Endoscopic lung volume reduction (eLVR) with endobronchial valves (EBV) in patients with hypercapnic respiratory failure

Trudzinski, Franziska; Ballek, D; Kaestner, F; Bals, Robert; Fähndrich, Sebastian; Lepper, Philipp M.

doi:10.1183/13993003.congress-2015.pa797

Cited by 1 publication

(3 citation statements)

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“…However, the exact effects of valve implantation in hypercapnic patients are still limited. In line with our findings, in a retrospective analysis, Trudzinski et al [13] found a significant decrease in pCO 2 from 55 mm Hg to 50 mm Hg after 3 months in 13 hypercapnic patients treated with one-way valves. There are also some case reports supporting the view that ELVR with valves might be a treatment strategy for patients with severe bullous emphysema and concomitant severe hypercapnia [31, 32].…”

Section: Discussion/conclusionsupporting

confidence: 92%

“…Implantation of one-way valves leads to a deflation of lung emphysema with partial amelioration of breathing mechanics. Recent studies have demonstrated significant improvements in lung function parameters, exercise capacity, and quality of life, with an overall reasonable safety profile with the Zephyr ® valve system (Pulmonx, Redwood City, CA, USA) (10)(11)(12)(13) or the Spiration Valve Sys-tem (Olympus, Center Valley, PA, USA) [9,10]. Nevertheless, a mandatory criterion for endoscopic lung volume reduction (ELVR) is pCO 2 <45-50 mm Hg.…”

Section: Introductionmentioning

confidence: 99%

“…Nevertheless, a mandatory criterion for endoscopic lung volume reduction (ELVR) is pCO 2 <45-50 mm Hg. Available data on patients with pCO 2 >45 mm Hg come from small retrospective studies on the implantation of endobronchial coils or valves that have been either uncontrolled or underpowered to detect meaningful clinical effects [11][12][13]. As such, these findings are still inconclusive, and a subject of debate is whether one-way valve implantation is a safe and efficient treatment approach for patients with significant hypercapnia.…”

Section: Introductionmentioning

confidence: 99%

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Endoscopic Lung Volume Reduction with One-Way Valves in Patients with Severe Chronic Obstructive Pulmonary Disease with Hypercapnia

et al. 2022

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Background: Robust clinical evidence on the efficacy and safety of endoscopic lung volume reduction (ELVR) with one-way valves in patients with severe lung emphysema with chronic hypercapnic respiratory failure is lacking. Objective: The aim of this study was to compare patient characteristics, clinical outcome measures, and incidences of adverse events between patients with severe COPD undergoing ELVR with one-way valves and with either a partial pressure of carbon dioxide (pCO2) of ≤45 mm Hg or with pCO2 >45 mm Hg. Methods: This was a multicentre prospective study of patients with severe lung disease who were evaluated based on lung function, exercise capacity (6-min walk test [6-MWT]), and quality-of-life tests. Results: Patients with pCO2 ≤45 mm Hg (n = 157) and pCO2 >45 mm Hg (n = 40) showed similar baseline characteristics. Patients with pCO2 ≤45 mm Hg demonstrated a significant increase in forced expiratory volume in 1 s (p < 0.001), a significant decrease in residual volume (RV) (p < 0.001), and significant improvements in the quality of life and 6-MWT at the 3-month follow-up. Patients with pCO2 >45 mm Hg had significant improvements in RV only (p < 0.05). There was a significant decrease in pCO2 between baseline and follow-up in hypercapnic patients, relative to the decrease in patients with pCO2 ≤45 mm Hg (p = 0.008). Patients who were more hypercapnic at baseline showed a greater reduction in pCO2 after valve placement (r = −0.38, p < 0.001). Pneumothorax was the most common adverse event in both groups. Conclusions: ELVR with one-way valves seems clinically beneficial with a remarkably good safety profile for patients with chronic hypercapnic respiratory failure.

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Section: Discussion/conclusionsupporting

confidence: 92%