Bronchoscopic lung volume reduction with endobronchial valves: a consensus statement on practical aspects of patient selection and periprocedural management

Endobronchial valve implantation to accomplish bronchoscopic lung volume reduction (BLVR) has been shown to improve pulmonary function, functional status, and dyspnea in patients with advanced emphysema complicated by hyperinflation without interlobar collateral ventilation. Patient selection and periprocedural management are largely derived from clinical trial inclusion criteria and limited to expert opinion. No consensus recommendations are available to guide practical aspects of BLVR. An international group of experts were invited to participate and were surveyed broadly regarding their BLVR-related practices, from which specific topics were selected by the group, followed by literature review on these topics. Recommendations regarding selected topics were formulated over three voting rounds using a modified Delphi technique requiring at least 80% consensus agreement. A total of 21 recommendations reached consensus and are detailed herein. One recommendation failed to reach consensus, and two other topics were found to have insufficient evidence to make specific recommendations. These consensus recommendations offer guidance on practical aspects of patient selection and periprocedural management topics related to BLVR with endobronchial valves and highlight gaps in current knowledge requiring further research.