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Lee SW, Lee SM, Shin SY, Park TS, Oh SY, Kim N, Hong Y, Lee JS, Oh YM, Lee SD, Seo JB. Improvement in Ventilation-Perfusion Mismatch after Bronchoscopic Lung Volume Reduction: Quantitative Image Analysis. Radiology 2017; 285:250-260. [PMID: 28510483 DOI: 10.1148/radiol.2017162148] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Purpose To evaluate whether bronchoscopic lung volume reduction (BLVR) increases ventilation and therefore improves ventilation-perfusion (V/Q) mismatch. Materials and Methods All patients provided written informed consent to be included in this study, which was approved by the Institutional Review Board (2013-0368) of Asan Medical Center. The physiologic changes that occurred after BLVR were measured by using xenon-enhanced ventilation and iodine-enhanced perfusion dual-energy computed tomography (CT). Patients with severe emphysema plus hyperinflation who did not respond to usual treatments were eligible. Pulmonary function tests, the 6-minute walking distance (6MWD) test, quality of life assessment, and dual-energy CT were performed at baseline and 3 months after BLVR. The effect of BLVR was assessed with repeated-measures analysis of variance. Results Twenty-one patients were enrolled in this study (median age, 68 years; mean forced expiratory volume in 1 second [FEV1], 0.75 L ± 0.29). After BLVR, FEV1 (P < .001) and 6MWD (P = .002) improved significantly. Despite the reduction in lung volume (-0.39 L ± 0.44), both ventilation per voxel (P < .001) and total ventilation (P = .01) improved after BLVR. However, neither perfusion per voxel (P = .16) nor total perfusion changed significantly (P = .49). Patients with lung volume reduction of 50% or greater had significantly better improvement in FEV1 (P = .02) and ventilation per voxel (P = .03) than patients with lung volume reduction of less than 50%. V/Q mismatch also improved after BLVR (P = .005), mainly owing to the improvement in ventilation. Conclusion The dual-energy CT analyses showed that BLVR improved ventilation and V/Q mismatch. This increased lung efficiency may be the primary mechanism of improvement after BLVR, despite the reduction in lung volume. © RSNA, 2017 Online supplemental material is available for this article.
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Affiliation(s)
- Sei Won Lee
- From the Department of Pulmonary and Critical Care Medicine and Clinical Research Center for Chronic Obstructive Airway Diseases (S.W.L., T.S.P., J.S.L., Y.M.O., S.D.L.) and Department of Radiology and Research Institute of Radiology (S.M.L., S.Y.S., S.Y.O., N.K., J.B.S.), Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 138-736, Korea; Department of Radiology, Kyung Hee University Hospital, College of Medicine, Kyung Hee University, Seoul, Korea (S.Y.S.); Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea (T.S.P.); and Department of Internal Medicine, College of Medicine, Kangwon National University, Chuncheon, Korea (Y.H.)
| | - Sang Min Lee
- From the Department of Pulmonary and Critical Care Medicine and Clinical Research Center for Chronic Obstructive Airway Diseases (S.W.L., T.S.P., J.S.L., Y.M.O., S.D.L.) and Department of Radiology and Research Institute of Radiology (S.M.L., S.Y.S., S.Y.O., N.K., J.B.S.), Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 138-736, Korea; Department of Radiology, Kyung Hee University Hospital, College of Medicine, Kyung Hee University, Seoul, Korea (S.Y.S.); Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea (T.S.P.); and Department of Internal Medicine, College of Medicine, Kangwon National University, Chuncheon, Korea (Y.H.)
| | - So Youn Shin
- From the Department of Pulmonary and Critical Care Medicine and Clinical Research Center for Chronic Obstructive Airway Diseases (S.W.L., T.S.P., J.S.L., Y.M.O., S.D.L.) and Department of Radiology and Research Institute of Radiology (S.M.L., S.Y.S., S.Y.O., N.K., J.B.S.), Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 138-736, Korea; Department of Radiology, Kyung Hee University Hospital, College of Medicine, Kyung Hee University, Seoul, Korea (S.Y.S.); Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea (T.S.P.); and Department of Internal Medicine, College of Medicine, Kangwon National University, Chuncheon, Korea (Y.H.)
