Endoscopic one-way endobronchial valves in the treatment of persistent air leak with empyema

Giacomo Cusumano, Alfonso Fiorelli, Salvatore Bellofiore, Carmelo Riscica Lizzio, Rosalia Giarlotta, Mario Santini, Alberto Terminella


Background: Persistent air leak complicated by empyema is a life-threatening condition especially in patients with pulmonary emphysema. Surgical approaches are often disappointing and demolitive surgery is often needed. Endobronchial valves have been successfully applied for persistent air leak but their use in case of concurrent empyema has been reported in very few cases. We present a case series of six consecutive patients with persistent air leak and empyema, successfully treated by endobronchial valves.
Methods: Bronchoscopic procedures included preliminary identification of the area of air leakage by bronchial occlusion using a balloon catheter. The nitinol and silicon valves (Pulmonx®) were inserted by means of flexible bronchoscopy in all cases. Chest drain was removed after negativity of microbiological essay from pleural liquid.
Results: Four patients had severe emphysema with chronic respiratory failure and smoking history. One patient was affected by rheumatoid arthritis and one had chronic heart failure and diabetes. Four cases were postoperative air leakage after lung resection and two cases were due persistent spontaneous pneumothorax. Empyema was mainly due to Acinetobacter baumannii or Pseudomonas aeruginosa or staphylococcus aureus. Procedures were successful in every case. Air-leaks stopped in the first 24 hours after procedure in two patients and within 7 days in the remaining cases. All patients were discharged within 3 weeks without complications.
Conclusions: Insertion of endobronchial valves is a safe and effective method for treating persistent air leak even during empyema in selected cases and especially for patient unfit for surgery.