Lung Volume Reduction Surgery at a Community Hospital

Bagley, Peter H.; Davis, Stephen K.; O’Shea, Michael; Coleman, Anne-Marie

doi:10.1378/chest.111.6.1552

Cited by 21 publications

(7 citation statements)

References 14 publications

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“…Three to 6 mo post-LVRS 28 of our 33 patients demonstrated decreases in Pa CO 2 with a mean decrease of 4%, a value that is concordant with that seen in other studies (7,15). Other investigators, however, have shown minimal changes in Pa CO 2 post-LVRS (6,10,12,14,16,17). There are many reasons for this apparent discrepancy.…”

Section: Discussionmentioning

confidence: 94%

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Relationship between Resting Hypercapnia and Physiologic Parameters before and after Lung Volume Reduction Surgery in Severe Chronic Obstructive Pulmonary Disease

Shade

Cordova²,

Lando³

et al. 1999

Am J Respir Crit Care Med

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Patients with severe chronic obstructive pulmonary disease (COPD) have varying degrees of hypercapnia. Recent studies have demonstrated inconsistent effects of lung volume reduction surgery (LVRS) on PaCO2; however, most series have excluded patients with moderate to severe hypercapnia. In addition, no study has examined the mechanisms responsible for the reduction in PaCO2 post-LVRS. We obtained spirometry, body plethysmography, diffusion capacity, respiratory muscle strength, 6-min walk test, and incremental symptom-limited maximal exercise data in 33 consecutive patients pre- and 3 to 6 mo post-LVRS, and explored the relationship between changes in PaCO2 and changes in the measured physiologic variables. All patients underwent bilateral LVRS via median sternotomy and stapling resection by the same cardiothoracic surgeon. Patients were 57 +/- 8 yr of age with severe COPD, hyperinflation, and air trapping (FEV1, 0.73 +/- 0.2 L; TLC, 7.3 +/- 1.6 L; residual volume [RV], 4.8 +/- 1.4 L), and moderate resting hypercapnia (PaCO2, 44 +/- 7 mm Hg; range, 32 to 56 mm Hg). Post-LVRS, PaCO2 decreased by 4% (PaCO2 pre 44 +/- 7 mm Hg, PaCO2 post 42 +/- 5 mm Hg; p = 0.003). Patients with higher baseline values of PaCO2 had the greatest reduction in PaCO2 post-LVRS (r = -0.61, p < 0.001). Significant correlations existed between reduction in PaCO2 and changes in FEV1 (r = -0.56; p = 0.0007), maximal inspiratory pressure (PImax) (r = -0.46; p = 0.009), diffusing capacity of the lungs for carbon monoxide (DLCO) (r = -0.47; p = 0.008), and RV/TLC (r = 0.41; p = 0. 02). Correlation existed also between reduction in PaCO2 and breathing pattern at maximal exercise: maximal minute ventilation (V Emax) (r = -0.47; p = 0.009), and tidal volume (VT) (r = -0.40; p = 0.02). The changes in PaCO2 post-LVRS showed marked intersubject variability. We conclude that LVRS, by reducing hyperinflation, air trapping, and improving respiratory muscle function, enables the lung and chest wall to act more effectively as a pump, thereby increasing alveolar ventilation and reducing baseline resting PaCO2. In addition, patients with higher baseline levels of PaCO2 demonstrate the greatest reduction in PaCO2 post-LVRS, and should not be excluded from receiving LVRS.

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Section: Discussionmentioning

confidence: 94%

“…The effect of LVRS on hypercapnia is variable. Some studies demonstrate a reduction in Pa CO 2 (3,7,(10)(11)(12)(13) after LVRS, while others show no change (6,(14)(15)(16)(17).…”

Section: Vmentioning

confidence: 99%

Relationship between Resting Hypercapnia and Physiologic Parameters before and after Lung Volume Reduction Surgery in Severe Chronic Obstructive Pulmonary Disease

Shade

Cordova²,

Lando³

et al. 1999

Am J Respir Crit Care Med

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“…HRQL after LVRS has also been assessed by other instruments, such as the Nottingham Health Profile [10,13], the Sickness Impact Profile [12,18,32,42], the Chronic Respiratory Disease Questionnaire [15] and the St. George9s respiratory Questionnaire [17]. In general, positive effects were found.…”

