Clinical vignette of bronchoscopic thermal vapour ablation: Malaysians’ first experience

We report a case of severe emphysema with bullae in a patient who underwent the new technique of bronchoscopic lung volume reduction to the right upper lobe. He was symptomatic with breathlessness and frequent exacerbations. He was not deemed suitable for a surgical lung volume reduction or bullectomy due to a very low forced expiratory volume in one second (FEV1). Endobronchial valves were not considered due to the incomplete fissures. The case was carefully screened, and was discussed in a multidisciplinary meeting prior to the final decision. This was the first case in Malaysia of bronchoscopic thermal vapour ablation (BTVA) for severe advanced emphysema. Multiple experts were involved prior, during and after the procedure. Despite having a poor lung reserve, he came through the procedure successfully with no immediate complications. His serial spirometry showed a 50% improvement at six months compared to baseline. This case highlights the important role of a multidisciplinary meeting, expert opinion and the careful selection of which patients should undergo BTVA. The procedure should be carried out at a centre of excellence in order to achieve a successful procedure.

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Physiological characterization of variability in response to lung volume reduction surgery

Journal of Applied Physiology ◽

10.1152/japplphysiol.00898.2001 ◽

2003 ◽

Vol 94 (1) ◽

pp. 20-30 ◽

Cited By ~ 28

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.

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

European Respiratory Journal ◽

10.1183/13993003.01766-2016 ◽

2017 ◽

Vol 49 (6) ◽

pp. 1601766 ◽

Cited By ~ 7

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.

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Implementation of Bronchoscopic Lung Volume Reduction Using One-Way Endobronchial Valves: A Retrospective Single-Centre Cohort Study

Respiration ◽

10.1159/000520885 ◽

2021 ◽

pp. 1-9

Author(s):

Rein Posthuma ◽

Anouk W. Vaes ◽

Kim H. M. Walraven ◽

Peyman Sardari Nia ◽

Jan U. Schreiber ◽

...

Keyword(s):

Lung Volume ◽

Real Life ◽

High Volume ◽

Forced Expiratory Volume ◽

Outcome Data ◽

Volume Reduction ◽

Small Subset ◽

Lung Volume Reduction ◽

Invasive Treatment

Background: Bronchoscopic lung volume reduction (BLVR) using 1-way endobronchial valves (EBV) has become a guideline treatment in patients with advanced emphysema. Evidence from this minimally invasive treatment derives mainly from well-designed controlled trials conducted in high-volume specialized intervention centres. Little is known about real-life outcome data in hospitals setting up this novel treatment and which favourable conditions are required for a continuous successful program. Objectives: In this study, we aim to evaluate the eligibility rate for BLVR and whether the implementation of BLVR in our academic hospital is feasible and yields clinically significant outcomes. Method: A retrospective evaluation of patients treated with EBV between January 2016 and August 2019 was conducted. COPD assessment test (CAT), forced expiratory volume in 1 s (FEV1), residual volume (RV), and 6-min walking test (6MWT) were measured at baseline and 3 months after intervention. Paired sample t tests were performed to compare means before and after intervention. Results: Of 350 subjects screened, 283 (81%) were not suitable for intervention mostly due to lack of a target lobe. The remaining 67 subjects (19%) underwent bronchoscopic assessment, and if suitable, valves were placed in the same session. In total, 55 subjects (16%) were treated with EBV of which 10 did not have complete follow-up: 6 subjects had their valves removed because of severe pneumothorax (n = 2) or lack of benefit (n = 4) and the remaining 4 had missing follow-up data. Finally, 45 patients had complete follow-up at 3 months and showed an average change ± SD in CAT −4 ± 6 points, FEV1 +190 ± 140 mL, RV −770 ± 790 mL, and +37 ± 65 m on the 6MWT (all p < 0.001). After 1-year follow-up, 34 (76%) subjects had their EBV in situ. Conclusion: Implementing BLVR with EBV is feasible and effective. Only 16% of screened patients were eligible, indicating that this intervention is only applicable in a small subset of highly selected subjects with advanced emphysema, and therefore a high volume of COPD patients is essential for a sustainable BLVR program.

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Endoscopic lung volume reduction with endobronchial valves in very low DLCO patients: results from the German Registry (Lungenemphysemregister e.V.)

ERJ Open Research ◽

10.1183/23120541.00449-2020 ◽

2020 ◽

pp. 00449-2020

Author(s):

Pavlina Lenga ◽

Christoph Ruwwe-Glösenkamp ◽

Christian Grah ◽

Joachim Pfannschmidt ◽

Jens Rückert ◽

...

