: Casal
authors.affiliation: Division of Pulmonary and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Hans J
authors.initials: HJ
authors.lastname: Lee
authors.affiliation: Division of Pulmonary and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: David
authors.initials: D
authors.lastname: Feller-Kopman
authors.affiliation: Division of Pulmonary and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Bernice
authors.initials: B
authors.lastname: Frimpong
authors.affiliation: Division of Pulmonary, Allergy, and Critical Care Medicine, University of Minnesota, Minneapolis, Minnesota.
authors.forename: H Erhan
authors.initials: HE
authors.lastname: Dincer
authors.affiliation: Division of Cardiothoracic Surgery, University of Minnesota, Minneapolis, Minnesota.
authors.forename: Eitan
authors.initials: E
authors.lastname: Podgaetz
authors.affiliation: Interventional Pulmonary, Department of Internal Medicine, University of Cincinnati, Cincinnati, Ohio.
authors.forename: Sadia
authors.initials: S
authors.lastname: Benzaquen
authors.affiliation: Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
authors.forename: Adnan
authors.initials: A
authors.lastname: Majid
authors.affiliation: Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
authors.forename: Erik
authors.initials: E
authors.lastname: Folch
authors.affiliation: Division of Thoracic Surgery and Interventional Pulmonology, Swedish Cancer Institute, Seattle, Washington.
authors.forename: Jed A
authors.initials: JA
authors.lastname: Gorden
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Barnes-Jewish Hospital, Washington University School of Medicine, St. Louis, Missouri.
authors.forename: Praveen
authors.initials: P
authors.lastname: Chenna
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Barnes-Jewish Hospital, Washington University School of Medicine, St. Louis, Missouri.
authors.forename: Alex
authors.initials: A
authors.lastname: Chen
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Interventional Pulmonary, Cooper Medical School of Rowan University, Camden, New Jersey.
authors.forename: Wissam
authors.initials: W
authors.lastname: Abouzgheib
authors.affiliation: The Johns Hopkins Bloomberg School of Public Health, Department of Biostatistics, Baltimore, Maryland.
authors.forename: Bareng Aletta
authors.initials: BA
authors.lastname: Sanny Nonyane
authors.affiliation: Division of Pulmonary and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Lonny B
authors.initials: LB
authors.lastname: Yarmus
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001980:Bronchi / Q000601:surgery*; D015505:Chest Tubes; D004322:Drainage; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D011013:Pneumonectomy / Q000009:adverse effects*; D011030:Pneumothorax / Q000601:surgery*; D011183:Postoperative Complications / Q000601:surgery*; D012189:Retrospective Studies; D013907:Thoracostomy / Q000009:adverse effects*