title: Clinical and radiological outcome following pneumothorax after endoscopic lung volume reduction with valves.
abstract: BACKGROUND
  Valve implantation has evolved as a therapy for patients with advanced emphysema. Although it is a minimally invasive treatment, it is associated with complications, the most common being pneumothorax. Pneumothorax occurs due to the rapid target lobe volume reduction and may be a predictor of clinical benefit despite this complication.
  
  
  OBJECTIVE
  The objective of this study was to conduct an exploratory data analysis of patients who developed a pneumothorax following endoscopic valve therapy for emphysema.
  
  
  METHODS
  This study performed a retrospective evaluation of pneumothorax management and the impact of pneumothorax on clinical outcomes in 70 patients following valve therapy in 381 consecutive patients.
  
  
  RESULTS
  Pneumothorax rate following valve therapy was 18%. Pneumothorax management consisted of chest tube insertion, valve removal, and surgical intervention in 87% (61/70), 44% (31/70), and 19% (13/70) of the patients, respectively. Despite pneumothorax, patients experienced modest but significant improvements in lung function parameters (forced expiratory volume in 1 second: 55±148 mL, residual volume: -390±964 mL, total lung capacity: -348±876; allP<0.05). Persistent lobar atelectasis 3 months after recovering from pneumothorax, which was associated with relevant clinical improvement, was observed in only 21% (15/70) of the patients.
  
  
  CONCLUSIONS
  Pneumothorax is a frequent severe complication following valve therapy that requires further intervention. Nevertheless, the pneumothorax does not impair the clinical status in the majority of patients. Patients with lobar atelectasis benefit after recovering from pneumothorax in terms of lung function parameters.
authors.affiliation: Pneumology and Critical Care Medicine, Thoraxklinik at University of Heidelberg; German Center for Lung Research.
authors.forename: D
authors.initials: D
authors.lastname: Gompelmann
authors.affiliation: Pneumology and Critical Care Medicine, Thoraxklinik at University of Heidelberg.
authors.forename: N
authors.initials: N
authors.lastname: Benjamin
authors.affiliation: Pneumology and Critical Care Medicine, Thoraxklinik at University of Heidelberg.
authors.forename: K
authors.initials: K
authors.lastname: Kontogianni
authors.affiliation: Pneumology and Critical Care Medicine, Thoraxklinik at University of Heidelberg; German Center for Lung Research.
authors.forename: Fjf
authors.initials: F
authors.lastname: Herth
authors.affiliation: German Center for Lung Research; Diagnostic and Interventional Radiology, Thoraxklinik at University of Heidelberg; Diagnostic and Interventional Radiology, University Hospital Heidelberg.
authors.forename: C P
authors.initials: CP
authors.lastname: Heussel
authors.affiliation: German Center for Lung Research; Thoracic Surgery, Thoraxklinik at University of Heidelberg, Heidelberg, Germany.
authors.forename: H
authors.initials: H
authors.lastname: Hoffmann
authors.affiliation: Pneumology and Critical Care Medicine, Thoraxklinik at University of Heidelberg; German Center for Lung Research.
authors.forename: R
authors.initials: R
authors.lastname: Eberhardt
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001999:Bronchoscopy / Q000009:adverse effects* / Q000295:instrumentation*; D015505:Chest Tubes; D020878:Device Removal; D005260:Female; D005541:Forced Expiratory Volume; D006304:Health Status; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D008176:Lung Volume Measurements; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D011030:Pneumothorax / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy; D011237:Predictive Value of Tests; D011474:Prosthesis Design; D011656:Pulmonary Emphysema / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D020127:Recovery of Function; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: COPD; emphysema; endoscopic valve therapy; pneumothorax