CHEST Guidelines-The-Real-World-Safety-of-Endobronchial-Valve

The-Real-World-Safety-of-Endobronchial-Valve_chest

Pdf Summary

The document discusses the real-world safety and complications associated with endobronchial valve (EBV) therapy for patients with severe emphysema, a condition commonly related to chronic obstructive pulmonary disease (COPD). EBV, used in bronchoscopic lung volume reduction (BLVR), aims to improve lung function by targeting and reducing dysfunctional, overinflated lung regions. This procedure was shown to enhance lung function and quality of life, offering a less invasive alternative to lung volume reduction surgery.<br /><br />Since the US FDA approved EBVs for BLVR in 2018, the number of procedures has risen, necessitating a clearer understanding of safety in real-world situations. The document references a study conducted by Costa Filho et al., which analyzed 467 hospitalizations for BLVR with EBV using the National Inpatient Sample database from 2018 to 2020. The study revealed that almost 48% of hospitalizations encountered at least one complication, with pneumothorax being the most frequent, occurring in 26.3% of cases. Other noted complications included acute respiratory failure, COPD exacerbation, pneumonia, and hemoptysis.<br /><br />While in-hospital mortality was low, pneumothorax emerged as the leading cause of postprocedural death. Despite its contribution to better patient outcomes, EBV therapy carries risks that require management, such as compensating for pneumothorax through conservative methods, chest tube placement, EBV removal, or surgery.<br /><br />Limitations of the study, such as database constraints preventing access to comprehensive clinical efficacy assessments and the absence of individual patient data, hinder a thorough evaluation of risks for certain populations. Nonetheless, the study aligns with past controlled trials, suggesting that EBV therapy remains a safe and valuable intervention. Future research is advised to refine patient selection criteria and strategies to minimize procedural risks as the population undergoing these procedures grows with the aging demographic.

Keywords

endobronchial valve

severe emphysema

chronic obstructive pulmonary disease

bronchoscopic lung volume reduction

pneumothorax

patient outcomes

real-world safety

complications

Costa Filho study

future research