Physiological characterization of variability in response to lung volume reduction surgery

2003 ◽  
Vol 94 (1) ◽  
pp. 20-30 ◽  
Author(s):  
Edward P. Ingenito ◽  
Stephen H. Loring ◽  
Marilyn L. Moy ◽  
Steven J. Mentzer ◽  
Scott J. Swanson ◽  
...  
Keyword(s):  
Lung Volume ◽  
Airway Resistance ◽  
Vital Capacity ◽  
Forced Expiratory Volume ◽  
Volume Reduction ◽  
Lung Mechanics ◽  
Lung Volume Reduction Surgery ◽  
Lung Volume Reduction ◽  
Recoil Pressure ◽  
Physiological Characterization

This paper examines potential physiological mechanisms responsible for improvement after lung volume reduction surgery (LVRS). In 25 patients (63 ± 9 yr; 11 men, 14 women), spirometry [forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC)], lung volumes [residual volume (RV) and total lung capacity (TLC)], small airway resistance, recoil pressures, and respiratory muscle contractility (RMC) were measured before and 4–6 mo after LVRS. Data were interpreted to assess how changes in each component of lung mechanics affect overall function. Among responders (ΔFEV1 ≥ 12%; 150 ml), improvement was primarily due to an increase in FVC, not to FEV1-to-FVC ratio. Among nonresponders, FEV1, FVC, and RV/TLC did not change after surgery, although recoil pressure increased in both groups. Both groups experienced a reduction in RMC after LVRS. In conclusion, LVRS improves function in emphysema by resizing the lung relative to the chest wall by reducing RV. LVRS does not change airway resistance but decreases RMC, which attenuates the potential benefits of LVRS that are generated by reducing RV/TLC. Among nonresponders, recoil pressure increased out of proportion to reduced volume, such that no increase in vital capacity or improvement in FEV1 occurred.

scholarly journals Individualised risk in patients undergoing lung volume reduction surgery: the Glenfield BFG score

2017 ◽  
Vol 49 (6) ◽  
pp. 1601766 ◽  
Author(s):  
Neil J. Greening ◽  
Paul Vaughan ◽  
Inger Oey ◽  
Michael C. Steiner ◽  
Mike D. Morgan ◽  
...  
Keyword(s):  
Risk Score ◽  
Lung Volume ◽  
Characteristic Curve ◽  
Risk Groups ◽  
Forced Expiratory Volume ◽  
Volume Reduction ◽  
Chronic Obstructive ◽  
Lung Volume Reduction Surgery ◽  
Lung Volume Reduction ◽  
Obstructive Pulmonary Disease

Lung volume reduction surgery (LVRS) has been shown to be beneficial in patients with chronic obstructive pulmonary disease, but there is low uptake, partly due to perceived concerns of high operative mortality. We aimed to develop an individualised risk score following LVRS.This was a cohort study of patients undergoing LVRS. Factors independently predicting 90-day mortality and a risk prediction score were identified. Reliability of the score was tested using area under the receiver operating characteristic curve (AUROC).237 LVRS procedures were performed. The multivariate analysis factors associated independently with death were: body mass index (BMI)<18.5 kg·m−2 (OR 2.83, p=0.059), forced expiratory volume in 1 s (FEV1)<0.71 L (OR 5.47, p=0.011) and transfer factor of the lung for carbon monoxide (TLCO) <20% (OR 5.56, p=0.031). A risk score was calculated and total score assigned. AUROC for the risk score was 0.80 and a better predictor than individual components (p<0.01). The score was stratified into three risk groups. Of the total patients, 46% were classified as low risk. Similar improvements in lung function and health status were seen in all groups. The score was introduced and tested in a further 71 patients. AUROC for 90-day mortality in this cohort was 0.84.It is possible to provide an individualised predictive risk score for LVRS, which may aid decision making for both clinicians and patients.

