Effect of Lung-Volume–Reduction Surgery in Patients with Severe Emphysema

Geddes, Duncan M.; Davies, Martin; Koyama, Hiroshi; Hansell, David M.; Pastorino, Ugo; Pepper, John; Agent, Penny; Cullinan, Paul; MacNeill, Stephanie J; Goldstraw, Peter

doi:10.1056/nejm200007273430402

Cited by 355 publications

(205 citation statements)

References 17 publications

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“…SZEKELY et al [191] reported that a 6-MWD ,200 m before or after pulmonary rehabilitation is an excellent preoperative predictor of unacceptable post-operative mortality at 6 months, with a specificity of 84%. Similarly, a randomised controlled study by GEDDES et al [192], to evaluate the effect of LVRS in patients with emphysema, indicated that a preoperative shuttle walk test (SWT) distance ,150 m was a predictor of high peri-operative mortality. Interestingly, in the National Emphysema Treatment Trial [193], exercise capacity was used to identify the subgroup of patients for whom LVRS has the most favourable survival and cost-effectiveness compared with medical therapy.…”

Section: Timed Walking Testsmentioning

confidence: 99%

“…KADIKAR et al [194] retrospectively observed the sensitivity and specificity of the 6-MWT to predict death in 145 patients who had undergone lung transplantation; a distance ,400 m appeared be an appropriate marker for listing patients for transplant. For LVRS, the threshold for a successful outcome has been reported to be ,150 m for the SWT [192] or 200 m for the 6-MWT [191].…”

Section: Timed Walking Testsmentioning

confidence: 99%

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Recommendations on the use of exercise testing in clinical practice

Palange¹,

Ward²,

Carlsen³

et al. 2006

European Respiratory Journal

549

390

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Evidence-based recommendations on the clinical use of cardiopulmonary exercise testing (CPET) in lung and heart disease are presented, with reference to the assessment of exercise intolerance, prognostic assessment and the evaluation of therapeutic interventions (e.g. drugs, supplemental oxygen, exercise training). A commonly used grading system for recommendations in evidence-based guidelines was applied, with the grade of recommendation ranging from A, the highest, to D, the lowest.For symptom-limited incremental exercise, CPET indices, such as peak O 2 uptake (V9O 2 ), V9O 2 at lactate threshold, the slope of the ventilation-CO 2 output relationship and the presence of arterial O 2 desaturation, have all been shown to have power in prognostic evaluation. In addition, for assessment of interventions, the tolerable duration of symptom-limited high-intensity constant-load exercise often provides greater sensitivity to discriminate change than the classical incremental test. Field-testing paradigms (e.g. timed and shuttle walking tests) also prove valuable.In turn, these considerations allow the resolution of practical questions that often confront the clinician, such as: 1) ''When should an evaluation of exercise intolerance be sought?''; 2) ''Which particular form of test should be asked for?''; and 3) ''What cluster of variables should be selected when evaluating prognosis for a particular disease or the effect of a particular intervention?''

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Section: Timed Walking Testsmentioning

confidence: 99%

Section: Timed Walking Testsmentioning

confidence: 99%

Recommendations on the use of exercise testing in clinical practice

Palange¹,

Ward²,

Carlsen³

et al. 2006

European Respiratory Journal

549

390

View full text Add to dashboard Cite

show abstract

“…Lung volume reduction surgery (LVRS) has been shown to have a beneficial effect on lung function, submaximal exercise capacity and quality of life in selected patients with severe emphysema [1][2][3], although individual results classically demonstrate large scatter [1]. Initially, it was proposed that the increase in maximal expiratory flow (MEF) observed after LVRS was mainly due to an improvement in lung elastic recoil after the surgical procedure [4].…”

mentioning

confidence: 99%

Effects of lung volume reduction surgery in hamsters with elastase-induced emphysema

Marchand¹,

Leyn²,

Gayan‐Ramirez³

et al. 2002

European Respiratory Journal

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Lung volume reduction surgery (LVRS) has been shown to improve respiratory mechanics in selected patients with severe emphysema. This is thought to be due to an improvement in lung elastic recoil. This study was aimed at gaining further understanding about the effects of LVRS on respiratory mechanics and airway function.Control hamsters instilled with saline (Ctrl; n=8) were compared with emphysematous animals that underwent either a sham operation (Sham; n=7) or an LVRS (LVRS; n=7).As expected, there was a significant increase in the static lung volumes in the Sham as compared to the Ctrl group and a significant decrease of these volumes in LVRS as compared to the Sham group. Surprisingly, emphysema was associated with a significant increase and LVRS with a significant decrease in vital capacity. Despite a tendency toward an increase in lung compliance as compared to Sham, indices of maximal expiratory flows tended to decrease with LVRS. As opposed to humans, there was no change in the distribution of airway diameters in Sham compared to Ctrl.These findings appear to be largely explained by the high compliance of the hamster chest wall. This allows for better matching between the emphysematous lung and the chest-wall sizes than in humans.

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“…Several large case series from centres with considerable experience have demonstrated a low operative mortality (v5%) and significant improvements in symptoms, pulmonary function, and exercise capacity in the short and intermediate term after LVRS [3][4][5][6][7]. Three prospective randomised studies confirmed functional improvements in the operated group, whereas this was not observed in the conservativelytreated control arm [8][9][10]. Nonetheless, controversy remained with respect to potential benefits and risk of the procedure [11,12].…”

mentioning

confidence: 96%

“…Initial enthusiasm for LVRS was soon dampened due to reports on surgical mortality rates of up to 17% [9]. A review of Medicare claims showed a 6-month mortality rate of 16.9% [15].…”

mentioning

confidence: 99%