Thoracoscopic lung volume reduction surgery for pulmonary emphysema patients with severe hypercapnia

Mitsui, Kazuhiro; Kurokawa, Yukinori; Kaiwa, Yoshihiro; Ando, Kenjiro; Kurosawa, Hájíme; Hida, Wataru; Satomi, Sasumu

doi:10.1007/bf02919542

Cited by 12 publications

(5 citation statements)

References 26 publications

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“…Tsunezuka et al [2000] 3 >50 mmHg Decrease in PaCO 2 from 52 ± 1 mmHg to 48 ± 2 mmHg. Mitsui et al [2001] 6 ⩾60 mmHg Decrease in PaCO 2 from 70.4 ± 9.4 mmHg to 46.9 ± 3.4 mmHg. Improvement in pulmonary function.…”

Section: Discussionmentioning

confidence: 94%

“…Although hypercapnia was found to increase the mortality rate associated with lung volume reduction surgery, it did not clearly identify patients for whom surgery posed a substantially higher risk than medical treatment [National Emphysema Treatment Trial Research Group, 2001]. Other studies on lung volume reduction surgery [Argenziano et al 1996; Albert et al 1998; Wisser et al 1998; O’Brien et al 1999; Shade et al 1999; Tsunezuka et al 2000; Mitsui et al 2001] analyzing patients with hypercapnic respiratory failure showed improvements of hypercapnia, pulmonary function, exercise capacity, dyspnea and quality of life. The studies are summarized in Table 3.…”

Section: Discussionmentioning

confidence: 99%

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Endoscopic lung volume reduction coil treatment in patients with chronic hypercapnic respiratory failure: an observational study

Simon

Harbaum

Oqueka

et al. 2016

Ther Adv Respir Dis

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Background:Endoscopic lung volume reduction coil (LVRC) treatment is an option for selected patients with severe emphysema. In the advanced stages, emphysema leads to respiratory failure: hypoxemia and eventually chronic hypercapnic respiratory failure. It can be hypothesized that LVRC treatment, a procedure targeting hyperinflation and thereby reducing ventilatory workload, may be especially beneficial in patients with chronic hypercapnic respiratory failure. This study was conducted to gain first insights into the effects and the safety of LVRC treatment in patients with emphysema and chronic hypercapnic respiratory failure.Methods:A retrospective observational study conducted in the Department of Respiratory Medicine at the University Medical Center Hamburg-Eppendorf, Germany on all patients with chronic hypercapnic respiratory failure in whom bilateral LVRC treatment was performed between 1 April 2012 and 30 September 2015.Results:During the study period, bilateral LVRC treatment was performed in 10 patients with chronic hypercapnic respiratory failure. Compared with baseline, bilateral LVRC treatment led to a significant increase in mean forced expiratory volume in one second (FEV1) from 0.5 ± 0.1 l to 0.6 ± 0.2 l (p = 0.004), a decrease in residual volume (RV) from 6.1 ± 0.9 l to 5.6 ± 1.1 l (p = 0.02) and a reduction in partial pressure of carbon dioxide in arterial blood (PaCO2) from 53 ± 5 mmHg to 48 ± 4 mmHg (p = 0.03). One case of hemoptysis requiring readmission to hospital was the only severe adverse event.Conclusions:LVRC treatment was safe and effective in patients with nonsevere chronic hypercapnic respiratory failure. It led not only to an improvement in lung function but also to a significant decrease in PaCO2.

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Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

Endoscopic lung volume reduction coil treatment in patients with chronic hypercapnic respiratory failure: an observational study

Simon

Harbaum

Oqueka

et al. 2016

Ther Adv Respir Dis

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“…Between October 1996 and May 1999, 18 male patients with severe emphysema aged 65.2 ± 6.4 years (mean ± SD) underwent LVRS by video‐assisted thoracoscopic surgery using staple resection at the Tohoku University Hospital (LVRS group) 11,12 . Each patient underwent bilateral simultaneous procedures.…”

Section: Methodsmentioning

confidence: 99%

Improved activities of daily living, psychological state and health‐related quality of life for 12 months following lung volume reduction surgery in patients with severe emphysema

Gotö

Kurosawa²,

Mori³

et al. 2004

Respirology

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“…Several investigators have suggested impaired outcome and higher mortality in patients with hypercapnia, 81,93,201,202 whereas others have not confirmed this finding. 102,[203][204][205][206] The most definitive data come from the NETT where baseline paCO 2 was not associated with impaired outcome despite over 30% of randomized patients exhibiting baseline hypercapnia. 20 Figure 7 Kaplan-Meier estimates of the probability of death as a function of the number of months after randomization in the National Emphysema Treatment Trial (NETT) in (A) high-risk patients, (B) patients with upper lobe predominant emphysema and low, postrehabilitation exercise capacity, and (C) patients with non-upper lobe predominant emphysema and high, postrehabilitation exercise capacity.…”

Section: Physiological Featuresmentioning

confidence: 99%

Surgical Therapy for Chronic Obstructive Pulmonary Disease

Martínez

Chang

2005

Seminars in Respiratory and Critical Care Medicine

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Many patients with severe chronic obstructive pulmonary disease (COPD) experience incapacitating breathlessness and exercise limitation. Multiple surgical techniques have been utilized to achieve resection of giant, localized bullae with documented short-term benefit in pulmonary function and dyspnea in highly selected patients. The poorest long-term outcome has been noted in those with greater degrees of emphysema in the remaining lung, greater underlying chronic bronchitis, and a bulla occupying less than one third of the hemithorax, particularly if compressed normal lung is not evident. Lung volume reduction surgery (LVRS) in the absence of giant bullae has become more widely accepted in selected patients. Bilateral LVRS procedures appear to result in greater short-term improvement than unilateral LVRS, whereas physiological benefits appear similar with video-assisted thoracoscopy (VATS) or median sternotomy (MS) techniques. Improvement in dyspnea and health status after LVRS has been documented and appears to be better preserved over longer-term follow-up than physiological improvement. Clear direction has been provided in identifying optimal candidates for bilateral LVRS; patients with a postbronchodilator forced expiratory volume in 1 second (FEV (1)) < or = 20% predicted and a diffusing capacity for carbon monoxide (DL (CO)) < or = 20% predicted or homogeneous emphysema exhibit a much higher mortality with LVRS than with medical management. Patients with upper-lobe predominant emphysema and a low postrehabilitation exercise tolerance exhibited a decreased risk of mortality after LVRS. Patients with non-upper lobe predominant emphysema on high-resolution computed tomography (HRCT) and a high postrehabilitation exercise capacity exhibit an increased risk of death after LVRS. Patients with upper lobe predominant emphysema and a high postrehabilitation exercise capacity or patients with non-upper lobe predominant emphysema and a low postrehabilitation exercise capacity do not have a survival advantage or disadvantage, whereas those with upper lobe predominant emphysema treated surgically are more likely to improve their exercise capacity after surgery. Lung transplantation is an option for a more limited number of patients. Consistent short-term spirometric improvement after both single- and double-lung transplant has been documented. Long-term results of lung transplantation are limited by significant complications that impair survival; an approximately 80% 1-year, 50% 5-year, and 35% 10-year survival has been reported. Bronchiolitis obliterans is the most important long-term complication of lung transplantation resulting in decreased pulmonary function. In general, a COPD patient can be considered an appropriate candidate for transplantation when the FEV (1) is below 25% predicted and/or the paCO (2) is > or = 55 mm Hg.

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Thoracoscopic lung volume reduction surgery for pulmonary emphysema patients with severe hypercapnia

Cited by 12 publications

References 26 publications

Endoscopic lung volume reduction coil treatment in patients with chronic hypercapnic respiratory failure: an observational study

Endoscopic lung volume reduction coil treatment in patients with chronic hypercapnic respiratory failure: an observational study

Improved activities of daily living, psychological state and health‐related quality of life for 12 months following lung volume reduction surgery in patients with severe emphysema

Surgical Therapy for Chronic Obstructive Pulmonary Disease

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