Endobronchial Valves for the Treatment of Advanced Emphysema

Klooster, Karin; Slebos, Dirk‐Jan

doi:10.1016/j.chest.2020.12.007

Cited by 55 publications

(74 citation statements)

References 48 publications

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“…The assessment of collateral ventilation status (presence or absence of collateral ventilation) is crucial in determining the eligibility of a patient for valve treatment for bronchoscopic lung volume reduction. The Chartis System provides a physiological assessment of airway under simulated conditions of valve placement in the target lobe to confirm the presence or absence of collateral ventilation (5,7,9,13). It is important to get a valid Chartis assessment, but sometimes the measurement can be challenging (10,14,15).…”

Section: Discussionmentioning

confidence: 99%

“…The presence or absence of collateral ventilation can be predicted based on the fissure completeness between lobes [ 7 , 8 ]. However, a more accurate assessment can be performed using the Chartis Pulmonary Assessment System (Pulmonx Inc., Redwood City, CA, USA), which provides a physiological assessment of airflow through the target lobe [ 5 , 9 ]. The Chartis system consists of a catheter with a balloon at the distal tip, designed to be inserted into the airways through the working channel of a bronchoscope.…”

Section: Introductionmentioning

confidence: 99%

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An adjusted and time-saving method to measure collateral ventilation with Chartis

et al. 2021

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IntroductionBronchoscopic lung volume reduction with endobronchial valves is an important treatment option in selected patients with severe emphysema and absence of collateral ventilation (CV) in the treatment target lobe. The Chartis system provides an important physiological assessment of the presence or absence of collateral ventilation. We aimed to evaluate a new feature and determine whether low flow during a Chartis measurement is predictive for the absence of collateral ventilation, and whether this allows for a procedure to be shortened by earlier terminating the Chartis measurement. This is measured with the “Volume Trend for the previous 20 s” (VT20).MethodsWe retrospectively evaluated 249 Chartis assessments of patients scheduled for bronchoscopic lung volume reduction procedures. The VT20 was calculated, and several thresholds were compared between patients with collateral ventilation (CV positive) and without collateral ventilation (CV negative).Results100% of the CV negative patients reached a threshold of VT20 ≤6 mL, whereas all CV positive patients reached a VT20 ≥7 mL. The median “time saved” between VT20=6 mL and end of assessment was 60 s (range 5 to 354 s).ConclusionThe threshold of VT20 ≤6 mL is a reliable method to exclude the presence of collateral ventilation when air flow rates are low and can therefore reduce bronchoscopic lung volume procedure times.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

An adjusted and time-saving method to measure collateral ventilation with Chartis

et al. 2021

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“…Although there seems to be some space to extend the inclusion criteria for treatment with endobronchial valves to treat emphysema patients (“marginal cases”), this is more the exception than the rule and it is strongly advised to discuss all qualified patients by an experienced multidisciplinary team and it is important to consider the risks in this patient group. 3 4 5 22…”

Section: Treatment Options For Emphysemamentioning

confidence: 99%

Bronchoscopic Lung Volume Reduction for Emphysema: Review and Update

Koster

Dijk

Slebos

2022

Semin Respir Crit Care Med

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In carefully selected patients with severe chronic obstructive pulmonary disease, characterized by emphysema and hyperinflation, lung volume reduction is an option to reduce lung hyperinflation, improve lung function, quality of life, and exercise capacity. Currently, there are several bronchoscopic and surgical treatment options to achieve lung volume reduction. It is important to carefully phenotype these patients, to select the optimal treatment option, with consideration of possible adverse events or contraindications, and it is highly recommended to discuss these treatment strategies in a multidisciplinary team. The treatment with one-way endobronchial valves has been investigated most extensively and more data are available regarding the treatment of more “marginal cases,” or subsequent lung volume reduction surgery. Other bronchoscopic lung volume reduction options include treatment with coils, thermal vapor ablation, and sclerosant agents. In this review, we aim to summarize the current clinical evidence on the bronchoscopic lung volume reduction therapies and important aspects regarding optimal patient selection.

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“…RV/TLC is a predictor for mortality too, indicating the importance of the marker [ 3 , 4 ]. Furthermore, both RV and RV/TLC are the key pulmonary function inclusion criteria for lung volume reduction treatment options [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

“…The CT scans are used for a descriptive evaluation mostly in terms of emphysema phenotyping, as well as a quantitative evaluation, and consist of a scan acquisition in inspiration and expiration. Quantitative analysis refers to the amount of emphysema, lobe volumes and fissure integrity scoring [ 5 , 6 ].The volume of the lungs in inspiration and expiration scans is analogous to the TLC and RV, respectively, normally derived by body plethysmography. The CT scans are commonly performed with use of a voice recording instructing the patient.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of spirometry-gated computed tomography to measure lung volumes in emphysema patients

et al. 2021

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IntroductionIn emphysema patients, being evaluated for bronchoscopic lung volume reduction (BLVR), accurate measurement of lung volumes is important. Total Lung Capacity (TLC) and Residual Volume (RV) are commonly measured by body-plethysmography, but can also be derived from chest computed tomography (CT). Spirometry-gated CT scanning potentially improves the agreement of CT and body-plethysmography.ObjectiveTo compare lung volumes derived from spirometry-gated CT and “breath-hold-coached” CT to the reference standard: body-plethysmography.MethodsIn this single centre retrospective cohort study, emphysema patients, evaluated for BLVR, underwent body-plethysmography, inspiration (TLC) and expiration (RV) CT-scan with spirometer guidance (“gated group”) or with breath-hold-coaching (“non-gated group”). Quantitative analysis was used to calculate lung volumes from the CT.ResultsWe included 200 patients (age 62±8 years, FEV1 29.2±8.7%, TLC 7.50±1.46 L, RV 4.54±1.07 L). The mean CT-derived TLC was 280(±340)ml lower compared to body-plethysmography in the gated group (n=100), and 590(±430)ml lower for the non-gated group (n=100) (both p<0.001). The mean CT-derived RV was 300(±470)ml higher in the gated group and 700(±720)ml higher in the non-gated group (both p<0.001). Pearson correlation factors were 0.947 for TLC gated, 0.917 for TLC non-gated, 0.823 for RV gated, 0.693 for RV non-gated, 0.539 for %RV/TLC gated and 0.204 for %RV/TLC non-gated. The differences between the gated and non-gated CT results for TLC and RV were significant for all measurements (p<0.001).ConclusionIn severe COPD patients with emphysema, CT-derived lung volumes are strongly correlated to body-plethysmography lung volumes, and especially for RV, more accurate when using spirometry-gating.

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Endobronchial Valves for the Treatment of Advanced Emphysema

Cited by 55 publications

References 48 publications

An adjusted and time-saving method to measure collateral ventilation with Chartis

An adjusted and time-saving method to measure collateral ventilation with Chartis

Bronchoscopic Lung Volume Reduction for Emphysema: Review and Update

Evaluation of spirometry-gated computed tomography to measure lung volumes in emphysema patients

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