Endobronchial Valve Therapy in Prolonged Air Leak Tratamiento con válvulas endobronquiales en la fuga aérea prolongada

Persistent air leak (PAL) is the most common complication following lung resection.1,2 It lengthens hospital stay and increases post-surgical morbidity and mortality due to the increased risk of empyema, fever or pneumonia.4 It can contribute to respiratory failure, limit activity, increase the time and costs of hospitalization and add to the risk of hospital-acquired infections.1 PAL is defined as prolonged air leak caused by an alveolopleural fistula lasting more than 7 days.1 Although the length of evolution described in the literature varies, the finding of air leak on day 5 post-surgery is considered as a “significant air leak”. If the air leak is continuous or occurs during inhalation or exhalation and presents with subcutaneous emphysema or respiratory failure, it normally becomes persistent.1,5 An alveolopleural fistula is the abnormal communication between the pulmonary parenchyma distal to a segmentary bronchus and the pleural space.3 After surgery, it may be caused by delayed healing of the lung surface, due mainly to underlying parenchymal disease.1 For this reason, PAL is more common after surgery for secondary spontaneous pneumothorax than after primary pneumothorax. An incidence of around 20% has been reported.1 Standard treatment of PAL is generally conservative, with continuous chest drainage. If the condition prolongs over time, surgical reintervention can be considered as a second option. This procedure can be burdensome in terms of morbidity, does not always guarantee a solution, and in some cases the problem may even be aggravated if the already diseased parenchyma is exposed to more injury.1 The most common surgical techniques currently available for treating this disease are further resection of the lung parenchyma at the site of the anatomical defect, reinforcement of sutures with bovine pericardium, pleurectomy, pleurodesis with autologous blood patches or other chemical agents such as fibrin sealant, sponges, ethanol, trichloroacetic acid, bronchial blockers or cautery using a fiberoptic bronchoscope.2 The wide range of therapeutic options indicate that no single approach is fully effective, and this has led to the introduction of less invasive approaches such as endobronchial valves, which provide shorter recovery