Collateral Ventilation Measurement Using Chartis

Abstract

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Endobronchial Valves for the Treatment of Advanced Emphysema

“…Both the Chartis measurement and the placement of the valves can be performed preferably in a single procedure (to avoid additional bronchoscopy-related adverse events 36 ), with deep conscious sedation or with general anesthesia. 3 , 37 , 38 In practice, it turns out that both Chartis and the placement of the valves with general anesthesia is more accurate and easier to perform because there is less coughing, less mucus production, and less mucosal swelling and that the diameter of the airways can be measured more precisely to select the correct valve size for placement. 3 , 4 , 38 The bronchoscopy itself can be performed according to local practice.…”

“… 3 , 37 , 38 In practice, it turns out that both Chartis and the placement of the valves with general anesthesia is more accurate and easier to perform because there is less coughing, less mucus production, and less mucosal swelling and that the diameter of the airways can be measured more precisely to select the correct valve size for placement. 3 , 4 , 38 The bronchoscopy itself can be performed according to local practice. A short course of prophylactic antibiotics and prednisolone can be considered around the treatment period.…”

“…Although patients with very severe COPD can be considered as a high-risk group in relation to the appearance of perioperative complications, anesthesia during these procedures does not cause additional adverse events and can be applied safely. 1 , 3 , 38 The Chartis System 4 , 34 that comprises the balloon catheter and console provides a physiologic measure of collateral ventilation ( Fig 5 ). With the use of the balloon catheter, the treatment target lobe is fully blocked temporarily, with the lobar air able only to escape through central lumen of the catheter, which is measured by the console.…”

“…The entire measurement takes approximately 10 to 15 minutes. 3 The Chartis measurement can also be used as a trial to assess the dependence of the treatment target’s contribution to the entire gas exchange. When using F io 2 levels approximately 30% to 40%, blocking the target should not result in a significant desaturation.…”

“…Bronchoscopic lung volume reduction (BLVR) with one-way endobronchial valve (EBV) is a minimally invasive treatment that has been shown to improve clinical outcomes in patients with advanced emphysema and severe hyperinflation. 1 , 2 Bronchoscopic placement of EBVs in a suitable target lobe, with proven absence of collateral ventilation with the use of the Chartis Pulmonary Assessment System (Pulmonx Corporation, Redwood City, CA), 3 induces a (partial) atelectasis of the target lobe. 4 This atelectasis ensures reduction in residual volume (RV) and results in an improvement in lung function, a greater exercise performance, and a better quality of life ( Table 1 ).…”