Treatment with endobronchial valves of persistent air leak in patients with pleural empyema.

C. Disdier*^a (Dr), B. De Vega-Sanchez^a (Dr), D. Vielba^a (Dr), I. Ramos^a (Dr), A. García-Onieva^a (Dr), S. Jaurrieta^a (Dr), M. Belver^a (Dr), S. Juarros^a (Dr), E. Rodrioguez-Flores^a (Dr), C. Rodriguez-Dupuy^a (Dr), S. Fernandez-Gay^a (Dr)

^a Hospital Clinico Universitario de Valladolid, Valladolid, SPAIN

* cdisdier@separ.es

Introduction: Pleural empyema associated with alveolopleural fistula (APF) is an entity with high morbidity and mortality. The objective of the study was to evaluate the efficacy and safety of treatment with endobronchial valves (EBV) in patients with empyema and APF.

Material and methods: From 1/1/2016 to 2/28/2021, all patients with pleural space infection and persistent air leak due to APF were prospectively studied. Prolonged leak (PL) was defined as persistent air drainage for more than 7 days. The therapeutic protocol included endothoracic drainage and antibiotic treatment. The leak location was performed by chest CT followed by bronchoscopy. Demographic characteristics, etiology, associated comorbidity, safety, and efficacy of APF treatment using endobronchial valves were analyzed.

Results 19 patients whose characteristics are described were included. 13 patients had active neoplasia and another two had neoplasms with complete response. Two patients had open thoracostomy. 38 germs were identified in pleural fluid and in 10 patients the infection was polymicrobial. 14 patients were treated with EBV and 24 valves were inserted. The median days between the diagnosis of the PL and the placement of the EBV was 31.5 days. Leak cessation was achieved in 11 patients (immediate and sustained in 4) after EBV placement, and the median time from EBV insertion to complete leak cessation was 11 days. In 8 patients, drainage removal was possible with a median of 54 days after valve insertion. One patient died during admission due to nosocomial COVID19 infection without improvement after EBV, and 3 patients died during the 6-month follow-up. Two patients suffered a recurrence of APF. Treatment with EBV in patients with empyema and APF was completely successful in 8 patients (57%) and partial in 5 more (35.7%).

Conclusions EBV treatment in patients with FAP and empyema is a safe and effective treatment

Disclosure of funding source(s): none