Aplicação terapêutica da ventilação colateral no enfisema pulmonar difuso: apresentação de um protocolo

Abstract

We present a protocol to test a new surgical procedure for the treatment of patients with diffuse lung emphysema who, after having received the golden standard treatment (pulmonary rehabilitation), continue to present respiratory failure with disabling dyspnea. Ten patients with severe lung hyperinflation will be evaluated. The method proposed is designed to create alternative expiratory passages for air trapped in the emphysematous lung by draining the lung parenchyma, thereby establishing communication between the alveoli and the external environment. The ten patients selected will be required to meet the inclusion criteria and to give written informed consent. Those ten patients will be included in the study pending the approval of the Ethics in Research Committee of the São Paulo Santa Casa School of Medicine, São Paulo, Brazil. The protocol we will employ in order to evaluate the proposed procedure is feasible and will show whether debilitated patients suffering from diffuse pulmonary emphysema can benefit from this procedure, which could represent an alternative to lung transplant or lung volume reduction surgery, the only options currently available.Keywords: Pulmonary Emphysema; Pulmonary Disease, Chronic Obstructive; Lung, Hyperlucent. ResumoApresentação de um protocolo, para testar uma nova opção de tratamento operatório nos doentes portadores de enfisema pulmonar difuso, nos quais a terapêutica clínica máxima, incluindo a reabilitação pulmonar, foi realizada e ainda assim, existe falência respiratória com dispnéia incapacitante. Serão avaliados dez doentes portadores de hiperinsuflação pulmonar grave. O método propõe promover passagens expiratórias alternativas à via aérea principal para o ar aprisionado no pulmão enfisematoso, por meio de uma drenagem do parênquima pulmonar, comunicando os alvéolos ao meio exterior. Serão selecionados dez doentes, com os consentimentos informados assinados, e com a aprovação do Comitê de Ética em Pesquisa da Faculdade de Ciências Médicas da Santa Casa de São Paulo. Os doentes selecionados deverão obedecer os critérios de inclusão para participar deste estudo. O protocolo de avaliação do procedimento proposto é viável e ao final será capaz de mostrar, se de fato há ou não benefício para um doente debilitado e sofrido, quando hoje as únicas soluções são o transplante de pulmão ou a cirurgia redutora de volume pulmonar.Descritores: Enfisema pulmonar; Doença pulmonar obstrutiva crônica; Pulmão hipertransparente. * Study carried out at

Validação técnica da drenagem pulmonar como tratamento do enfisema pulmonar avançado: estudo anatômico em cadáveres

“…( 9 , 10 ) However, in his study of collateral ventilation, Macklem, in 1978, ( 13 ) hypothetically mentions creation of communication between the emphysematous parenchyma and the environment as a way of decompressing trapped air.…”

“…To provide one more treatment alternative for the relief of the debilitating effects of advanced emphysema, surgeons at our institution presented, in 2008, a new protocol ( 9 ) for the treatment of patients with either homogeneous or heterogeneous pulmonary emphysema who, even after having undergone the gold standard treatment, continue to have disabling dyspnea.…”

“…In our original study, ( 9 ) the inclusion criteria were as follows: having emphysema; being 75 years or younger; being disabled despite having undergone the gold standard treatment (pulmonary rehabilitation); having chest X-ray findings of lung hyperinflation and HRCT findings of homogeneous or heterogeneous emphysema; having a post-bronchodilator FEV 1 less than 35-30% of predicted, a TLC greater than 250% of predicted, and a DLCO less than 50% of predicted; having stopped smoking at least three months before the procedure; and being on a waiting list for LTx or LVRS.…”