Abstract Introduction Persistent air leak (PAL) is a common postoperative complication of lung resection leading to increased complications and hospital length of stay (LOS). Endobronchial valves (EBV) have emerged as a treatment option, but depend on appropriate placement for success. We describe a novel technique of utilizing the Chartis System (CS) to guide EBV placement for PAL. Case Description A 68 year-old former smoker was admitted to the hospital after a left upper lobe (LUL) lobectomy for a lung nodule. Her hospital course was complicated by PAL, which was refractory to two attempts at chemical pleurodesis. Interventional pulmonology was consulted for EBV placement, and she underwent bronchoscopy on postoperative day 11. The LUL stump appeared visually intact with no dehiscence. No air leak was visible on the chest tube, prohibiting use of sequential balloon occlusion to guide EBV placement. Consequently, CS was used to localize the source of air leak by sequentially occluding airways and measuring the degree of negative pressure through the isolated segment. Measurements were taken in all LLL subsegments, and the lateral segment showed the greatest degree of negative pressure, indicating that this was the most likely source of air leak. Accordingly, two EBV’s were placed in the LLL lateral segment. The PAL was immediately resolved postoperatively. The chest tube was removed the following day and the patient was discharged home. Discussion PAL is a common postoperative complication following lung resection that leads to prolonged hospitalizations and increased morbidity and mortality. EBV’s have emerged as a management option to limit airflow through the alveolar-pleural defect, thus promoting healing, and have been shown to lead to resolution of PAL and reduce hospital LOS. Critical to successful EBV placement is localization of the air leak, which is typically done by sequential balloon occlusion of bronchopulmonary segments. This was not possible in our patient who did not have an observable air leak while on positive pressure ventilation. CS is a device developed by PulmonX to help guide placement of EBV’s for bronchoscopic lung volume reduction. It uses a balloon to occlude the selected airway, and measures flow and pressure through a central catheter to detect collateral ventilation. In this case, we describe a novel use of CS to help identify the source of PAL and guide EBV placement, which led to successful, immediate postoperative resolution of PAL. This abstract is funded by: None
Borchart et al. (Fri,) studied this question.