Predictors of Improvement in FEV 1 (Forced Expiratory Volume in 1 s) After Lung Volume Reduction Surgery

Surgery Today ◽  
2000 ◽  
Vol 30 (4) ◽  
pp. 328-332 ◽  
Author(s):  
Hiroshi Date ◽  
Keiji Goto ◽  
Ryo Souda ◽  
Shigehito Endou ◽  
Motoi Aoe ◽  
...  
Keyword(s):  
Lung Volume ◽  
Forced Expiratory Volume ◽  
Volume Reduction ◽  
Lung Volume Reduction Surgery ◽  
Lung Volume Reduction

scholarly journals Identification of target zones for lung volume reduction surgery using three-dimensional computed tomography rendering

2020 ◽  
Vol 6 (3) ◽  
pp. 00305-2020
Author(s):  
Claudio Caviezel ◽  
Tamara Froehlich ◽  
Didier Schneiter ◽  
Urs Muehlematter ◽  
Thomas Frauenfelder ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Lung Volume ◽  
New Technology ◽  
Pulmonary Function Tests ◽  
Three Dimensional ◽  
Forced Expiratory Volume ◽  
Volume Reduction ◽  
Lung Volume Reduction Surgery ◽  
Target Zones ◽  
Lung Volume Reduction

BackgroundThe key issues for performing lung volume reduction surgery (LVRS) is the identification of the target zones. Recently introduced three-dimensional computed tomography rendering methods are used to identify the morphological distribution and its severity of lung emphysema by densitometry. We demonstrate a new software for emphysema imaging and show the pre- and post-operative results in patients undergoing LVRS planned based on this new technology.MethodsA real-time three-dimensional image analysis software system was used pre- and 3 months post-operatively in five patients with heterogeneous emphysema and a single patient with homogeneous morphology scheduled for LVRS. Focus was on low attenuation areas with <950 HU, distribution on both lungs and the value of the three-dimensional images for planning surgery. Functional outcome was assessed by pulmonary function tests after 3 months.ResultsFive patients underwent bilateral LVRS and one patient had unilateral LVRS. All patients showed a median increase in forced expiratory volume in 1 s of 70% (range 30–120%), compared with baseline values. Hyperinflation (expressed as residual volume/total lung capacity ratio) was reduced by 30% (range 5–32%). In the patients with heterogeneous emphysema, the pre- and post-operative computed tomography scans and the densitometries showed a decrease in low attenuation areas by 23% (right side) and by 17% (left side), respectively.ConclusionWe demonstrate three-dimensional computed tomography-rendered images for planning personalised remodelling of hyperinflated lungs using LVRS. This user-friendly software has the potential to assist surgeons and interventional pulmonologists to select patients and to visualise target areas in LVRS procedures.

Cardiac Morphology in Lung Volume Reduction Surgery for Endstage Emphysema

2003 ◽  
Vol 11 (1) ◽  
pp. 48-51
Author(s):  
Wickii T Vigneswaran ◽  
Eva V Chomka ◽  
Vladmir Jelnin ◽  
M Janeen Hernan ◽  
Francis J Podbielski
Keyword(s):  
Lung Volume ◽  
Right Heart Catheterization ◽  
Forced Expiratory Volume ◽  
Left Ventricular ◽  
Volume Reduction ◽  
Heart Catheterization ◽  
Lung Volume Reduction Surgery ◽  
Lung Volume Reduction ◽  
Cardiac Morphology ◽  
And Function

Lung volume reduction surgery for endstage emphysema produces significant improvements in various pulmonary parameters, but its effects on cardiac morphology and function have not been clearly defined. Ten patients scheduled for lung volume reduction surgery underwent pulmonary function testing, right-heart catheterization, and electron beam computed tomography of the heart. These studies were repeated 12–16 weeks after the procedure. Quantitative assessments of right and left ventricular function and left ventricular muscle mass were obtained. Postoperatively, all patients showed significant improvements in forced expiratory volume at one minute compared to the preoperative value (1.57 ± 0.24 L versus 1.10 ± 0.21 L), predicted residual lung volume (115% ± 15% versus 205% ± 15%), and 6-minute walk test (318 ± 17 m versus 267 ± 24 m). There were no significant differences between postoperative and preoperative right ventricular end-diastolic volumes (167.3 ± 21.2 mL versus 169.2 ± 17.3 mL) or left ventricular end-diastolic volumes (112.5 ± 10.2 mL versus 119.2 ± 9.7 mL).

