title: Management of Prolonged Pulmonary Air Leaks With Endobronchial Valve Placement.
abstract: BACKGROUND
  Prolonged pulmonary air leaks (PALs) are associated with increased morbidity and extended hospital stay. We sought to investigate the role of bronchoscopic placement of 1-way valves in treating this condition.
  
  
  METHODS
  We queried a prospectively maintained database of patients with PAL lasting more than 7 days at a tertiary medical center. Main outcome measures included duration of chest tube placement and hospital stay before and after valve deployment.
  
  
  RESULTS
  Sixteen patients were eligible to be enrolled from September 2012 through December 2014. One patient refused to give consent, and in 4 patients, the source of air leak could not be identified with bronchoscopic balloon occlusion. Eleven patients (9 men; mean age, 65 ± 15 years) underwent bronchoscopic valve deployment. Eight patients had postoperative PAL and 3 had a secondary spontaneous pneumothorax. The mean duration of air leak before valve deployment was 16 ± 12 days, and the mean number of implanted valves was 1.9 (median, 2). Mean duration of hospital stay before and after valve deployment was 18 and 9 days, respectively (P = .03). Patients who had more than a 50% decrease in air leak on digital monitoring had the thoracostomy tube removed within 3-6 days. There were no procedural complications related to deployment or removal of the valves.
  
  
  CONCLUSIONS
  Bronchoscopic placement of 1-way valves is a safe procedure that could help manage patients with prolonged PAL. A prospective randomized trial with cost-efficiency analysis is necessary to better define the role of this bronchoscopic intervention and demonstrate its effect on air leak duration.
authors.affiliation: Section of Thoracic Surgery.
authors.forename: Charles
authors.initials: C
authors.lastname: Bakhos
authors.affiliation: Division of Pulmonary Medicine.
authors.forename: Peter
authors.initials: P
authors.lastname: Doelken
authors.affiliation: Department of Cardiothoracic Surgery, Hofstra Northwell School of Medicine, New Hyde Park, New York, USA.
authors.forename: Stevan
authors.initials: S
authors.lastname: Pupovac
authors.affiliation: Department of Surgery, Albany Medical Center, Albany, New York, USA.
authors.forename: Ashar
authors.initials: A
authors.lastname: Ata
authors.affiliation: Section of Thoracic Surgery.
authors.forename: Tom
authors.initials: T
authors.lastname: Fabian
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001999:Bronchoscopy / Q000295:instrumentation / Q000379:methods; D015505:Chest Tubes; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy; D011030:Pneumothorax / Q000209:etiology / Q000628:therapy*; D011183:Postoperative Complications / Q000628:therapy*; D019736:Prostheses and Implants; D016896:Treatment Outcome
keywords: Air leak; Endoscopic; Lobectomy; Valve; Wedge