Lung Volume Reduction Surgery in Ventilator-Dependent COPD Patients

Criner, Gerard J.; O’Brien, Gerard; Furukawa, Satoshi; Cordova, Francis; Swartz, Morris A.; M, Fallahnejad; D’Alonzo, Gilbert E.

doi:10.1378/chest.110.4.877

Cited by 44 publications

(11 citation statements)

References 11 publications

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“…Our experience has been quite different. We (32) have previously shown that LVRS can be safely performed even on ventilated patients with severe hypercapnia (mean Pa CO 2 60 mm Hg). We did not exclude patients in this study based upon initial Pa CO 2 , and in fact included seven patients whose Pa CO 2 level was Ͼ 50 mm Hg.…”

Section: Discussionmentioning

confidence: 96%

Relationship between Resting Hypercapnia and Physiologic Parameters before and after Lung Volume Reduction Surgery in Severe Chronic Obstructive Pulmonary Disease

Shade

Cordova²,

Lando³

et al. 1999

Am J Respir Crit Care Med

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Patients with severe chronic obstructive pulmonary disease (COPD) have varying degrees of hypercapnia. Recent studies have demonstrated inconsistent effects of lung volume reduction surgery (LVRS) on PaCO2; however, most series have excluded patients with moderate to severe hypercapnia. In addition, no study has examined the mechanisms responsible for the reduction in PaCO2 post-LVRS. We obtained spirometry, body plethysmography, diffusion capacity, respiratory muscle strength, 6-min walk test, and incremental symptom-limited maximal exercise data in 33 consecutive patients pre- and 3 to 6 mo post-LVRS, and explored the relationship between changes in PaCO2 and changes in the measured physiologic variables. All patients underwent bilateral LVRS via median sternotomy and stapling resection by the same cardiothoracic surgeon. Patients were 57 +/- 8 yr of age with severe COPD, hyperinflation, and air trapping (FEV1, 0.73 +/- 0.2 L; TLC, 7.3 +/- 1.6 L; residual volume [RV], 4.8 +/- 1.4 L), and moderate resting hypercapnia (PaCO2, 44 +/- 7 mm Hg; range, 32 to 56 mm Hg). Post-LVRS, PaCO2 decreased by 4% (PaCO2 pre 44 +/- 7 mm Hg, PaCO2 post 42 +/- 5 mm Hg; p = 0.003). Patients with higher baseline values of PaCO2 had the greatest reduction in PaCO2 post-LVRS (r = -0.61, p < 0.001). Significant correlations existed between reduction in PaCO2 and changes in FEV1 (r = -0.56; p = 0.0007), maximal inspiratory pressure (PImax) (r = -0.46; p = 0.009), diffusing capacity of the lungs for carbon monoxide (DLCO) (r = -0.47; p = 0.008), and RV/TLC (r = 0.41; p = 0. 02). Correlation existed also between reduction in PaCO2 and breathing pattern at maximal exercise: maximal minute ventilation (V Emax) (r = -0.47; p = 0.009), and tidal volume (VT) (r = -0.40; p = 0.02). The changes in PaCO2 post-LVRS showed marked intersubject variability. We conclude that LVRS, by reducing hyperinflation, air trapping, and improving respiratory muscle function, enables the lung and chest wall to act more effectively as a pump, thereby increasing alveolar ventilation and reducing baseline resting PaCO2. In addition, patients with higher baseline levels of PaCO2 demonstrate the greatest reduction in PaCO2 post-LVRS, and should not be excluded from receiving LVRS.