Keyword(s):

Quality Of Life ◽

Adverse Events ◽

Exercise Capacity ◽

Lung Volume ◽

Forced Expiratory Volume ◽

Volume Reduction ◽

Lung Volume Reduction ◽

Lung Emphysema

BackgroundEndoscopic lung volume reduction (ELVR) with valves has been suggested to be the key strategy for patients with severe emphysema and concomitant low diffusion capacity of the lung for carbon monoxide (DLCO). However, robust evidence is still missing. We therefore aim to compare clinical outcomes in relation to DLCO for patients treated with ELVR.MethodsWe assessed DLCO at baseline and 3-months follow-up and compared pre- and postprocedural pulmonary function test (PFT), quality of life, exercise capacity and adverse events. This is a retrospective subanalysis of prospectively collected data from the German Lung Emphysema Registry.Results121 patients treated with ELVR were analysed. 34 patients with a DLCO ≤20% and 87 patients with a DLCO >20% showed similar baseline characteristics. After ELVR, there was a decrease of residual volume (both p<0.001 to baseline) in both groups and both demonstrated better quality of life (p<0.01 to baseline). Forced expiratory volume in 1 s (FEV1) improved significantly only in patients with a DLCO >20% (p<0.001 to baseline). Exercise capacity remained almost unchanged in both groups (p=0.3). The most frequent complication for both groups was a pneumothorax (DLCO ≤20%: 17.6% versus DLCO >20%: 16.1%; p=0.728). However, there were no significant differences in other adverse events between both groups.ConclusionsELVR improves lung function as well as quality of life in patients with DLCO >20% and DLCO ≤20%. Adverse events did not differ between groups. Therefore, ELVR should be considered as a treatment option, even in patients with a very low DLCO.

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Nursing care of the thoracoscopic lung volume reduction patient

American Journal of Critical Care ◽

10.4037/ajcc1996.5.6.412 ◽

1996 ◽

Vol 5 (6) ◽

pp. 412-419

Author(s):

KJ Vaca ◽

JF Osterloh ◽

CJ Daake ◽

NR Noedel

Keyword(s):

Quality Of Life ◽

Pulmonary Function ◽

Nursing Care ◽

Lung Volume ◽

Forced Expiratory Volume ◽

Minute Volume ◽

Volume Reduction ◽

Lung Volume Reduction ◽

Prolonged Air Leak

BACKGROUND: Several methods to surgically enhance pulmonary function and improve the quality of life in patients with bullous emphysema are currently being evaluated. One of these methods, lung volume reduction, is performed in patients with bullous emphysema that can no longer be well managed with medical therapy. OBJECTIVES: The focus of this article is to review bullectomy via unilateral thoracoscopy with an endoscopic stapler in the management of end-stage pulmonary emphysema, and to discuss nursing care of these patients. METHODS: An experimental study was used, including review of the literature and analysis of clinical experience using chi-square and t test analyses of pre- and postoperative variables. RESULTS: At 3-month follow-up there were significant improvements in forced expiratory volume in 1 second, forced vital capacity, minute volume ventilation, partial pressure of oxygen, residual volume, and 6-minute walk when pre- and postoperative parameters were compared. Operative mortality was 4%, with the most common complication being prolonged air leak, occurring in 30% of patients studied. CONCLUSIONS: There is now consistent preliminary information to support the concept that lung volume reduction improves pulmonary function and quality of life in a significant percentage of patients.

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

Surgery Today ◽

10.1007/s005950050595 ◽

2000 ◽

Vol 30 (4) ◽

pp. 328-332 ◽

Cited By ~ 5

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

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Quasilobar minimalist lung volume reduction surgery

European Journal of Cardio-Thoracic Surgery ◽

10.1093/ejcts/ezab174 ◽

2021 ◽

Author(s):

Eugenio Pompeo ◽

Ahmed Elkhouly ◽

Paola Rogliani ◽

Mario Dauri ◽

Michael Peer ◽

...

Keyword(s):

