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Slama A, Ceulemans LJ, Hedderich C, Boehm PM, Van Slambrouck J, Schwarz S, Vandervelde CM, Kamler M, Jaksch P, Van Raemdonck D, Hoetzenecker K, Aigner C. Lung Volume Reduction Followed by Lung Transplantation in Emphysema-A Multicenter Matched Analysis. Transpl Int 2022; 35:10048. [PMID: 35497884 PMCID: PMC9047703 DOI: 10.3389/ti.2022.10048] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 03/24/2022] [Indexed: 11/29/2022]
Abstract
Objective: The impact of previous lung volume reduction surgery (LVRS) or endoscopic lung volume reduction (ELVR) on lung transplantation (LuTX) remains unclear. This study assesses the risk of previous lung volume reduction on the outcome of a later LuTX. Methods: Patients suffering from emphysema who underwent bilateral LuTX were included in this multicenter analysis. Study groups were defined as: previous LVRS, previous ELVR, controls. Imbalances were corrected by coarsened exact matching for center, gender, age, diagnosis, and BMI. A comparative analysis of intraoperative characteristics, perioperative outcome and long-term survival was performed. Results: 615 patients were included (LVRS = 26; ELVR = 60). Compared to controls, LVRS patients had a higher rate of postoperative ECMO (15.4 vs. 3.9%; p = 0.006), whereas ELVR patients suffered more often from wound infections (8.9% vs. 2.5%; p = 0.018). Perioperative outcome, duration of ventilation, ICU stay, and hospital stay were comparable between groups. Bacterial colonization of the airway differed significantly between both LVR groups and controls in pre- and post-LuTX cultures. Survival was not impacted (1-/3-/5-year survival for LVRS: 92.3%/85.7%/77.1%; controls: 91.3%/82.4%/76.3%; p = 0.58 | ELVR: 93.1%/91%/91%; controls 91.2%/81.7%/75.3%; p = 0.17). Conclusion: Lung volume reduction does not impact short and long-time survival after bilateral LuTX. Due to differences in airway colonization after LVR, caution to prevent infectious complications is warranted.
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Affiliation(s)
- Alexis Slama
- Department of Thoracic Surgery and Thoracic Endoscopy, University Medicine Essen, Ruhrlandklinik, Essen, Germany.,West German Center for Lung Transplantation, University Medicine Essen, Essen, Germany
| | - Laurens J Ceulemans
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Chronic Diseases and Metabolism, Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium
| | - Celia Hedderich
- Department of Thoracic Surgery and Thoracic Endoscopy, University Medicine Essen, Ruhrlandklinik, Essen, Germany
| | - Panja M Boehm
- Clinic of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - Jan Van Slambrouck
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Chronic Diseases and Metabolism, Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium
| | - Stefan Schwarz
- Clinic of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
| | | | - Markus Kamler
- West German Center for Lung Transplantation, University Medicine Essen, Essen, Germany
| | - Peter Jaksch
- Clinic of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - Dirk Van Raemdonck
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Chronic Diseases and Metabolism, Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium
| | | | - Clemens Aigner
- Department of Thoracic Surgery and Thoracic Endoscopy, University Medicine Essen, Ruhrlandklinik, Essen, Germany.,West German Center for Lung Transplantation, University Medicine Essen, Essen, Germany
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Instructional Training Compared with Self-Study for Pulmonary Function Test Interpretation. ATS Sch 2021; 2:566-580. [PMID: 35079740 PMCID: PMC8751683 DOI: 10.34197/ats-scholar.2021-0035oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 07/12/2021] [Indexed: 11/18/2022] Open
Abstract
Background Pulmonary diseases have considerable prognostic relevance for all-cause mortality. Most patients with lung diseases such as chronic obstructive pulmonary disease are treated by general practitioners. Understanding the clinical consequences such as pulmonary hyperinflation or reduced diffusion capacity is important for the management and prognosis of patients with chronic respiratory disorders. Therefore, the interpretation of pulmonary function testing (PFT) results needs to see more emphasis in the medical education curriculum. Objective To develop PFT training for final-year medical students and to compare the efficacy of instructional training to self-reliant textbook study. Methods A two-armed randomized control trial compares learning outcomes in PFT interpretation. A total of 25 final-year medical students were selected at random into the 1) instructional training group or 2) self-reliant textbook study group on PFT interpretation. The learning time for both groups was 2 hours. The duration of the written pre- and post-training examinations was 60 minutes each. Both exams had a knowledge section (30 questions, maximum 120 points) and a skills section (11 case studies, maximum 75 points). Results The instructional training group acquired significantly more knowledge and, in particular, higher skill levels when compared with the self-reliant reading group. In the reading group, knowledge scores increased from 48 to 60% (12%) and skills scores increased from 14 to 22% (8%), whereas in the instructional group, knowledge increased from 47 to 71% (24%) and skills from 18 to 58% (40%). A multivariate analysis (Pillai’s Trace: 0.633; P < 0.001) as well as follow-up univariate analyses reveal that these differences are statistically significant (knowledge: F = 8.811, df = 1, P = 0.007; skills F = 33.965, df = 1, P < 0.001). Interestingly, there was no significant group effect in the pure knowledge gain about respiratory disorders per se. Conclusion The self-reliant study group was less able to translate their newly acquired knowledge into interpretation of comprehensive PFT reports. A mandatory 2-hour instructional training greatly enhances the students’ knowledge and skills about PFT interpretation. Obligatory PFT instructional training should therefore be included in the students’ curriculum.
