In her morning report case last Wednesday, first year fellow Emily Olson focused on a case of secondary spontaneous pneumothorax (SSP) with delayed resolution. Remember, think about IP/thoracic surgery involvement if you’ve got leak for a week (or 5 days)
One strategy for managing persistent pneumothorax is endobronchial valve use. Because most of us are familiar with use of valves in COPD lung volume reduction, we reviewed the inclusion/exclusion criteria for use in this context (LIBERATE trial, AJRCCM 2018)
While noting that these criteria do not apply to application of valves for persistent pneumothorax
Finally, we discussed 2 methods used to guide endobronchial valve deployment for persistent air leak:
- Sequential balloon occlusion – assess collateral ventilation, goal to reduce airflow by >50% with occlusion
- Intrapleural methylene blue instillation – tends to follow path of least resistance, meaning that may localize only one target at a time
Source: Respiratory Medicine 137 (2018) 213–218
Great discussion, Emily!
