No abstract

This multicentre, blinded, sham-controlled study was performed to assess the safety and effectiveness of bronchial valve therapy using a bilateral upper lobe treatment approach without the goal of lobar atelectasis.Patients with upper lobe predominant severe emphysema were randomised to bronchoscopy with (n537) or without (n536) IBV Valves for a 3-month blinded phase. A positive responder was defined as having both a o4-point improvement in St George's Respiratory Questionnaire (SGRQ) and a lobar volume shift as measured by quantitative computed tomography.At 3 months, there were eight (24%) positive responders in the treated group versus none (0%) in the control group (p50.002). Also, there was a significant shift in volume in the treated group from the upper lobes (mean¡SD -7.3¡9.0%) to the non-treated lobes (6.7¡14.5%), with minimal change in the control group (p,0.05). Mean SGRQ total score improved in both groups (treatment: -4.3¡16.2; control: -3.6¡10.7). The procedure and devices were well tolerated and there were no differences in adverse events reported in the treatment and control groups.Treatment with bronchial valves without complete lobar occlusion in both upper lobes was safe, but not effective in the majority of patients.

Our results indicate that the endoscopic treatment of post-intubation tracheal stenoses performed in an expert setting can be considered a safe first-line therapy, leaving some selected cases and the relapsing stenoses, for surgical resection.

No abstract

Acute respiratory acidosis does not affect plasma potassium concentration.