| | - Tai Sun Park
- From the Department of Pulmonary and Critical Care Medicine and Clinical Research Center for Chronic Obstructive Airway Diseases (S.W.L., T.S.P., J.S.L., Y.M.O., S.D.L.) and Department of Radiology and Research Institute of Radiology (S.M.L., S.Y.S., S.Y.O., N.K., J.B.S.), Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 138-736, Korea; Department of Radiology, Kyung Hee University Hospital, College of Medicine, Kyung Hee University, Seoul, Korea (S.Y.S.); Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea (T.S.P.); and Department of Internal Medicine, College of Medicine, Kangwon National University, Chuncheon, Korea (Y.H.)
| | - Sang Young Oh
- From the Department of Pulmonary and Critical Care Medicine and Clinical Research Center for Chronic Obstructive Airway Diseases (S.W.L., T.S.P., J.S.L., Y.M.O., S.D.L.) and Department of Radiology and Research Institute of Radiology (S.M.L., S.Y.S., S.Y.O., N.K., J.B.S.), Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 138-736, Korea; Department of Radiology, Kyung Hee University Hospital, College of Medicine, Kyung Hee University, Seoul, Korea (S.Y.S.); Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea (T.S.P.); and Department of Internal Medicine, College of Medicine, Kangwon National University, Chuncheon, Korea (Y.H.)
| | - Namkug Kim
- From the Department of Pulmonary and Critical Care Medicine and Clinical Research Center for Chronic Obstructive Airway Diseases (S.W.L., T.S.P., J.S.L., Y.M.O., S.D.L.) and Department of Radiology and Research Institute of Radiology (S.M.L., S.Y.S., S.Y.O., N.K., J.B.S.), Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 138-736, Korea; Department of Radiology, Kyung Hee University Hospital, College of Medicine, Kyung Hee University, Seoul, Korea (S.Y.S.); Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea (T.S.P.); and Department of Internal Medicine, College of Medicine, Kangwon National University, Chuncheon, Korea (Y.H.)
| | - Yoonki Hong
- From the Department of Pulmonary and Critical Care Medicine and Clinical Research Center for Chronic Obstructive Airway Diseases (S.W.L., T.S.P., J.S.L., Y.M.O., S.D.L.) and Department of Radiology and Research Institute of Radiology (S.M.L., S.Y.S., S.Y.O., N.K., J.B.S.), Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 138-736, Korea; Department of Radiology, Kyung Hee University Hospital, College of Medicine, Kyung Hee University, Seoul, Korea (S.Y.S.); Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea (T.S.P.); and Department of Internal Medicine, College of Medicine, Kangwon National University, Chuncheon, Korea (Y.H.)
| | - Jae Seung Lee
- From the Department of Pulmonary and Critical Care Medicine and Clinical Research Center for Chronic Obstructive Airway Diseases (S.W.L., T.S.P., J.S.L., Y.M.O., S.D.L.) and Department of Radiology and Research Institute of Radiology (S.M.L., S.Y.S., S.Y.O., N.K., J.B.S.), Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 138-736, Korea; Department of Radiology, Kyung Hee University Hospital, College of Medicine, Kyung Hee University, Seoul, Korea (S.Y.S.); Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea (T.S.P.); and Department of Internal Medicine, College of Medicine, Kangwon National University, Chuncheon, Korea (Y.H.)
| | - Yeon-Mok Oh
- From the Department of Pulmonary and Critical Care Medicine and Clinical Research Center for Chronic Obstructive Airway Diseases (S.W.L., T.S.P., J.S.L., Y.M.O., S.D.L.) and Department of Radiology and Research Institute of Radiology (S.M.L., S.Y.S., S.Y.O., N.K., J.B.S.), Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 138-736, Korea; Department of Radiology, Kyung Hee University Hospital, College of Medicine, Kyung Hee University, Seoul, Korea (S.Y.S.); Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea (T.S.P.); and Department of Internal Medicine, College of Medicine, Kangwon National University, Chuncheon, Korea (Y.H.)