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Dass C, Goldbach A, Dako F, Kumaran M, Steiner R, Criner GJ. Role of Imaging in Bronchoscopic Lung Volume Reduction Using Endobronchial Valve: State of the Art Review. J Thorac Imaging 2021; 36:131-141. [PMID: 32740228 DOI: 10.1097/rti.0000000000000549] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) is becoming one of the leading causes of mortality and morbidity throughout the world. The National Emphysema Treatment Trial demonstrated that lung volume reduction surgery can improve pulmonary function, exercise capacity, and quality of life in select subgroups of patients with COPD. In recent years, few bronchoscopic lung volume reduction (BLVR) procedures have undergone clinical trials with the goal of establishing an effective and safe alternative approach for reducing hyperinflation in patients with severe emphysema who are symptomatic despite optimal medical management, but are poor surgical candidates. Of these BLVR procedures, only deployment of 1-way endobronchial valves (EBVs) has the largest pool of scientific data available to date to support its clinical utility. Two EBV systems have been food and drug administration-approved within the last year to meet the clinical demands of this select group of patients with COPD. On the basis of the results of multiple randomized clinical trials, the recommendations of the original 2016 Expert Panel Report on BLVR usage criteria of EBV have been updated in 2019. The outcome of EBV therapy is maximized in certain image-based COPD phenotypes. Imaging plays a major role in patient selection, target lobe identification, and in the management of postprocedural adverse events. With the expected widespread use of EBV therapy in the coming years, knowledge and familiarity of the Role of Imaging in BLVR using EBVs is essential for radiologists attempting to make meaningful contribution toward improving clinical outcomes.
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Affiliation(s)
- Chandra Dass
- Department of Radiology, Division of Cardiothoracic Imaging
| | | | - Farouk Dako
- Department of Radiology, Division of Cardiothoracic Imaging
| | - Maruti Kumaran
- Department of Radiology, Division of Cardiothoracic Imaging
| | - Robert Steiner
- Department of Radiology, Division of Cardiothoracic Imaging
| | - Gerard J Criner
- Department of Thoracic Medicine and Surgery, Temple University Hospital, Philadelphia, PA
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Dumanli A, Metin B, Gunay E. Endobronchial valve vs coil for lung volume reduction in emphysema: results from a tertiary care centre in Turkey. Ann Saudi Med 2020; 40:469-476. [PMID: 33307740 PMCID: PMC7733646 DOI: 10.5144/0256-4947.2020.469] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 09/25/2020] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Bronchoscopic lung volume reduction (BLVR) by either the endobronchial valve (EBV) or coil (EBC) procedure is recommended for severe emphysematous patients. BLVR applications generally help healthy lung areas ventilate more comfortably by reducing the hyperinflation and improving the contraction capacity of diaphragm. OBJECTIVES Compare our experience with valve and coil BLVR devices. DESIGN Retrospective. SETTING Single tertiary care centre. PATIENTS AND METHODS Demographic data, vital signs, pulmonary function tests (PFTs), the six-minute walking test (6MWT), vital signs, arterial blood gases and complications were recorded. MAIN OUTCOME MEASURES Change in PFTs and completion of the 6MWT. SAMPLE SIZE 60 Turkish men with a diagnosis of chronic pulmonary lung disease. RESULTS Clinical and demographic characteristics were similar in patients who underwent EBV and EBC. Thirty (96.8%) EBV patients and 27 (93.1%) of the EBC patients were able to properly complete the PFT before the procedures, but all complied after the procedures. Significant improvement in PFTs were achieved after the procedure and there were no statistically significant differences in post-procedure performance. For the 6MWT, the completion rate improved from 15 (48.4%) to 19 (61.3%) patients in the EBV patients (P=.125) and from 19 (65.5%) to 21 (72.4%) patients in the EBC patients (P=.500). There was no significant difference in completion rates for the walking test for either group (median 32 meters in EBV patients and 37 meters in EBC patients; P=.652). Vital signs and arterial blood gases were similar in the two groups. The rates of complications were similar in both groups. CONCLUSION Endobronchial valves and coils are safe and effective methods for BLVR for patients with severe emphysema. LIMITATIONS Relatively small sample, retrospective design, single-centre retrospective study. CONFLICT OF INTEREST None.
