Endobronchial Valves for Endoscopic Lung Volume Reduction: Best Practice Recommendations from Expert Panel on Endoscopic Lung Volume Reduction
Dirk-Jan Slebos, Pallav L Shah, Felix J F Herth, Arschang Valipour, Dirk-Jan Slebos, Pallav L Shah, Felix J F Herth, Arschang Valipour
Abstract
Endoscopic lung volume reduction (ELVR) is being adopted as a treatment option for carefully selected patients suffering from severe emphysema. ELVR with the one-way endobronchial Zephyr valves (EBV) has been demonstrated to improve pulmonary function, exercise capacity, and quality of life in patients with both heterogeneous and homogenous emphysema without collateral ventilation. In this "expert best practices" review, we will highlight the practical aspects of this therapy. Key selection criteria for ELVR are hyperinflation with a residual volume >175% of predicted, forced expiratory volume <50% of predicted, and a 6-min walking distance >100 m. Patients with repeated infectious complications, severe bronchiectasis, and those with unstable cardiovascular comorbidities should be excluded from EBV treatment. The procedure may be performed with either conscious sedation or general anesthesia and positive pressure mechanical ventilation using a flexible endotracheal tube or a rigid bronchoscope. Chartis and EBV placement should be performed in 1 procedure when possible. The sequence of valve placement should be orchestrated to avoid obstruction and delivery of subsequent valves. If atelectasis has not occurred by 1 month after procedure, evaluate valve position on CT and consider replacing the valves that are not optimally positioned. Pneumothorax is a common complication and typically occurs in the first 2 days following treatment. A management algorithm for pneumothorax has been previously published. Long-term sequelae from EBV therapy do occur but are easily manageable.
© 2016 The Author(s) Published by S. Karger AG, Basel.
Figures
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CT analysis revealing emphysema morphology…
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CT analysis revealing emphysema morphology not recommended for treatment.
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Correct Chartis balloon catheter placement…
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Correct Chartis balloon catheter placement to occlude the right lower lobe (RLL) airway…
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Chartis system output screen demonstrating…
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Chartis system output screen demonstrating assessment time and volume of exhaled air from…
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Chartis procedure showing absence of…
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Chartis procedure showing absence of collateral flow performed under different anesthetic methods. a…
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Chartis balloon placement occluding the…
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Chartis balloon placement occluding the RB6 segment in order to achieve appropriate measurement…
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Currently available sizes of Zephyr®…
Fig. 8
Currently available sizes of Zephyr® endobrochial valves (EBV, Pulmonx) designed to occlude varying…
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An HRCT scan with homogeneous…
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An HRCT scan with homogeneous emphysema distribution ( a ) with an accompanying…
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EBV 4.0 EDC delivery catheter…
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EBV 4.0 EDC delivery catheter with depth markers illustrating the appropriate length of…
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EBV delivery catheter width sizing…
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EBV delivery catheter width sizing wings used to determine the minimum and maximum…
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Partial deployment technique illustrating EBV…
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Partial deployment technique illustrating EBV placed directly onto the next distal carina.
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The EBV delivery catheter with…
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The EBV delivery catheter with a depth marker distal to the ostium ensuring…
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Axial reconstruction of a CT…
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Axial reconstruction of a CT image demonstrating poor valve misplacement and subsegmental airflow…
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Source: PubMed