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Section: Discussionmentioning

confidence: 96%

Relationship between Resting Hypercapnia and Physiologic Parameters before and after Lung Volume Reduction Surgery in Severe Chronic Obstructive Pulmonary Disease

Shade

Cordova²,

Lando³

et al. 1999

Am J Respir Crit Care Med

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“…Although several studies show a relationship between RV/TLC ratio and outcome, in general these relationships have been relatively disappointing. An arterial carbon dioxide tension ofw6.7-7.3 kPa (w50-55 mmHg) has also been related to poor outcome [12,104,105], although this is still debated by other groups [73,[106][107][108]. Finally, a low preoperative exercise capacity (6MWD v200 m) has been related to poor outcome [105].…”

Section: Selection Of Candidatesmentioning

confidence: 99%

Treatment of chronic respiratory failure: lung volume reduction surgery versus rehabilitation

Decramer¹

2003

European Respiratory Journal

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“…Even 18 months after the operation, lung function and exercise tolerance are well maintained. Recently CRINER et al [12] published a report where they operated on three ventilator dependent COPD patients. In all cases there was a successful weaning and an improvement in functional state.…”

Section: Discussionmentioning

confidence: 99%

Lung volume reduction surgery as an emergency and life-saving procedure

Hansson

Jorens²,

Schil³

et al. 1997

Eur Respir J

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Lung volume reduction surgery (LVRS) is emerging as a promising and unique therapeutic option for rigorously selected patients with severe debilitating emphysema. A 51 yr old man with generalized emphysema developed bilateral pneumothoraces during his first holiday abroad. Due to respiratory insufficiency, intubation and mechanical ventilation were necessary. In total, six chest tubes were inserted but massive air leak persisted and his respiratory condition deteriorated due to bronchopneumonia and sepsis. The patient was transferred to Belgium. As a last resort, bilateral LVRS was performed through a median sternotomy. The most diseased areas of the upper lobes containing the air leak were resected bilaterally and a pleurectomy was associated. Three months after operation, there was a remarkable improvement in spirometric values with an increase in forced expiratory volume in one second of almost 100%. The results were sustained after a follow-up of 18 months.In this dramatic case, lung volume reduction surgery proved to be effective, and was even a life saving procedure. Eur Respir J 1997; 10: 2650-2652 Lung volume reduction surgery (LVRS) was originally described by BRANTIGAN and MUELLER [1] in 1957, as a surgical treatment for patients with end-stage emphysema. It was reintroduced by COOPER et al. [2] in 1995, who used the term "pneumectomy" to describe resection of poorly ventilated functionless lung. LVRS has become a novel palliative procedure for a subgroup of patients with advanced emphysema [3]. In this case, we performed LVRS in a ventilator dependent patient with chronic obstructive pulmonary disease (COPD), a situation where LVRS has been considered to be contraindicated. Case reportA 51 yr old man with severe COPD and a predominant emphysema component due to nicotine abuse had a forced expiratory volume in one second (FEV1) of 0.92 L, which was stable and did not improve despite treatment with bronchodilators and steroids. During his holiday in a southern European country, he experienced fever and dyspnoea, and was therefore admitted to a local hospital. Physical examination revealed severe dyspnoea, a decreased consciousness (with a normal cortical and brain stem function), hypercapnia (arterial carbon dioxide tension (Pa,CO 2 ) 9.57 kPa (72 mmHg)), severe obstruction to airflow, expiratory wheezing and fever above 38°C. A chest radiograph showed a bilateral pneumothorax and thus two chest tubes were inserted to treat the pneumothorax. His condition deteriorated rapidly due to respiratory insufficiency and sepsis, and intubation and mechanical ventilation were necessary. Cardiopulmonary resuscitation (CPR) was initiated because of cardiac arrest. After 1 min, the circulatory state was re-established, and an additional four chest tubes with separated suction systems were inserted ( fig. 1). The patient was then transferred to Belgium by a private insurance company.On arrival, the patient was ventilated by a volumecontrolled ventilator, and enormous airleaks were observed CASE STUDY Fig. ...

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Lung Volume Reduction Surgery in Ventilator-Dependent COPD Patients

Cited by 44 publications

References 11 publications

Relationship between Resting Hypercapnia and Physiologic Parameters before and after Lung Volume Reduction Surgery in Severe Chronic Obstructive Pulmonary Disease

Relationship between Resting Hypercapnia and Physiologic Parameters before and after Lung Volume Reduction Surgery in Severe Chronic Obstructive Pulmonary Disease

Treatment of chronic respiratory failure: lung volume reduction surgery versus rehabilitation

Lung volume reduction surgery as an emergency and life-saving procedure

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