Change in quality of life after lung volume reduction surgery

1999 ◽  
Vol 8 (6) ◽  
pp. 389-396 ◽  
Author(s):  
KL Anderson
Keyword(s):  
Quality Of Life ◽  
Functional Status ◽  
Lung Volume ◽  
Forced Expiratory Volume ◽  
Volume Reduction ◽  
Lung Volume Reduction Surgery ◽  
Lung Volume Reduction ◽  
Quality Of Life Scale ◽  
Life Scale

BACKGROUND: Lung volume reduction surgery has been reintroduced for treatment of severe emphysema. Goals of this surgery are to decrease dyspnea, increase exercise tolerance, and improve quality of life. OBJECTIVES: To describe the effect of lung volume reduction surgery on overall quality of life, disease severity, dyspnea, and functional status during the first 12 months after surgery. METHODS: Data were collected for 20 patients (mean age, 63 years; 15 men) before and 3, 6, and 12 months after lung volume reduction surgery. Disease severity was determined by percentage of forced expiratory volume in 1 second (compared with established norms); functional status, by a 6-minute walk test; dyspnea, by scores on a visual analog scale; and overall quality of life, by scores on the Quality of Life Scale. RESULTS: Scores on the Quality of Life Scale and distance walked increased significantly after surgery, and these increases were maintained at 6 and 12 months, respectively. Percentage of forced expiratory volume in 1 second increased significantly 3 months after surgery, but changes at 6 and 12 months were not significant. Changes in dyspnea ratings were not significant. No pattern of correlations among study variables was significant. CONCLUSIONS: Quality of life and functional status are improved after lung volume reduction surgery. Because none of the physiological variables were related to changes in quality of life, alternative explanations for these improvements must be explored in future studies.

Dynamic lung mechanics in late-stage emphysema before and after lung volume reduction surgery

2007 ◽  
Vol 155 (3) ◽  
pp. 234-242 ◽  
Author(s):  
A. Cortney Henderson ◽  
Edward P. Ingenito ◽  
Edgardo S. Salcedo ◽  
Marilyn L. Moy ◽  
John J. Reilly ◽  
...  
Keyword(s):  
Lung Volume ◽  
Late Stage ◽  
Volume Reduction ◽  
Lung Mechanics ◽  
Lung Volume Reduction Surgery ◽  
Lung Volume Reduction ◽  
Before And After

scholarly journals Lower lobe lung volume reduction surgery: a case report

2020 ◽  
Vol 2020 (9) ◽  
Author(s):  
Mohammed J Al-Jaghbeer ◽  
Umur Hatipoglu ◽  
Sid Murthy ◽  
Yvonne Meli ◽  
Atul C Mehta
Keyword(s):  
Lung Volume ◽  
Lower Lobe ◽  
Supplemental Oxygen ◽  
Volume Reduction ◽  
Chronic Obstructive ◽  
Lung Volume Reduction Surgery ◽  
Lung Volume Reduction ◽  
Obstructive Pulmonary Disease ◽  
Heterogeneous Distribution ◽  
Optimal Medical Management

ABSTRACT Lung volume reduction surgery (LVRS) is an option for select patients with advanced chronic obstructive pulmonary disease (COPD). Current guidelines recommend LVRS for patients with appropriate physiology and heterogeneous distribution of emphysema predominately involving upper lobes. We present an unusual case of a 72-year-old male with an advanced COPD who suffered with recurrent exacerbations despite optimal medical management. He underwent a two-stage bilateral lower lobe LVRS for heterogeneous lower lobe emphysema via video-assisted thoracoscopic (VATS) approach. This resulted in a significant subjective as well as objective improvement in his pulmonary functions, 6-min walk distance and subsequent discontinuation of supplemental oxygen.

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