scholarly journals Endoscopic lung volume reduction coils for patients with severe emphysema – a single-center retrospective analysis

2020 ◽  
Author(s):  
Sebastian Mang ◽  
Niklas Hus ◽  
Hans-Joachim Schäfers ◽  
Holger Wehrfritz ◽  
Alexander Massmann ◽  
...  
Keyword(s):  
Overall Survival ◽  
Lung Function ◽  
Lung Volume ◽  
Volume Reduction ◽  
Walking Distance ◽  
Chronic Obstructive ◽  
Lung Volume Reduction ◽  
Bilateral Pneumothorax ◽  
Severe Emphysema ◽  
Major Complications

Abstract BackgroundPatients with chronic obstructive pulmonary disease (COPD) and lung emphysema may benefit from surgical or endoscopic lung volume reduction (ELVR). Previously reported outcomes of nitinol-coil-based endoscopic lung volume reduction techniques have been ambiguous.Objectives The analysis was done to analyze outcomes of ELVR with nitinol-coils in patients with severe pulmonary emphysema.MethodsFrom September 2013 to November 2014, our center performed a total of 41 coil implantations on 29 patients with severe emphysema. Coils were bronchoscopically placed during general anesthesia. 12 out of 29 patients received contralateral treatments 4-6 weeks later to avoid bilateral pneumothorax. Lung function and 6-minute walking distance were assessed one week prior, one week after as well as 6 to 12 months after the procedure. Patients were followed up to 48 months after ELVR and overall mortality was compared to a historic cohort.ResultsWhile coil-based ELVR led to significant short-term improvement of vital capacity (VC, + 0.14 l ± 0.39 l, p = 0.032) and hyperinflation (ΔRV / TLC -2.32% ± 6.24%, p = 0.022), no significant changes were observed in 6-minute walking distance (6-MWD) or forced expiratory volume in one second (FEV1). Benefits were short-lived, with only 15.4% and 14.3% of patients showing sustained improvements in FEV1 or residual volume (RV) after 6 months. Adverse events included hemoptysis (40 %) and pneumothorax (3.4 %), major complications occurred in 6.9% of cases. Overall survival without lung transplant was 63.8% after 48 months following ELVR, differing insignificantly from what BODE indices of patients would have predicted as median 4-year survival (57%) at the time of ELVR treatment.ConclusionEndoscopic lung volume reduction coils can achieve small and short-lived benefits in lung function at the cost of major complications in a highly morbid cohort. Treatment failed to improve 4-year overall survival. ELVR coils are not worthwhile the risk for most patients with severe emphysema.

scholarly journals Bronchoscopic lung volume reduction in chronic obstructive pulmonary disease: History and progress

2015 ◽  
Vol 3 (4) ◽  
pp. 147-150
Author(s):  
Gang Hou
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Lung Volume ◽  
Clinical Effect ◽  
Volume Reduction ◽  
Chronic Obstructive ◽  
Lung Volume Reduction ◽  
Obstructive Pulmonary Disease ◽  
Severe Emphysema ◽  
Development Procedure

Abstract Emphysema is one of the pathological manifestations of chronic obstructive pulmonary disease (COPD), which leads to lung hyperinflation, decreased activity of the diaphragm, decreased compliance of the lung, and difficulties in gas exchange. The clinical effect of pharmacological treatment for patients with severe emphysema is limited. In recent years, the emergence of bronchoscopic lung volume reduction (BLVR) has opened up the possibility for the management of COPD with severe emphysema. The article aims to summarize the development, procedure, and methodology of BLVR as well as its clinical efficacy.

scholarly journals Predictive value of Chartis measurement for lung function improvements in bronchoscopic lung volume reduction

2020 ◽  
Vol 14 ◽  
pp. 175346662093250
Author(s):  
Johannes Wienker ◽  
Rüdiger Karpf-Wissel ◽  
Faustina Funke ◽  
Christian Taube ◽  
Julia Wälscher ◽  
...  
Keyword(s):  
Lung Function ◽  
Lung Volume ◽  
A Priori ◽  
Chronic Obstructive Lung Disease ◽  
Forced Expiratory Volume ◽  
Volume Reduction ◽  
Functional Improvement ◽  
Chronic Obstructive ◽  
Lung Volume Reduction ◽  
Obstructive Pulmonary Disease

