Mechanisms of Relief of Exertional Breathlessness Following Unilateral Bullectomy and Lung Volume Reduction Surgery in Emphysema

O’Donnell, Denis E.; Webb, Katherine A.; Bertley, John C.; Chau, Laurence.K.L.; Conlan, A. Alan

doi:10.1378/chest.110.1.18

Cited by 154 publications

(101 citation statements)

References 29 publications

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“…By way of contrast, O'DONNELL et al [53] did not find any improvement in V 'O 2 ,max in a heterogeneous group of patients, despite postoperative rehabilitation. Dyspnoea, evaluated by variable means, has also been shown to decrease after LVRS [39±43, 45,47,48,50,51,53,54,56,57,60,69].…”

Section: Pathophysiological Basis Of Functional Impairment In Emphysemamentioning

confidence: 82%

“…Recent reports, however, have showed significantly improved carbon monoxide transfer factor (TL,CO) in some studies [4,50,54,60,66], while in others there was a tendency towards improvement [39,48,51,53,67]. Overall, this suggests that LVRS may lead to recruitment of the capillary bed.…”

Section: Pathophysiological Basis Of Functional Impairment In Emphysemamentioning

confidence: 83%

“…Overall, this suggests that LVRS may lead to recruitment of the capillary bed. Reports of carbon monoxide transfer coefficient (KCO) did not show significant shortterm improvement [39,53,59,66].…”

Section: Pathophysiological Basis Of Functional Impairment In Emphysemamentioning

confidence: 95%

“…Others found a lack of significant improvement in FEV1/VC [4,48,53,59]. When reported, airway resistance and specific airway conductance were always improved after surgery [4,53,56,59,63,64].…”

Section: Pathophysiological Basis Of Functional Impairment In Emphysemamentioning

confidence: 97%

“…Indeed, arterial oxygen tension (Pa,O 2 ) increased in all studies reporting this variable [4, 39, 41±45, 48, 50, 52±54, 56±58, 67, 68], although the improvement was only statistically significant in half of the studies [42,45,48,50,53,56,58,68]. Similarly, arterial carbon dioxide tension (Pa,CO 2 ) either showed a tendency to decrease [4,39,43,44,48,52,53,56,58] or a statistically significant decrease [41,42,45,54,57,67,68].…”

Section: Pathophysiological Basis Of Functional Impairment In Emphysemamentioning

confidence: 99%

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Physiological basis of improvement after lung volume reduction surgery for severe emphysema: where are we?

Marchand¹,

Gayan‐Ramirez²,

Leyn³

et al. 1999

Eur Respir J

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Physiological basis of improvement after lung volume reduction surgery for severe emphysema: where are we? E. Marchand, G. Gayan-Ramirez, P. De Leyn, M. Decramer. #ERJ Journals Ltd 1999. ABSTRACT: Lung volume reduction surgery has become an accepted therapeutic option to relieve the symptoms of selected patients with severe emphysema. In a majority of these patients, it causes objective as well as subjective functional improvement. A proper understanding of the physiological determinants underlying these beneficial effects appears very important in order to better select patients for the procedure that is currently largely carried out on an empirical basis.Lung volume reduction surgery has two distinct effects. Firstly, it causes an increased elastic recoil, which at least partially explains the enhanced maximal expiratory flow. Secondly, it is associated with a reduction of hyperinflation which allows for an increase in global inspiratory muscle strength and in diaphragmatic contribution to tidal volume as well as a decrease in the inspiratory elastic load imposed by the chest wall. Taken together, these effects result in a reduced work of breathing and in an enhanced maximal ventilation which both contribute to the increased exercise capacity and reduced dyspnoea after surgery. The improved lung recoil and the reduced hyperinflation after volume reduction surgery were the primary postulates upon which the usual selection criteria for the procedure were based. It is now likely that these are correct. Nevertheless, some patients do not benefit from lung volume reduction surgery and the current literature does not allow for a refinement of the selection process from a physiological point of view.The exact mechanisms underlying the improvement in lung recoil, lung mechanics, and respiratory muscle function remain incompletely understood. Moreover, the effects of lung volume reduction surgery on gas exchange and pulmonary haemodynamics still need to be more fully investigated. An analysis of the characteristics of patients who do not benefit from the procedure and the development of an animal model for lung volume reduction surgery would probably help address these important issues. Eur Respir J 1999; 13: 686±696.

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Section: Pathophysiological Basis Of Functional Impairment In Emphysemamentioning

confidence: 82%

Section: Pathophysiological Basis Of Functional Impairment In Emphysemamentioning

confidence: 83%

Section: Pathophysiological Basis Of Functional Impairment In Emphysemamentioning

confidence: 95%

Section: Pathophysiological Basis Of Functional Impairment In Emphysemamentioning

confidence: 97%

Section: Pathophysiological Basis Of Functional Impairment In Emphysemamentioning

confidence: 99%

See 3 more Smart Citations

Physiological basis of improvement after lung volume reduction surgery for severe emphysema: where are we?

Marchand¹,

Gayan‐Ramirez²,

Leyn³

et al. 1999

Eur Respir J

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Effects of Nd:YAG laser irradiation on morphometry and lung function in elastase-induced emphysema in rats

et al. 1998

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Impaired respiratory mechanics in pulmonary emphysema: Evaluation with dynamic breathing MRI

Suga

Tsukuda

Awaya

et al. 1999

J. Magn. Reson. Imaging

134

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To evaluate impaired respiratory mechanics in pulmonary emphysema, dynamic breathing magnetic resonance imaging (BMRI) was acquired with fast‐gradient echo pulse sequences at fixed thoracic planes over two to three slow, deep respiratory cycles in 6 controls and 28 patients with pulmonary emphysema including 9 patients undergoing lung volume reduction surgery (LVRS). Respiratory motions of the diaphragm and chest wall (D/CW) were assessed by a cineloop view, a fusion display of maximal inspiratory and expiratory images, and the time‐distance curves. By contrast with normal subjects with regular synchronous D/CW motions, the patients frequently showed reduced, irregular, or asynchronous motions, with significant decreases in the maximal amplitude of D/CW motions (MAD and MACW), and the length of apposition of the diaphragm (LAD) (P < 0.0001, P < 0.001, P < 0.01, respectively). After LVRS, nine patients showed improvements in D/CW configuration and mobility, with significantly increased MAD, MACW, and LAD (P < 0.01, P < 0.0001, and P < 0.05, respectively). In 40 studies of 28 patients including the post‐LVRS examinations, the normalized MAD and MACW significantly correlated with %FEV1 (r = 0.881 and r = 0.906; P < 0.0001, respectively). BMRI seems useful for noninvasively and directly assessing the impaired respiratory mechanics associated with abnormal ventilation in pulmonary emphysema, and also for monitoring the effects of LVRS. J. Magn. Reson. Imaging 1999;10:510–520. © 1999 Wiley‐Liss, Inc.

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Mechanisms of Relief of Exertional Breathlessness Following Unilateral Bullectomy and Lung Volume Reduction Surgery in Emphysema

Cited by 154 publications

References 29 publications

Physiological basis of improvement after lung volume reduction surgery for severe emphysema: where are we?

Physiological basis of improvement after lung volume reduction surgery for severe emphysema: where are we?

Effects of Nd:YAG laser irradiation on morphometry and lung function in elastase-induced emphysema in rats

Impaired respiratory mechanics in pulmonary emphysema: Evaluation with dynamic breathing MRI

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