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Affiliation(s)
- Ahmet Dumanli
- From the Department of Chest Surgery, Afyonkarahisar University of Health Sciences, Afyonkarahisar, Turkey
| | - Bayram Metin
- From the Department of Chest Surgery, Acibadem Hospitals Group, Kayseri, Turkey
| | - Ersin Gunay
- From the Department of Pulmonology, Afyonkarahisar University of Health Sciences, Afyonkarahisar, Turkey
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Labarca G, Uribe JP, Pacheco C, Folch E, Kheir F, Majid A, Jantz MA, Mehta HJ, Patel N, Herth FJF, Fernandez-Bussy S. Bronchoscopic Lung Volume Reduction with Endobronchial Zephyr Valves for Severe Emphysema: A Systematic Review and Meta-Analysis. Respiration 2019; 98:268-278. [PMID: 31117102 DOI: 10.1159/000499508] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 03/09/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Endoscopic lung volume reduction using Zephyr® valves has been recently adopted as a treatment option for patients with severe emphysema without collateral ventilation (CV). OBJECTIVES To assess the efficacy and safety of Zephyr valves in such a population. METHODS Studies were identified from MEDLINE and EMBASE databases. All searches were current until June 2018. We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) evaluating the efficacy and safety of Zephyr. We defined as outcome: change in forced expiratory volume in 1 s (FEV1), in the 6-min walking test (6MWT), in the St George's Respiratory Questionnaire (SGRQ), and in residual volume (RV). Safety analysis included relative risk (RR) of pneumothorax. We assessed the quality of the evidence using GRADE. RESULTS 7 RCTs reported on Zephyr valves and 5 RCTs included only patients without CV. Zephyr improved FEV1 with a mean difference (MD) of 17.36% (CI, 9.28-25.45, I2 = 78%). Subgroup analysis showed significant FEV1 improvement following Zephyr placement in patients with heterogeneous distribution: MD = 21.78% (CI, 8.70-34.86, I2 = 89%) and 16.27% (CI, 8.78-23.76, I2 = 0%) in patients with homogeneous emphysema. Studies with a follow-up of 3 months reported FEV1 MD = 17.19% (CI, 3.16-31.22, I2 = 89%) compared to studies with a follow-up of 6-12 months, which showed a consistent improvement of FEV1 MD = 17.90% (CI, 11.47-24.33, I2 = 0%). Zephyr also showed improvement of SGRQ, 6MWT, and RV. RR of pneumothorax was 6.32 (CI, 3.74-10.67, I2 = 0%). CONCLUSION In this population, Zephyr valves provided significant and clinically meaningful short-term improvements in either homogeneous or heterogeneous emphysema without CV but with an increase in adverse events.
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Affiliation(s)
- Gonzalo Labarca
- Facultad de Medicina, Universidad San Sebastian, Concepcion, Chile, .,Complejo Asistencial Dr. Victor Rios Ruiz, Los Angeles, Chile,
| | - Juan Pablo Uribe
- Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | | | - Erik Folch
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Fayez Kheir
- Division of Pulmonary, Critical Care Medicine and Environmental Medicine, Tulane University, New Orleans, Louisiana, USA
| | - Adnan Majid
- Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Michael A Jantz
- Division of Pulmonary and Critical Care, University of Florida, Gainesville, Florida, USA
| | - Hiren J Mehta
- Division of Pulmonary and Critical Care, University of Florida, Gainesville, Florida, USA
| | - Neal Patel
- Division of Pulmonology and Critical Care Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Felix J F Herth
- Department of Pulmonology and Critical Care, Heidelberg, Germany
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Gülşen A. Bronchoscopic Lung Volume Reduction: A 2018 Review and Update. Turk Thorac J 2018; 19:141-149. [PMID: 30083406 PMCID: PMC6077007 DOI: 10.5152/turkthoracj.2018.18044] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 06/11/2018] [Indexed: 11/22/2022]
Abstract
Bronchoscopic lung volume reduction (BLVR) procedure has expanded the treatment spectrum of patients with end-stage emphysema. These treatments include valve, coil, thermal vapor ablation, bio-lung volume reduction, targeted lung denervation, and airway bypass stent. This short review provides an up-to-date information on BLVR treatments, their clinical benefits, and an overview of complications. BLVR treatments generally affect dyspnea by reducing hyperinflation and residual volume (RV). Benefits of treatment are associated with improvement in lung function parameters (forced expiration volume in the first second, total lung capacity, RV, and 6-minute walking test) and quality of life. Serious potential pulmonary complications, such as pneumothorax, pneumonia, respiratory failure, and chronic obstructive pulmonary disease exacerbation, may also occur after BLVR treatment. In addition to these, low-cost BLVR methods, such as autologous blood and fibrin glue, are in the developmental stage. Bronchoscopic lung volume reduction treatments are a promising method with positive results for patients with severe emphysema. The widespread use of these techniques, inadequate selection of patients, and non-critical and, therefore, unsuccessful use of BLVR in non-specialist centers lead to a false negative impression of the effectiveness of these techniques. In addition to these considerations, it is obvious that these treatments, which are quite expensive, are burdening social health systems. The reduction of costs or the development of lower-cost treatment methods is important for the future and for the availability of treatments.
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Affiliation(s)
- Aşkın Gülşen
- Division of Clinical and Molecular Allergology, Research Center Borstel, Airway Research, Center North (ARCN), Member of the German Center for Lung Research, Borstel, Germany
- Interdisciplinary Allergy Outpatient Clinic, Department of Pneumology, University of Lübeck, Germany
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