collateral ventilation
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CHEST Journal ◽  
2021 ◽  
Vol 160 (4) ◽  
pp. A1876
Author(s):  
T. David Koster ◽  
Karin Klooster ◽  
Hallie McNamara ◽  
Narinder SHARGILL ◽  
Sri Radhakrishnan ◽  
...  

Respiration ◽  
2021 ◽  
pp. 1-12
Author(s):  
Ralf Eberhardt ◽  
Dirk-Jan Slebos ◽  
Felix J.F. Herth ◽  
Kaid Darwiche ◽  
Manfred Wagner ◽  
...  

<b><i>Rationale:</i></b> The long-term safety and effectiveness of bronchoscopic lung volume reduction with Zephyr endobronchial valves in subjects with severe homogeneous emphysema with little to no collateral ventilation beyond 3 months have yet to be established. <b><i>Methods:</i></b> Ninety-three subjects were randomized to either bronchoscopic lung volume reduction with Zephyr valves or standard of care (SoC) (1:1). Zephyr valve subjects were assessed at 3, 6, and 12 months. SoC subjects were assessed at 3 and 6 months; they were then offered crossover to Zephyr valve treatment. <b><i>Results:</i></b> The mean group difference (Zephyr valve – SoC) for change in FEV<sub>1</sub> from baseline to 6 months was 16.3 ± 22.1% (mean ± SD; <i>p</i> &#x3c; 0.001). Secondary outcomes showed the mean between-group difference for the six-minute walk distance of +28.3 ± 55.3 m (<i>p</i> = 0.016); St. George’s Respiratory Questionnaire, −7.51 ± 9.56 points (<i>p</i> &#x3c; 0.001); modified Medical Research Council, −0.42 ± 0.81 points (<i>p</i> = 0.019); BODE index, −0.85 ± 1.39 points (<i>p</i> = 0.006); and residual volume of −430 ± 830 mL (<i>p</i> = 0.011) in favor of the Zephyr valve group. At 6 months, there were significantly more responders based on the minimal clinically important difference for these same measures in the Zephyr valve versus the SoC group. The clinical benefits were persistent at 12 months. The percentage of subjects with respiratory serious adverse events was higher in the Zephyr valve group compared to SoC during the first 30 days post-procedure but not statistically different for the Zephyr valve and SoC groups from 31 days to 6 months, and stable in the Zephyr valve group out to 12 months. There were 2 deaths in the SoC group in the 31-day to 6-month period and none in the Zephyr valve group out to 12 months. <b><i>Conclusions:</i></b> Bronchoscopic lung volume reduction with Zephyr valves in subjects with severe homogeneous emphysema and little to no collateral ventilation provides clinically meaningful change from baseline in lung function, quality of life, exercise capacity, dyspnea, and the BODE index at 6 months, with benefits maintained out to 12 months.


2021 ◽  
pp. 00191-2021
Author(s):  
T. David Koster ◽  
Karin Klooster ◽  
Hallie McNamara ◽  
Narinder S. Shargill ◽  
Sri Radhakrishnan ◽  
...  

IntroductionBronchoscopic lung volume reduction with endobronchial valves is an important treatment option in selected patients with severe emphysema and absence of collateral ventilation (CV) in the treatment target lobe. The Chartis system provides an important physiological assessment of the presence or absence of collateral ventilation. We aimed to evaluate a new feature and determine whether low flow during a Chartis measurement is predictive for the absence of collateral ventilation, and whether this allows for a procedure to be shortened by earlier terminating the Chartis measurement. This is measured with the “Volume Trend for the previous 20 s” (VT20).MethodsWe retrospectively evaluated 249 Chartis assessments of patients scheduled for bronchoscopic lung volume reduction procedures. The VT20 was calculated, and several thresholds were compared between patients with collateral ventilation (CV positive) and without collateral ventilation (CV negative).Results100% of the CV negative patients reached a threshold of VT20 ≤6 mL, whereas all CV positive patients reached a VT20 ≥7 mL. The median “time saved” between VT20=6 mL and end of assessment was 60 s (range 5 to 354 s).ConclusionThe threshold of VT20 ≤6 mL is a reliable method to exclude the presence of collateral ventilation when air flow rates are low and can therefore reduce bronchoscopic lung volume procedure times.


2021 ◽  
Vol 8 (2) ◽  
pp. 41-45
Author(s):  
Joseph Mammarappallil ◽  
Neil R. MacIntyre ◽  
Kamran Mahmood ◽  
Samantha J. Womack ◽  
H Cecil Charles

Collateral Ventilation (CV) has become an important clinical issue with the increasing use of bronchoscopic lung volume reduction (BLVR) using endobronchial valve surgery in patients with severe COPD. The endobronchial valve BLVR procedure often uses one way valves to occlude segmental bronchi in lung regions with severe overinflation resulting from airway narrowing and collapse during exhalation. For BLVR to succeed, CV to the treated region must be minimal or absent. Current approaches to evaluating CV for both planning and follow-up of BLVR procedures involve CT imaging to assess fissure closure. Current techniques to assess regional lung function (including CV) are limited. Standard pulmonary function testing involving analysis of inert gas wash-in/wash-out can only provide statistical distributions without anatomic correlates. Herein we propose the use of fluorine magnetic resonance imaging of biologically inert perfluorinated gas mixed with oxygen to evaluate regional ventilation, in particular, interlobar collateral ventilation. We have evaluated normal subjects and subjects diagnosed with chronic obstructive pulmonary disease and have observed gas transfer at lobar fissures consistent with collateral ventilation.


Author(s):  
Fei Yao ◽  
Weibing Wu ◽  
Quan Zhu ◽  
Rong Zhai ◽  
Xinfeng Xu ◽  
...  

Respiration ◽  
2020 ◽  
Vol 99 (6) ◽  
pp. 516-520 ◽  
Author(s):  
Jorrit B.A. Welling ◽  
T. David Koster ◽  
Jorine E. Hartman ◽  
Marlies van Dijk ◽  
Huib A.M. Kerstjens ◽  
...  

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