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Pediatrics

Research Snapshot Theater: Future of Critical Care, Pediatric

(407) Endobronchial Valves for Pediatric Air-Leak Syndrome to Liberalize From Extracorporeal Support

Tuesday, February 25, 2025
10:00am – 11:00am Eastern Time
Location: Connections Central - RST 11

    First Author(s)

  • Bhavesh Patel, MD

    Childrens Hospital of Philadelphia, USA

    • Co-Author(s)

  • SD

    Shyam Deshpande, MD

    Physician Fellow
    Children's Hospital of Philadelphia, United States

  • AK

    AJ Katz, MD

    Physician Fellow
    Children's Hospital of Philadelphia, United States

  • Paula Magee, MD, MPH (she/her/hers)

    Children's Hospital of Philadelphia
    Philadelphia, Pennsylvania, USA

  • Vanessa M. Mazandi, MD,

    Attending Physician
    Department of Anesthesiology and Critical Care Medicine, The Children’s Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
    Philadelphia, Pennsylvania, United States

  • AC

    Aoife Corcoran, MD

    Physician
    Children's Hospital of Philadelphia, United States

  • Garrett P. Keim, MD, MSCE (he/him/his)

    Assistant Professor of Anesthesiology, Critical Care and Pediatrics
    Children's Hospital of Philadelphia
    Philadelphia, Pennsylvania, United States

  • AH

    Adam S. Himebauch, MD

    Assistant Professor
    The Children's Hospital of Philadelphia, United States

  • TK

    Todd J. Kilbaugh, MD

    Attending Physician and Medical Director of the ECMO Center
    Department of Anesthesiology and Critical Care Medicine, The Children’s Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA, United States

  • HH

    Holly Hedrick, MD

    Physician
    Children's Hospital of Philadelphia, United States

  • PP

    Pelton Phinizy, MD

    Physician
    Children's Hospital of Philadelphia, United States

  • AW

    Antoinnette Wannes Daou, MD

    Physician
    Children's Hospital of Philadelphia, United States

  • JP

    Joseph Piccione, MD

    Physician
    Children's Hospital of Philadelphia, United States

  • KS

    Kumaran Senthil, MD

    Assistant Professor of Anesthesiology and Critical Care
    Childrens Hospital of Philadelphia
    Philadelphia, PA, United States

Introduction: A previously healthy 14-year-old 45kg female was admitted to the pediatric intensive care unit with influenza and Streptococcus pneumoniae left lower lobe pneumonia requiring invasive ventilation with progression to severe acute respiratory distress syndrome by hospital day 5.

Description: She developed a left tension pneumothorax requiring a chest tube on day 10. Despite ongoing air leak, she had improved respiratory mechanics and was extubated on day 14. The following day, she developed a left tension pneumothorax despite continuous air evacuation from her existing chest tube and required a second left chest tube. She was intubated with a double-lumen endotracheal tube (ETT) to facilitate single-lung ventilation, resulting in cessation of air leak and improved hemodynamics, but required venovenous extracorporeal membrane oxygenation (ECMO) for oxygenation failure. On day 16, our interventional pulmonology team localized her air leak to the left upper lobe (LUL) with endobronchial balloon occlusion. Her double lumen ETT was replaced with a standard ETT to facilitate placement of 2 endobronchial valves (EBV) in the LUL anterior and apicoposterior segments which resolved her air leak and facilitated liberalization from ECMO within 48 hours. She subsequently required 4 additional EBVs (1 in LUL anterior segment, 1 in LUL apicoposterior segment, 1 in lingula superior segment, 1 in lingula inferior segment) for recurrence of left-sided air leak. She completed 40 days of broad-spectrum antibiotics after EBV placement, underwent tracheostomy on day 24, and was discharged to inpatient rehabilitation on day 87. Her tracheostomy was removed on day 107, she was discharged home on day 113, and returned to her subjective baseline functional status, engaging in competitive dance and playing the flute. She returned for elective removal of her 6 EBVs 8 months later without complications or recurrent air leak.

Discussion: We present a case of EBV placement in a pediatric patient for refractory air leak secondary to necrotizing pneumonia that facilitated liberalization from ECMO without infectious complications refractory to prolonged antibiotics, nor recurrence of pneumothorax after EBV removal.