Background: Bronchoscopic lung volume reduction (BLVR) via valve implantation can be achieved by targeting severely hyperinflated and emphysematously destructed lung areas in patients with chronic obstructive lung disease. Lack of collateral ventilation (CV) is important for good outcomes with BLVR. CV can be measured using the catheter-based Chartis system. The aim of this study was to evaluate the correlation between total exhaled volume drained from the target lobe measured by Chartis and clinical outcomes after BLVR in CV-negative patients. Methods: From January 2016 to March 2019, 60 patients were included in this retrospective single-center analysis. Drained volume (TVol) measured by Chartis was recorded and compared with lung function and physical performance parameters. Outcome variables included the percentage change in lung function [forced expiratory volume in 1 s (FEV1), residual volume (RV), and inspiratory vital capacity (IVC)]. Secondary outcomes were the degree of target lobe volume reduction (TLVR), change in 6-min walk distance (6MWD), and change in chronic obstructive pulmonary disease (COPD) assessment test (CAT) score. Results: Drained volume correlated significantly with post-BLVR change in FEV1 ( r = 0.663), IVC ( r = 0.611), RV ( r = −0.368), and TLVR ( r = 0.635) (all p < 0.05). In a priori-defined patient subgroups based on drained volume [<100 ml ( n = 19), 100−400 ml ( n = 33), and >400 ml ( n = 8)]; mean changes in FEV1 were 2.6%, 17.4%, and 51.3%; in RV were −3.9%, −10.6%, and −23.8%; in IVC were −4.0%, 10.6%, and 62.4%; and in TLVR were 525 ml (39%), 1375 ml (73%) and 1760 ml (100%), respectively. There were no significant correlations between absolute and percentage changes in 6MWD and the CAT score. Lung volume reduction was diagnosed in 32 (53%) cases. Conclusion: Drained volume measured by the Chartis system correlated with functional improvement in CV-negative patients undergoing BLVR. The reviews of this paper are available via the supplemental material section.

scholarly journals Lung Volume Reduction following Recurrent Pneumonia: An Unusual Finding in a COPD Patient

2017 ◽  
Vol 2017 ◽  
pp. 1-4
Author(s):  
Yihenew Negatu ◽  
Philip T. Diaz
Keyword(s):  
Lung Function ◽  
Lung Volume ◽  
Volume Reduction ◽  
Chronic Obstructive ◽  
Lung Volume Reduction ◽  
Recurrent Pneumonia ◽  
Obstructive Pulmonary Disease ◽  
Reduction Techniques ◽  
Anatomic Distribution

Chronic Obstructive Pulmonary Disease (COPD) is a progressive disease. Frequent pneumonias and exacerbations are known to accelerate its progression. We present a case of severe emphysema whose lung function paradoxically improved following recurrent pneumonia, without lung volume reduction surgery (LVRS). A 54-year-old female with severe COPD presented for LVRS evaluation. She was not a candidate for the surgery because of the unsuitable anatomic distribution of her emphysema. The patient experienced recurrent pneumonia over the years but her lung function and oxygen requirement showed marked improvement. Follow-up imaging studies showed decreased lung volumes and focal fibrotic changes. We believe that the improvement in her lung function overtime is the reflection of lung volume reduction as a result of parenchymal remodeling due to repeated lung infection. These findings seen in our patient contribute important information for the continued effort in developing nonsurgical lung volume reduction techniques.

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.

scholarly journals Mechanisms of gas exchange response to lung volume reduction surgery in severe emphysema

2011 ◽  
Vol 110 (4) ◽  
pp. 1036-1045 ◽  
Author(s):  
George Cremona ◽  
Joan A. Barbara ◽  
Teresa Melgosa ◽  
Lorenzo Appendini ◽  
Josep Roca ◽  
...  
Keyword(s):  
Mechanical Properties ◽  
Chronic Obstructive Pulmonary Disease ◽  
Lung Function ◽  
Gas Exchange ◽  
Pulmonary Disease ◽  
Lung Volume ◽  
Chronic Obstructive ◽  
Lung Volume Reduction Surgery ◽  
Lung Volume Reduction ◽  
Obstructive Pulmonary Disease

Lung volume reduction surgery (LVRS) improves lung function, respiratory symptoms, and exercise tolerance in selected patients with chronic obstructive pulmonary disease, who have heterogeneous emphysema. However, the reported effects of LVRS on gas exchange are variable, even when lung function is improved. To clarify how LVRS affects gas exchange in chronic obstructive pulmonary disease, 23 patients were studied before LVRS, 14 of whom were again studied afterwards. We performed measurements of lung mechanics, pulmonary hemodynamics, and ventilation-perfusion (V̇a/Q̇) inequality using the multiple inert-gas elimination technique. LVRS improved arterial Po2 (PaO2) by a mean of 6 Torr ( P = 0.04), with no significant effect on arterial Pco2 (PaCO2), but with great variability in both. Lung mechanical properties improved considerably more than did gas exchange. Post-LVRS PaO2 depended mostly on its pre-LVRS value, whereas improvement in PaO2 was explained mostly by improved V̇a/Q̇ inequality, with lesser contributions from both increased ventilation and higher mixed venous Po2. However, no index of lung mechanical properties correlated with PaO2. Conversely, post-LVRS PaCO2 bore no relationship to its pre-LVRS value, whereas changes in PaCO2 were tightly related ( r2 = 0.96) to variables, reflecting decrease in static lung hyperinflation (intrinsic positive end-expiratory pressure and residual volume/total lung capacity) and increase in airflow potential (tidal volume and maximal inspiratory pressure), but not to V̇a/Q̇ distribution changes. Individual gas exchange responses to LVRS vary greatly, but can be explained by changes in combinations of determining variables that are different for oxygen and carbon dioxide.

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