EFFICACY OF ENDOBRONCHIAL VALVE PLACEMENT IN THE MANAGEMENT OF PULMONARY HEMORRHAGE: A COMPARATIVE STUDY.

BACKGROUND: Pulmonary hemorrhage is a critical, life-threatening complication of diverse pulmonary pathologies, most commonly pulmonary tuberculosis, and often necessitates emergent intervention. Conventional therapeutic modalities yield inconsistent outcomes, whereas endobronchial valve (EBV) placement has emerged as a promising, minimally invasive alternative for achieving selective airway occlusion and hemostasis. OBJECTIVE: To evaluate the clinical efficacy of EBV placement compared with conventional conservative management in patients presenting with pulmonary hemorrhage. METHODS: A comparative cohort study was conducted at the National Center for Tuberculosis and Lung Diseases (Tbilisi, Georgia), involving 17 patients who underwent EBV placement and 26 patients treated conservatively. Outcomes assessed included hemorrhage recurrence, survival, sudden hemorrhage-related mortality, hematologic recovery, incidence of aspiration pneumonia, duration of hospitalization, and health-related quality of life (HRQoL) measured with the St. George's Respiratory Questionnaire (SGRQ). RESULTS: Hemorrhage recurrence at 180 days was lower in the EBV group (5.9%, 1/17) than in the control group (34.6%, 9/26; χ²=4.75, p=0.042 by uncorrected χ²; p=0.071 with Yates' correction, not statistically significant at this sample size). The 180-day survival rate was higher in the EBV group (85.7%) than in controls (54.3%). No sudden hemorrhage-related deaths occurred in the EBV group, versus 5 of 26 (19.2%) in the control group, although this difference did not reach statistical significance (Fisher's exact test, p=0.139). Hematologic recovery improved significantly within the EBV group over one month (hemoglobin, hematocrit, ESR, and WBC all p<0.01), with the control group showing smaller or non-significant within-group changes. Aspiration pneumonia was less frequent in the EBV group (23.5% vs. 69.2%; χ²=6.86, p=0.0088), and mean hospital stay was shorter (13.7 vs. 51.9 days; p<0.0001). SGRQ scores improved significantly in the EBV group at 180 days (65.4→42.3, a 35.4% reduction; p<0.001), with no significant change in the control group. CONCLUSION: EBV placement is associated with reduced hemorrhage recurrence, improved survival, fewer complications, and better quality of life compared with conservative therapy in patients with pulmonary hemorrhage, although the recurrence and mortality comparisons should be re-verified statistically before this is presented as a definitive finding.