Endobronchial valve placement for persistent air leaks in patients with underlying lung disease: a case series from a resource-strapped county hospital.

Current guidelines recommend pleurodesis or video-assisted thoracoscopic surgery (VATS) for the management of persistent air leaks (PALs). However, for those with underlying lung disease, the interventions may not be feasible. Endobronchial valve (EBV) placement has shown early promise as a viable option in this patient population. The aim of our study is to evaluate the time to successful resolution of PALs following EBV placement. We hypothesize that its early implementation may reduce hospital costs, particularly in the setting of a public safety-net hospital. A single-center retrospective case series study was conducted on six consecutive patients who received EBVs for PALs. Successful resolution of PAL was defined as the following: (I) complete cessation of bubbling in the atrium, (II) no pneumothorax recurrence on clamp trial, (III) removal of chest tube(s) without re-expansion of the pneumothorax. Hospitalization lengths were compared, including chest tube insertion to valve placement, valve placement to removal of the chest tube, and hospital discharge. Of the six PAL cases, five were attributed to spontaneous secondary pneumothoraces arising from various chronic lung diseases. In 83.3% (5/6) of cases, the chest tubes were successfully removed before discharge; in one case, the patient was discharged with a Heimlich valve, which was removed a week later in the clinic. On average, chest tubes were removed 4 days post-EBV insertion, compared with preceding hospital stay duration (mean: 29.4±46.9 days). Early use of EBVs for PALs may prove to be more cost-effective than standard-of-care interventions, despite higher upfront costs. Our case series demonstrating 6/6 successful closures surpasses that seen in the current literature. This may be attributed to intervening on a subset of patients with chronic lung disease and spontaneous secondary pneumothoraces who might have benefited from inadvertent lung volume reduction in the process. Our results suggest that EBV placement may be superior to prolonged chest tube suction in this subpopulation. Early intervention may translate into greater cost savings from reduced hospital days.