Section: Discussionmentioning

confidence: 99%

“…the Short Form 36-item questionnaire (SF-36), as in the present study [10,14]. Others followed aspects of quality of life in LVRS for up to 6 months only [11,[15][16][17][18] or 12 months [19] or reported for a longer time period, but only a small number of patients were followed for up to 18 months [12,13].…”

mentioning

confidence: 86%

Improved quality of life after lung volume reduction surgery

Hamacher¹,

S²,

C³

et al. 2002

Eur Respir J

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Lung volume reduction surgery (LVRS) improves dyspnoea, pulmonary function, and physical performance in patients with severe pulmonary emphysema. This study investigated the impact of LVRS on health-related quality of life (HRQL) over a 2-yr period following surgery.Thirty-nine consecutive patients were prospectively assessed before LVRS, and followed over 24 months postoperatively. The assessments included pulmonary function, dyspnoea (Medical Research Council (MRC) dyspnoea score), 6-min walking distance (6MWD) and HRQL using the Short Form 36-item questionnaire (SF-36) .Several domains of SF-36 improved considerably over 2 yrs after surgery: Physical Functioning: 39 ¡ 4 (mean ¡ SEM) versus 16 ¡ 2 (pv0.01); Vitality: 51 ¡ 3 versus 32 ¡ 3 (pv0.01); Social Functioning: 72 ¡ 4 versus 51 ¡ 5 (pv0.01). Also, improvements in pulmonary function (forced expiratory volume in one second (FEV1): 27 ¡ 1% predicted, residual volume (RV)/total lung capacity (TLC): 0.65¡0.01), 6 MWD (274¡16 m) and dyspnoea (MRC: 3.9¡01) were sustained for up to 2 yrs after LVRS (FEV1 36¡2% pred, RV/TLC: 0.58¡0.02; 6 MWD: 342¡19 m; MRC: 2.0¡0.2; pv0.05).In patients with severe emphysema, lung volume reduction surgery had positive effects on health-related quality of life and pulmonary function over 2 yrs.

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“…Bagley et al 25 used the Chronic Respiratory Disease Questionnaire (CRQ) developed by Guyatt and colleagues,43 Cooper et al 39 used two well validated generic quality of life measures (the Nottingham Health Profile44 and the SF3645), and Cordova et al used the Sickness Impact Profile 46. Full details of the QOL results are presented in table 5.…”

Section: Resultsmentioning

confidence: 99%

Lung volume reduction surgery (LVRS) for chronic obstructive pulmonary disease (COPD) with underlying severe emphysema

Young

Fry‐Smith

Hyde

1999

Thorax

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Background-Lung volume reduction surgery (LVRS) has recently re-emerged as a surgical option for the treatment of end stage chronic obstructive pulmonary disease (COPD) due to underlying severe emphysema. Advocates of LVRS claim that it represents a significant breakthrough in the management of this challenging group of patients while sceptics point to uncertainty about the eVectiveness of the operation. Methods-A systematic review was conducted of the evidence on the eVects of LVRS in patients with end stage COPD secondary to severe emphysema. Results-The most rigorous evidence on the eVectiveness of LVRS came from case series. Seventy five potentially relevant studies were identified and 19 individual series met the methodological criteria for inclusion. The pattern of results was consistent across individual studies despite a significant degree of clinical heterogeneity. Significant short term benefits occurred across a range of outcomes which appeared to continue into the longer term. Physiological improvements were matched by functional and subjective improvements. Early mortality rates were low and late mortality rates compared favourably with those of the general COPD population. However, the entire research base for the intervention is subject to the limitations of study designs without parallel control groups.Conclusions-LVRS appears to represent a promising option in the management of patients with severe end stage emphysema. However, until the results of ongoing clinical trials are available, the considerable uncertainty that exists around the eVectiveness and cost eVectiveness of the procedure will remain.

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Lung Volume Reduction Surgery at a Community Hospital

Cited by 21 publications

References 14 publications

Relationship between Resting Hypercapnia and Physiologic Parameters before and after Lung Volume Reduction Surgery in Severe Chronic Obstructive Pulmonary Disease

Relationship between Resting Hypercapnia and Physiologic Parameters before and after Lung Volume Reduction Surgery in Severe Chronic Obstructive Pulmonary Disease

Improved quality of life after lung volume reduction surgery

Lung volume reduction surgery (LVRS) for chronic obstructive pulmonary disease (COPD) with underlying severe emphysema

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