Nursing Care After Endobronchial Valve Placement: Optimizing Patient Recovery and Outcomes

Q What is endobronchial valve (EBV) therapy? What does the evidence tell us about optimal nursing practices for the care of patients after EBV placement?

A Michael Gabrilovich, MD, PhD, and Meredith Padilla, PhD, RN, CCRN-CMC, reply:

Endoscopic lung volume reduction (ELVR) is a US Food and Drug Administration–approved minimally invasive procedure to treat hyperinflation and reduce the symptoms of severe emphysema.¹ During bronchoscopy, a 1-way EBV is inserted into airways proximal to the areas of the lungs most affected by the disease (Figures 1 and 2).^2,3 This procedure can substantially improve lung function by redirecting the air away from the hyperinflated sections and toward the healthier sections of the lung. In the absence of collateral ventilation (ie, air coming into the targeted lobe from other lobes), the 1-way valve allows air and secretions to leave the lobe but not go back in, reducing hyperinflation.^1,4–9

Hyperinflation of the lung is like having a large balloon of air inside the chest, compressing the healthier parts of the lung and the major blood vessels while flattening the diaphragm. Deflating hyperinflated areas can improve ventilation and perfusion matching in less-affected lung lobes and optimize diaphragmatic function. Inserting these valves is a minimally invasive procedure, and they can be removed and replaced if needed. Endoscopic lung volume reduction has been shown to have the following benefits for patients: