Thoracoscopic Lung Volume Reduction Surgery Reduces Dyspnea and Improves Exercise Capacity in Patients with Emphysema

Keller, Cesar A.; Ruppel, Gregg; Hibbett, Alan; Osterloh, Joan; Naunheim, Keith S.

doi:10.1164/ajrccm.156.1.9609101

Cited by 60 publications

(50 citation statements)

References 15 publications

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“…Recent reports, however, have showed significantly improved carbon monoxide transfer factor (TL,CO) in some studies [4,50,54,60,66], while in others there was a tendency towards improvement [39,48,51,53,67]. Overall, this suggests that LVRS may lead to recruitment of the capillary bed.…”

Section: Pathophysiological Basis Of Functional Impairment In Emphysemamentioning

confidence: 83%

“…In one study [48] reporting the results of static lung volumes, TLC was not significantly reduced after unilateral thoracoscopic LVRS using a stapling device. Nevertheless, RV was significantly reduced after the surgical procedure in this study [48]. Volumes measured by dilution techniques have only scarcely been reported.…”

Section: Pathophysiological Basis Of Functional Impairment In Emphysemamentioning

confidence: 97%

“…Three groups reported improved FEV1/VC ratios, using stapling techniques and with most patients operated on bilaterally [52,61,62]. Others found a lack of significant improvement in FEV1/VC [4,48,53,59]. When reported, airway resistance and specific airway conductance were always improved after surgery [4,53,56,59,63,64].…”

Section: Pathophysiological Basis Of Functional Impairment In Emphysemamentioning

confidence: 97%

“…Indeed, arterial oxygen tension (Pa,O 2 ) increased in all studies reporting this variable [4, 39, 41±45, 48, 50, 52±54, 56±58, 67, 68], although the improvement was only statistically significant in half of the studies [42,45,48,50,53,56,58,68]. Similarly, arterial carbon dioxide tension (Pa,CO 2 ) either showed a tendency to decrease [4,39,43,44,48,52,53,56,58] or a statistically significant decrease [41,42,45,54,57,67,68].…”

Section: Pathophysiological Basis Of Functional Impairment In Emphysemamentioning

confidence: 99%

“…Moreover, there is a decrease in TLC, in FRC and in residual volume (RV) measured by plethysmography [4, 39, 41±44, 49±51, 53, 54, 56±60]. In one study [48] reporting the results of static lung volumes, TLC was not significantly reduced after unilateral thoracoscopic LVRS using a stapling device. Nevertheless, RV was significantly reduced after the surgical procedure in this study [48].…”

Section: Pathophysiological Basis Of Functional Impairment In Emphysemamentioning

confidence: 99%

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Physiological basis of improvement after lung volume reduction surgery for severe emphysema: where are we?

Marchand¹,

Gayan‐Ramirez²,

Leyn³

et al. 1999

Eur Respir J

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Physiological basis of improvement after lung volume reduction surgery for severe emphysema: where are we? E. Marchand, G. Gayan-Ramirez, P. De Leyn, M. Decramer. #ERJ Journals Ltd 1999. ABSTRACT: Lung volume reduction surgery has become an accepted therapeutic option to relieve the symptoms of selected patients with severe emphysema. In a majority of these patients, it causes objective as well as subjective functional improvement. A proper understanding of the physiological determinants underlying these beneficial effects appears very important in order to better select patients for the procedure that is currently largely carried out on an empirical basis.Lung volume reduction surgery has two distinct effects. Firstly, it causes an increased elastic recoil, which at least partially explains the enhanced maximal expiratory flow. Secondly, it is associated with a reduction of hyperinflation which allows for an increase in global inspiratory muscle strength and in diaphragmatic contribution to tidal volume as well as a decrease in the inspiratory elastic load imposed by the chest wall. Taken together, these effects result in a reduced work of breathing and in an enhanced maximal ventilation which both contribute to the increased exercise capacity and reduced dyspnoea after surgery. The improved lung recoil and the reduced hyperinflation after volume reduction surgery were the primary postulates upon which the usual selection criteria for the procedure were based. It is now likely that these are correct. Nevertheless, some patients do not benefit from lung volume reduction surgery and the current literature does not allow for a refinement of the selection process from a physiological point of view.The exact mechanisms underlying the improvement in lung recoil, lung mechanics, and respiratory muscle function remain incompletely understood. Moreover, the effects of lung volume reduction surgery on gas exchange and pulmonary haemodynamics still need to be more fully investigated. An analysis of the characteristics of patients who do not benefit from the procedure and the development of an animal model for lung volume reduction surgery would probably help address these important issues. Eur Respir J 1999; 13: 686±696.

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Section: Pathophysiological Basis Of Functional Impairment In Emphysemamentioning

confidence: 83%

Section: Pathophysiological Basis Of Functional Impairment In Emphysemamentioning

confidence: 97%

Section: Pathophysiological Basis Of Functional Impairment In Emphysemamentioning

confidence: 97%

Section: Pathophysiological Basis Of Functional Impairment In Emphysemamentioning

confidence: 99%

Section: Pathophysiological Basis Of Functional Impairment In Emphysemamentioning

confidence: 99%

See 3 more Smart Citations

Physiological basis of improvement after lung volume reduction surgery for severe emphysema: where are we?

Marchand¹,

Gayan‐Ramirez²,

Leyn³

et al. 1999

Eur Respir J

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Management of Dyspnea in Patients With Far-Advanced Lung Disease

Luce

Luce²

2001

JAMA

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Dyspnea is a common problem among patients with interstitial fibrosis, lung cancer, cystic fibrosis, and chronic obstructive pulmonary disease. The slow but steady progression of such diseases, often punctuated by acute exacerbations or secondary illnesses, can lead to decision-making dilemmas among patients and their caregivers, such as when to accept mechanical ventilation, when to forgoe aggressive therapies, and when to make formal end-of-life care plans. Two cases, a 74-year-old woman with dyspnea secondary to emphysema and a 65-year-old woman with recurrent lung cancer and severe exertional fatigue and dyspnea, illustrate how dyspneic patients approaching the end of life can be evaluated and treated. Four management strategies for dyspnea are discussed: reducing ventilatory impedance, reducing ventilatory demand, improving respiratory muscle function, and altering central perception. Physicians should encourage end-stage lung disease patients and their families to discuss issues such as hospitalization and mechanical ventilation, to prepare advance directives, and to participate in a plan to manage their dyspnea.

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Management of Dyspnea in Patients With Far-Advanced Lung Disease

Markowitz¹

2002

JAMA

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EVERE DYSPNEA IS COMMON AMONG PATIENTS WITH end-stage lung disease but is disabling and challenging to treat. Using interviews with 2 patients with severe dyspnea, one with end-stage chronic obstructive pulmonary disease and the other with lung cancer, Drs Luce and Luce discuss approaches to helping alleviate dyspnea for patients nearing the end of life, and maximizing comfort and function for the patients' remaining time. THE PATIENTS' STORIESMrs D is a 74-year-old woman, followed up for the past 4 years for management of dyspnea secondary to emphysema. Her pulmonologist, Dr M, relates that she has had a substantial active (25 pack-years) and passive (husband smoked 2 packs per day) tobacco exposure. She is thin, with pursed-lip breathing and sternocleidomastoid contractions. Pulmonary function tests demonstrate severe airflow obstruction, air trapping, and marked reduction in diffusing capacity.Portable oxygen allows her to continue activities outside of the home, including shopping, visiting family, and attending professional football games-her passion. On supplementary oxygen (4 L /min) her symptoms have improved, with increased exercise tolerance and resolution of pedal edema. She uses a variable regimen of inhaled ipratropium bromide, albuterol, and fluticasone propionate, in addition to oral prednisone.Mrs I is a 65-year-old woman diagnosed with limitedstage small-cell lung cancer in 1995. She was treated with chemotherapy (cisplatin and etoposide) and radiation, with substantial decrease in the size of the tumor. She is now cared for by Dr K, a pulmonary oncologist. In December 1999, she experienced a central nervous system (CNS) recurrence of her cancer and was treated with radiation and corticosteroids. Though her neurologic symptoms improved, she became extremely fatigued and dyspneic upon exertion. Simple activities of daily living are quite difficult, in part due to her shortness of breath, and she has opted to forgo further antineoplastic therapy in favor of home hospice care. PERSPECTIVESMrs D and Mrs I, as well as their physicians and family members, were interviewed in June 2000 by Perspectives editors. MRS D: It's kind of hard to get your breath back. If you're riding a horse or you're swimming you can get the breath in and out fast enough. But with shortness of breath, coming out takes longer. It's the only way I can explain it . . . Once I lose it, it's kind of hard to catch it. That's what scares me.DR M (Mrs D's pulmonologist): Probably the hardest thing pulmonologists do is help patients prepare for the end of life, particularly patients with chronic obstructive pulmonary disease, as this preterminal period can be so prolonged. While it's important to address end-of-life care early, I am concerned that Dyspnea is a common problem among patients with interstitial fibrosis, lung cancer, cystic fibrosis, and chronic obstructive pulmonary disease. The slow but steady progression of such diseases, often punctuated by acute exacerbations or secondary illnesses, can lead to decisionmaking dilemmas...

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Thoracoscopic Lung Volume Reduction Surgery Reduces Dyspnea and Improves Exercise Capacity in Patients with Emphysema

Cited by 60 publications

References 15 publications

Physiological basis of improvement after lung volume reduction surgery for severe emphysema: where are we?

Physiological basis of improvement after lung volume reduction surgery for severe emphysema: where are we?

Management of Dyspnea in Patients With Far-Advanced Lung Disease

Management of Dyspnea in Patients With Far-Advanced Lung Disease

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