Georgian Biomedical News ISSN (Online): 2720-8796 ISSN (Print): 2720-7994 Downloaded from gbmn.org. For personal use only. No other uses without permission Copyright © 2022. All rights reserved VOLUME 1. ISSUE 2. APRIL-JUNE 2023 ISSN (Online): 2720-8796 ISSN (Print): 2720-7994 Novel Bronchoscopic Management of Bleeding from The Respiratory Tract Teona Mskhaladze, 1 David Tchkonia, 2 Kakha Vacharadze, 1 Gia Lursmanashvili, 3 Natia Adamia, 4 Mikolay Chkonia 5 Background: Surgery is generally considered the treatment of choice for pulmonary hemorrhage. Unfortunately, existing data on alternative treatment methods are very scarce. However, the use of bronchoscopic procedures in managing such issues is gaining acceptance. Objectives: In the present study, we aimed to improve the efficacy of managing pulmonary bleeding with a new interventional bronchoscopic procedure such as endobronchial valve placement (EVP). Methods: For the first time in Georgia, we used a novel bronchoscopic procedure known as EVP with Medlung endobronchial valves. Results: In the patients who underwent EVP, the survival rate of 180 days after the intervention was 85.7%, compared to 54.3% in the conservative treatment group. Furthermore, it should be emphasized that sudden deaths because of profuse pulmonary bleeding did not occur in the research group. At the same time, 5 (19.23%) cases of pulmonary bleeding death occurred in the control group. Conclusions: EVP demonstrated remarkable effectiveness in pulmonary bleeding, with a lower death rate, while surgery is linked with a significantly higher risk. Keywords: Bleeding from the respiratory tract, endobronchial valve implantation. BACKGROUND ccording to the World Health Organization (WHO) and other agencies, pulmonary hemorrhage is one of the top causes of mortality in patients with respiratory diseases. 1 Increased pressure in the blood vessels supplying the tracheobronchial tree and pulmonary system, lung disease, or mechanical damage to the respiratory tract can cause massive bleeding, with deaths ranging from 11.5-29% in the case of conventional treatment, whereas mortality rates because of pulmonary artery embolization range from 15.3% to 31.0%. 2 Surgery is generally considered the treatment of choice for such complications. However, there are frequent cases when surgical treatment is not possible for various reasons (widespread, bilateral, acute inflammatory, and purulent processes in the lungs, low functional indicators, or severe comorbidities). Therefore, data on alternative treatment options could be more extensive. However, the use of bronchoscopic procedures in managing these issues is gaining acceptance. 3 Despite their expanding popularity, bronchoscopic procedures must adhere to evidence-based scientific criteria. METHODS To stop the bleeding from the respiratory system, we used the novel bronchoscopy technique of Endobronchial valve placement (EVP). Currently, two types of endobronchial valves (EBV) based on nitinol (nickel-titanium) are in use in the United States: Spiration® Valve System (Olympus Respiratory, Redmond, WA, USA) and Emphasys Zephyr® Endobronchial Valve System (Pulmonx, Redwood City, CA, USA). In the present study, we used the endobronchial valve made by LTD "Medlung" (Russia) based on a rubber compound (Fig.1). FIGURE 1. The endobronchial valve of the company "Medlung" Explanations: 1. Hollow cylinder; 2. Internal valve opening; 3. The bridge that holds the valve; 4. Radial petals that allow fixation of the valve inside of a bronchus; 5. Collapsible petal-like valve. "Medlung" has granted permission to use the present image. 4 ABSTRACT A DOI: 10.52340/GBMN.2023.01.01.29