Intrabullous blood injection for lung volume reduction

Kanoh, Soichiro; Kobayashi, Hideo; Motoyoshi, Kazuo

doi:10.1136/thx.2007.087957

Cited by 19 publications

(12 citation statements)

References 11 publications

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“…The use of autologous blood and fibrinogen to trigger a scarring response and achieve volume reduction could avoid the need for expensive devices, and expensive and potentially toxic agents. Pilot work in Japan has shown promise 29 and further trials are under way.…”

Section: Bronchoscopic Instillation Of Autologous Blood For Volume Rementioning

confidence: 99%

A randomised controlled study of Bronchoscopic Lung Volume Reduction with endobronchial valves for patients with Heterogeneous emphysema and Intact interlobar Fissures: the BeLieVeR-HIFi study

et al. 2015

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BackgroundDespite optimal therapy many patients with emphysema remain significantly breathless and limited. Bronchoscopic lung volume reduction (BLVR), using valves placed to allow air to leave but not enter the worst-affected areas of the lung, has been proposed as a way to improve lung function in these patients, but response is variable because interlobar collateral ventilation prevents the devices from working. Based on retrospective analysis of clinical trials, patients with heterogeneous emphysema and intact interlobar fissures are most likely to benefit.ObjectivesTo establish whether or not it is possible to identify patients prospectively who will reliably benefit from endobronchial valve placement.DesignProspective, randomised, parallel-group, double-blind, sham-controlled trial.SettingThe study was performed at a single specialist centre.ParticipantsAdult patients with heterogeneous emphysema and a target lobe with intact interlobar fissures were eligible if they had significant gas trapping (total lung capacity > 100% predicted, residual volume > 150% predicted), breathlessness [Medical Research Council (MRC) dyspnoea score of ≥ 3] and exercise limitation (6-minute walk distance of < 450 m). Participants were on optimised pharmacotherapy and were non-smokers.InterventionsStudy participants were randomised to either unilateral lobar endobronchial valve placement aiming to achieve lobar atelectasis or bronchoscopy and ‘sham’ valve placement.Main outcome measuresThe primary end point was improvement in forced expiratory volume in 1 second (FEV1) in the treatment arm compared with the control arm measured 90 days post procedure. Secondary end points were change in lung volumes, gas transfer, exercise capacity (both walking and endurance cycle ergometry) and health-related quality of life.ResultsIn total, 50 patients were recruited, 25 to each arm; 62% were male and mean (standard deviation) FEV1% predicted was 31.7% (10.2%). The primary end point of the study was met as FEV1increased by 24.8% [95% confidence interval (CI) 8.0% to 41.5%] in the treatment arm and by 3.9% (95% CI 0.7% to 7.1%) in the control arm [between-group difference 20.9% (95% CI 4.3% to 37.5%);p = 0.033]. There were both statistically and clinically significant improvements in lung volumes and carbon monoxide gas transfer as well as endurance time and dynamic hyperinflation during cycle ergometry. Two deaths occurred in the treatment arm and one control patient was unable to attend for follow-up assessment because of a prolonged pneumothorax. Two pneumothoraces occurred in the treatment arm.ConclusionsWith appropriate selection of patients through a multidisciplinary team it is possible to produce a significant improvement in lung function through lobar occlusion with endobronchial valves in heterogeneous emphysema. Prospective trials are needed to compare the effect of BLVR with surgical approaches in terms of magnitude and duration of benefit.Trial registrationCurrent Controlled Trials ISRCTN04761234.FundingThis project was funded by the Efficacy and Mechanism Evaluation (EME) programme, a MRC and NIHR partnership.

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Section: Bronchoscopic Instillation Of Autologous Blood For Volume Rementioning

confidence: 99%

A randomised controlled study of Bronchoscopic Lung Volume Reduction with endobronchial valves for patients with Heterogeneous emphysema and Intact interlobar Fissures: the BeLieVeR-HIFi study

et al. 2015

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“…Bronchoscopic injection of autologous blood and fibrinogen into an emphysematous bulla has also effected similar volume reduction [ 58 , 59 ] but has not been extensively studied except for small pilot projects. The results however are encouraging as they have reported no significant adverse events so far, and the procedure being irreversible may have lasting results and thus warrants a large prospective study.…”

Section: Techniques In Lung Volume Reduction (Lvr)mentioning

confidence: 99%

Surgical and Bronchoscopic Lung Volume Reduction in Chronic Obstructive Pulmonary Disease

et al. 2014

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Chronic obstructive pulmonary disease (COPD) is the most extensively studied and researched disease in pulmonology and a cause of significant morbidity, mortality, and financial burden on patient's family and country's economy. Its management continues to be a challenge to both the physician and the patient's family. So far, it is preventable and treatable but not curable. Emphysema, a phenotype of COPD, is the most debilitating condition associated with progressive exercise intolerance and severe dyspnea. Despite decades of research, medical treatments available so far have helped improve quality of life and slowed down the decline in respiratory function but did not significantly improve the survival benefits. Though surgical lung volume reduction (LVR) procedures have shown some promise in context to functional gains and survival but, only in a carefully selected group of patients, bronchoscopic LVR procedures are yet to explore their full potential and limitations. This paper retrospectively studied the developments so far, medical and surgical, with special emphasis on the bronchoscopic procedures of lung volume reduction, and tried to comparatively analyze the risks and benefits of each one of them through various trials and studies done to date.

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“…There are also concerns that atelectasis may diminish with time because of biodegradation of the hydrogel [26]. An interesting parallel development has been the bronchoscopic injection of autologous blood and fibrinogen into an emphysematous bulla to affect similar volume reduction [33]. …”

Section: Biological Lung Volume Reductionmentioning

confidence: 99%

Bronchoscopic Lung Volume Reduction

Ernst

Anantham

2011

Pulmonary Medicine

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The application of lung volume reduction surgery in clinical practice is limited by high postoperative morbidity and stringent selection criteria. This has been the impetus for the development of bronchoscopic approaches to lung volume reduction. A range of different techniques such as endobronchial blockers, airway bypass, endobronchial valves, thermal vapor ablation, biological sealants, and airway implants have been employed on both homogeneous as well as heterogeneous emphysema. The currently available data on efficacy of bronchoscopic lung volume reduction are not conclusive and subjective benefit in dyspnoea scores is a more frequent finding than improvements on spirometry or exercise tolerance. Safety data are more promising with rare procedure-related mortality, few serious complications, and short hospital length of stay. The field of bronchoscopic lung volume reduction continues to evolve as ongoing prospective randomized trials build on earlier feasibility data to clarify the true efficacy of such techniques.

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Intrabullous blood injection for lung volume reduction

Cited by 19 publications

References 11 publications

A randomised controlled study of Bronchoscopic Lung Volume Reduction with endobronchial valves for patients with Heterogeneous emphysema and Intact interlobar Fissures: the BeLieVeR-HIFi study

A randomised controlled study of Bronchoscopic Lung Volume Reduction with endobronchial valves for patients with Heterogeneous emphysema and Intact interlobar Fissures: the BeLieVeR-HIFi study

Surgical and Bronchoscopic Lung Volume Reduction in Chronic Obstructive Pulmonary Disease

Bronchoscopic Lung Volume Reduction

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