Chest

Chest

Volume 113, Issue 6, June 1998, Pages 1497-1506
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Clinical Investigations: Surgery
Serial Lung Function and Elastic Recoil 2 Years After Lung Volume Reduction Surgery for Emphysema

https://doi.org/10.1378/chest.113.6.1497Get rights and content

Study objective

To evaluate serial lung function studies, including elastic recoil, in patients with severe emphysema who undergo lung volume reduction surgery (LVRS). To determine mechanism(s) responsible for changes in airflow limitation.

Methods

We studied 12 (10 male) patients aged 68±9 years (mean±SD) 6 to 12 months prior to and at 6-month intervals for 2 years after thoracoscopic bilateral LVRS for emphysema.

Results

At 2 years post-LVRS, relief of dyspnea remained improved in 10 of 12 patients, and partial or full-time oxygen dependency was eliminated in 2 of 7 patients. There was significant reduction in total lung capacity (TLC) compared with pre-LVRS baseline, 7.8±0.6 L (mean±SEM) (133±5% predicted) vs 8.6±0.6 L (144±5% predicted) (p=0.003); functional residual capacity, 5.6±0.5 L (157±9% predicted) vs 6.7±0.5 L (185±10% predicted) (p=0.001); and residual volume, 4.9±0.5 L (210±16% predicted) vs 6.0±0.5 L (260±13% predicted) (p=0.000). Increases were noted in FEV1, 0.88±0.08 L (37±6% predicted) vs 0.72±0.05 L (29±3% predicted) (p=0.02); diffusing capacity, 8.5±1.0 mL/min/mm Hg (43±3% predicted) vs 4.2±0.7 mL/min/mm Hg (18±3% predicted) (p=0.001); static lung elastic recoil pressure at TLC (Pstat), 13.7±0.5 cm H2O vs 11.3±0.6 cm H2O (p=0.008); and maximum oxygen consumption, 8.7±0.8 mL/min/kg vs 6.9±1.5 mL/min/kg (p=0.03). Increase in FEV1 correlated with the increase in TLC Pstat/TLC (r=0.75, p=0.03), but not with any baseline parameter.

Conclusion

Two years post-LVRS, there is variable clinical and physiologic improvement that does not correlate with any baseline parameter. Increased lung elastic recoil appears to be the primary mechanism for improved airflow limitation.

Section snippets

Patient Selection

From February through June 1995, we evaluated 28 patients aged 67±8 years (mean±SD) who underwent LVRS. The intent was to obtain preoperative and postoperative lung function studies, including measurements of lung elasticity at 6-month intervals. Following LVRS, five patients died (at 1, 16, 17, 20, and 24 months) from respiratory failure, one patient was unavailable for follow-up, and three patients refused to be retested. Incomplete data were obtained in 7 of the remaining 19 patients since

RESULTS

Results of serial complete lung function and resting arterial blood gas studies in 12 patients appear in Table 1. Spirometry, lung volumes, and diffusion studies were available in patients 6 to 12 months prior to surgery, and results (data not shown) were similar when compared with 2-week preoperative baseline values, despite aggressive therapeutic intervention, including physical rehabilitation. The average hospital stay was 10.7±1.0 days (mean±SD). Dyspnea16 was improved in every patient by

DISCUSSION

Results in the present study reveal that at 24 months after targeted bilateral stapled LVRS for severe, nonbullous generalized emphysema, 12 selected patients maintained significant improvements in lung function, with variable relief from dyspnea, improved oxygen independence, and increased exercise tolerance when compared with baseline. This is primarily due to increased lung elastic recoil despite the reduction in lung volume. However, preoperative clinical, physiologic, and CT lung studies

CONCLUSIONS

The results in the present study extend our earlier experience13, 14, 15 and document the variable clinical and physiologic improvement in lung elastic recoil and expiratory airflow limitation observed 2 years after bilateral LVRS in 12 selected symptomatic patients with severe, generalized emphysema who had exhausted medical therapy. The increase in lung elastic recoil peaked at 6 months post-LVRS. We urge caution in the interpretation and extension of the data because of lack of a control

ACKNOWLEDGMENT

Robert Hyatt, MD, provided critical review of this manuscript and Andy Newsom, CPFT, RCP provided technical assistance.

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    • Cited by (0)

    Supported by Department of Energy grant DE-FG03-91ER61227, American Lung Association grant CI-030-N, CTRDRP (California Tobacco Related Disease Research Program) grant 6RT-0158, and a Chapman Research Grant (Dr. Brenner).

    Reprint requests: Arthur F. Gelb, MD, FCCP, 3650 E South St, Suite 308, Lakewood, CA 90712

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    Copyright © 1998 The American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.