Nursing care of the thoracoscopic lung volume reduction patient

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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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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Lung Volume Reduction for Emphysema and The Canadian Lung Volume Reduction (CLVR) Surgery Project

Canadian Respiratory Journal ◽

10.1155/1999/817812 ◽

1999 ◽

Vol 6 (1) ◽

pp. 26-32 ◽

Cited By ~ 10

Author(s):

John D Miller ◽

Richard A Malthaner ◽

Charles H Goldsmith ◽

Gerard Cox ◽

David Higgins ◽

...

Keyword(s):

Quality Of Life ◽

Pulmonary Function ◽

Exercise Capacity ◽

Lung Volume ◽

Medical Management ◽

Volume Reduction ◽

Airflow Limitation ◽

Lung Volume Reduction ◽

Preliminary Results

OBJECTIVE: To review the literature on the surgical treatment of emphysema and to present preliminary results from a pilot study of lung volume reduction (LVR) surgery.DESIGN: Case series of consecutive patients referred for LVR surgery. Outcomes were quality of life, pulmonary function and exercise capacity.SETTING: Two university-affiliated hospitals in Ontario.POPULATION STUDIED: Patients between the ages of 40 and 75 years with emphysema who had severe airflow limitation, hyperinflation of the lungs and impaired quality of life.INTERVENTION: Bilateral reductions with multiple wedge resections of the lung using a linear stapling device with bovine pericardial buttressing were completed via a median sternotomy.MAIN RESULTS: Of 50 patients referred, 24 underwent LVR surgery. Mean age of the cohort was 63 years. Operative 30-day or in hospital mortality was 8%. Two other patients (8%) died from respiratory failure after LVR within the first year. Postoperative complications included prolonged air leaks (six of 24), tracheobronchitis (five of 24), mechanical ventilation (four of 24) and pneumonia (three of 24). Mean length of stay was 18 days (median 12 days). At one year, there was a sustained decrease in total lung capacity from 133% to 123% predicted. There were improvements in forced expiratory volume in 1 s, from 22% of predicted preoperatively to 32% postoperatively, and in 6 min walk performance, from 345 to 381 m. Improvements were also noted in the quality of life assessments.CONCLUSIONS: Preliminary results suggest that LVR surgery is feasible and may improve the patient’s quality of life, pulmonary function and exercise capacity. A randomized clinical trial comparing LVR plus the best medical management with the best medical management alone is currently underway to determine the effectiveness of LVR.

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Change in quality of life after lung volume reduction surgery

American Journal of Critical Care ◽

10.4037/ajcc1999.8.6.389 ◽

1999 ◽

Vol 8 (6) ◽

pp. 389-396 ◽

Cited By ~ 9

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.

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