| | - Sang-Do Lee
- From the Department of Pulmonary and Critical Care Medicine and Clinical Research Center for Chronic Obstructive Airway Diseases (S.W.L., T.S.P., J.S.L., Y.M.O., S.D.L.) and Department of Radiology and Research Institute of Radiology (S.M.L., S.Y.S., S.Y.O., N.K., J.B.S.), Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 138-736, Korea; Department of Radiology, Kyung Hee University Hospital, College of Medicine, Kyung Hee University, Seoul, Korea (S.Y.S.); Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea (T.S.P.); and Department of Internal Medicine, College of Medicine, Kangwon National University, Chuncheon, Korea (Y.H.)
| | - Joon Beom Seo
- From the Department of Pulmonary and Critical Care Medicine and Clinical Research Center for Chronic Obstructive Airway Diseases (S.W.L., T.S.P., J.S.L., Y.M.O., S.D.L.) and Department of Radiology and Research Institute of Radiology (S.M.L., S.Y.S., S.Y.O., N.K., J.B.S.), Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 138-736, Korea; Department of Radiology, Kyung Hee University Hospital, College of Medicine, Kyung Hee University, Seoul, Korea (S.Y.S.); Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea (T.S.P.); and Department of Internal Medicine, College of Medicine, Kangwon National University, Chuncheon, Korea (Y.H.)
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Pompeo E, Rogliani P, Palombi L, Orlandi A, Cristino B, Dauri M. The complex care of severe emphysema: role of awake lung volume reduction surgery. ANNALS OF TRANSLATIONAL MEDICINE 2015; 3:108. [PMID: 26046049 DOI: 10.3978/j.issn.2305-5839.2015.04.17] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 04/16/2015] [Indexed: 11/14/2022]
Abstract
The resectional lung volume reduction surgery (LVRS) procedure entailing nonanatomic resection of destroyed lung regions through general anesthesia with single-lung ventilation has shown to offer significant and long-lasting improvements in respiratory function, exercise capacity, quality of life and survival, particularly in patients with upper-lobe predominant emphysema and low exercise capacity. However mortality and morbidity rates as high as 5% and 59%, respectively, have led to a progressive underuse and have stimulated investigation towards less invasive surgical and bronchoscopic nonresectional methods that could assure equivalent clinical results with less morbidity. We have developed an original nonresectional LVRS method, which entails plication of the most severely emphysematous target areas performed in awake patients through thoracic epidural anesthesia (TEA). Clinical results of this ultra-minimally invasive procedure have been highly encouraging and in a uni-center randomized study, intermediate-term outcomes paralleled those of resectional LVRS with shorter hospital stay and fewer side-effects. In this review article we analyze indications, technical details and results of awake LVRS taking into consideration the available data from the literature.
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Affiliation(s)
- Eugenio Pompeo
- Departments of 1 Thoracic Surgery, 2 Pulmonology, 3 Epidemiology and Public Health, 4 Anatomic Pathology, 5 Anesthesia and Intensive Care, Policlinico Tor Vergata University, Rome, Italy
| | - Paola Rogliani
- Departments of 1 Thoracic Surgery, 2 Pulmonology, 3 Epidemiology and Public Health, 4 Anatomic Pathology, 5 Anesthesia and Intensive Care, Policlinico Tor Vergata University, Rome, Italy
| | - Leonardo Palombi
- Departments of 1 Thoracic Surgery, 2 Pulmonology, 3 Epidemiology and Public Health, 4 Anatomic Pathology, 5 Anesthesia and Intensive Care, Policlinico Tor Vergata University, Rome, Italy
| | - Augusto Orlandi
- Departments of 1 Thoracic Surgery, 2 Pulmonology, 3 Epidemiology and Public Health, 4 Anatomic Pathology, 5 Anesthesia and Intensive Care, Policlinico Tor Vergata University, Rome, Italy
| | - Benedetto Cristino
- Departments of 1 Thoracic Surgery, 2 Pulmonology, 3 Epidemiology and Public Health, 4 Anatomic Pathology, 5 Anesthesia and Intensive Care, Policlinico Tor Vergata University, Rome, Italy
| | - Mario Dauri
- Departments of 1 Thoracic Surgery, 2 Pulmonology, 3 Epidemiology and Public Health, 4 Anatomic Pathology, 5 Anesthesia and Intensive Care, Policlinico Tor Vergata University, Rome, Italy
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