Lung Volume ◽

Study Groups ◽

Forced Expiratory Volume ◽

Volume Reduction ◽

Perioperative Outcomes ◽

Morbidity Rate ◽

Residual Volume ◽

Control Groups ◽

Lung Volume Reduction ◽

Thoracic Epidural

Abstract OBJECTIVES Our goal was to assess the results and the costs of the quasilobar minimalist (QLM) thoracoscopic lung volume reduction (LVR) surgical method developed to minimize the trauma from the operation and the anaesthesia and to maximize the effect of the lobar volume reduction. METHODS Forty patients with severe emphysema underwent QLM-LVR that entailed adoption of sole intercostal block analgesia and lobar plication through a single thoracoscopic incision. Results were compared after propensity matching with 2 control groups undergoing non-awake resectional LVR with double-lumen tracheal intubation or awake non-resectional LVR by plication with thoracic epidural anaesthesia. As a result, we had 3 matched groups of 30 patients each. RESULTS Baseline forced expiratory volume in 1 s, residual volume, the 6-min walking test and the modified Medical Research Council dyspnoea index were 0.77 ± 0.18, 4.97 ± 0.6, 328 ± 65 and 3.3 ± 0.7, respectively, with no intergroup difference after propensity score matching. The visual pain score was better (P < 0.007), the hospital stay was shorter (P < 0.04) and overall costs were lower (P < 0.04) in the QLM-LVR group than in the control groups. The morbidity rate was lower with QLM-LVR than with non-awake resectional-LVR (P = 0.006). Significant improvements (P < 0.001) occurred in all study groups during the follow-up period. At 24 months, improvements in residual volume and dyspnoea index were significantly better with QLM-LVR (P < 0.04). CONCLUSIONS QLM-LVR proved safe and showed better perioperative outcomes and lower procedure-related costs than the control groups. Similar clinical benefit occurred at 12 months, but absolute improvements in residual volume and dyspnoea index were better in the QLM-LVR group at 24 months.

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A Patient with GOLD Stage 3 COPD « cured » by One-Way Endobronchial Valves

Medicina ◽

10.3390/medicina55030065 ◽

2019 ◽

Vol 55 (3) ◽

pp. 65

Author(s):

Eric Marchand ◽

Jean-Paul d’Odemont ◽

Michael V Dupont

Keyword(s):

Lung Volume ◽

Lower Lobe ◽

Volume Reduction ◽

Chronic Obstructive ◽

Therapeutic Approaches ◽

Lung Volume Reduction ◽

Obstructive Pulmonary Disease ◽

Gold Stage ◽

Appropriate Therapy ◽

The Right

Lung hyperinflation is a main determinant of dyspnoea in patients with chronic obstructive pulmonary disease (COPD). Surgical or bronchoscopic lung volume reduction are the most efficient therapeutic approaches for reducing hyperinflation in selected patients with emphysema. We here report the case of a 69-year old woman with COPD (GOLD stage 3-D) referred for lung volume reduction. She complained of persistent disabling dyspnoea despite appropriate therapy. Chest imaging showed marked emphysema heterogeneity as well as severe hyperinflation of the right lower lobe. She was deemed to be a good candidate for bronchoscopic treatment with one-way endobronchial valves. In the absence of interlobar collateral ventilation, 2 endobronchial valves were placed in the right lower lobe under general anaesthesia. The improvement observed 1 and 3 months after the procedure was such that the patient no longer met the pulmonary function criteria for COPD. The benefit persisted after 3 years.

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Spontaneous rupture of the right hemidiaphragm after video-assisted lung volume reduction operation

The Annals of Thoracic Surgery ◽

10.1016/s0003-4975(02)03478-1 ◽

2002 ◽

Vol 74 (3) ◽

pp. 929-931 ◽

Cited By ~ 5

Author(s):

Serban C Stoica ◽

Stewart R Craig ◽

Sing Yang Soon ◽

William S Walker

Keyword(s):

Lung Volume ◽

Spontaneous Rupture ◽

Volume Reduction ◽

Lung Volume Reduction ◽

Reduction Operation ◽

Video Assisted ◽

The Right

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Intrabullous blood injection for lung volume reduction

Thorax ◽

10.1136/thx.2007.087957 ◽

2008 ◽

Vol 63 (6) ◽

pp. 564-565 ◽

Cited By ~ 13

Author(s):

S Kanoh ◽

H Kobayashi ◽

K Motoyoshi

Keyword(s):

Lung Volume ◽

Lung Diseases ◽

Autologous Blood ◽

Volume Reduction ◽

Body Plethysmography ◽

Lung Volume Reduction ◽

Emphysematous Lung ◽

Autologous Blood Injection ◽

Blood Injection ◽

The Right

Bronchoscopic treatment for emphysematous lung diseases has attracted clinical attention, and several different approaches are being investigated. We present a case of emphysematous bullae that was effectively treated with a newly developed bronchoscopic intervention, autologous blood injection. A 59-year-old man was referred to our institution with exertional dyspnoea. Chest CT showed emphysema and bullae with a diameter of 12 cm in the right upper lobe. Bronchoscopic treatment was introduced as an alternative to surgery. Autologous blood and fibrinogen solution were infused into bullae via the transbronchial catheter, under fluoroscopic guidance. Post-treatment CT showed marked contraction of bullae to a diameter of 3 cm, corresponding to a volume reduction of 800 ml on body plethysmography. A significant reduction in dyspnoea was also noted. This therapeutic approach is less invasive and may represent a good option for reducing lung volume.

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