Endobronchial Valves For Persistent Air Leak in Children: Two Case Reports and Review of the Literature

Endobronchial Valves For Persistent Air Leak in Children: Two Case Reports and Review of the Literature | Authorea try { document.documentElement.classList.add('js'); } catch (e) { } var _gaq = _gaq || []; _gaq.push(['_setAccount', 'G-8VDV14Y67G']); _gaq.push(['_trackPageview']); (function() { var ga = document.createElement('script'); ga.type = 'text/javascript'; ga.async = true; ga.src = ('https:' == document.location.protocol ? 'https://ssl' : 'http://www') + '.google-analytics.com/ga.js'; var s = document.getElementsByTagName('script')[0]; s.parentNode.insertBefore(ga, s); })(); Skip to main content Preprints Collections Wiley Open Research IET Open Research Ecological Society of Japan All Collections About About Authorea FAQs Contact Us Quick Search anywhere Search for preprint articles, keywords, etc. Search Search ADVANCED SEARCH SCROLL This is a preprint and has not been peer reviewed. Data may be preliminary. 30 June 2025 V1 Latest version Share on Endobronchial Valves For Persistent Air Leak in Children: Two Case Reports and Review of the Literature Authors : Zeynep Demir 0009-0005-8564-4933 , Marisa Schwab , Karthik Balakrishnan , Douglas Sidell 0000-0002-2088-6502 , Brian Shaller , Dwayne Free , and Kubra Melike Bozkanat [email protected] Authors Info & Affiliations https://doi.org/10.22541/au.175129932.29633164/v1 Published Pediatric Pulmonology Version of record Peer review timeline 341 views 143 downloads Contents Abstract Supplementary Material Information & Authors Metrics & Citations View Options References Figures Tables Media Share Abstract Background: Persistent air leak (PAL) is a rare but serious issue in children, often caused by necrotizing pneumonia, thoracic surgery, or chest trauma. While many cases respond to basic treatment, severe PAL may require prolonged respiratory support and invasive procedures. Endobronchial valves (EBVs), mainly used in adults, are becoming an option for select pediatric patients. Case Summary: We report two cases of necrotizing pneumonia in children that were complicated by severe PAL, leading to extended extracorporeal membrane oxygenation (ECMO) support. In both cases, placing Zephyr® EBVs (Pulmonx, Redwood City, CA, USA) successfully resolved the air leak, allowing for decannulation and hospital discharge without major complications. We also reviewed pediatric literature and identified 22 published cases of EBV use in children with PAL. Most cases reported favorable outcomes with minimal adverse effects. Conclusion: EBVs help heal bronchopleural and alveolopleural fistulas by causing targeted atelectasis in affected lung areas. Success depends on careful planning before the procedure. This includes imaging and bronchoscopic localization of the leak, especially in smaller children’s airways. Zephyr valves come in smaller sizes, which may benefit this group. Our report and the literature review show that EBVs are a safe and effective, minimally invasive option for treating severe PAL in critically ill children. More research is needed to establish selection criteria, procedural techniques, and long-term follow-up. Supplementary Material File (ebv_final_draft_kmb-2.docx) Download 2.32 MB File (figures.docx) Download 2.26 MB File (table 1 ebv manuscript.docx) Download 25.49 KB Information & Authors Information Version history V1 Version 1 30 June 2025 Peer review timeline Published Pediatric Pulmonology Version of Record 27 Apr 2026 Published Copyright This work is licensed under a Non Exclusive No Reuse License. Keywords endobronchial valves pediatric interventional pulmonology persistent air leak Authors Affiliations Zeynep Demir 0009-0005-8564-4933 Bursa Uludag Universitesi Tip Fakultesi View all articles by this author Marisa Schwab Stanford University School of Medicine View all articles by this author Karthik Balakrishnan Stanford University School of Medicine View all articles by this author Douglas Sidell 0000-0002-2088-6502 Stanford University School of Medicine View all articles by this author Brian Shaller Stanford University School of Medicine View all articles by this author Dwayne Free Stanford University School of Medicine View all articles by this author Kubra Melike Bozkanat [email protected] Stanford University School of Medicine View all articles by this author Metrics & Citations Metrics Article Usage 341 views 143 downloads .FvxKWukQNSOunydq8rnd { width: 100px; } Citations Download citation Zeynep Demir, Marisa Schwab, Karthik Balakrishnan, et al. Endobronchial Valves For Persistent Air Leak in Children: Two Case Reports and Review of the Literature. Authorea . 30 June 2025. DOI: https://doi.org/10.22541/au.175129932.29633164/v1 If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. Simply select your manager software from the list below and click Download. For more information or tips please see 'Downloading to a citation manager' in the Help menu . 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