Document Type

Journal Article

Publication Title

Medicine

Volume

102

Issue

31

First Page

E34434

PubMed ID

37543787

Publisher

Wolters Kluwer

School

School of Nursing and Midwifery

RAS ID

61970

Comments

Sidhu, C., Wilsmore, N., Shargill, N., & Rangamuwa, K. (2023). Lung volume reduction for emphysema using one-way endobronchial valves: An Australian cohort. Medicine, 102(31), article e34434. https://doi.org/10.1097/MD.0000000000034434

Abstract

Emphysema can be associated with gas trapping and hyperinflation, which negatively impacts on quality of life, life expectancy, and functional capacity. Lung volume reduction (LVR) surgery can reduce gas trapping and improve mortality in select patients but carries a high risk of major complications. Bronchoscopic techniques for LVR using one-way endobronchial valves (EBV) have become an established efficacious alternative to surgery. A bi-center retrospective cohort study was conducted on patients with severe emphysema who underwent endoscopic lung volume reduction (ELVR) using Pulmonx Zephyr EBVs. Symptomatic patients with gas-trapping and hyperinflation on lung function testing were selected. Target-lobe selection was based on quantitative imaging analysis and ventilation-perfusion scintigraphy. Successful procedures were determined from clinical review, imaging and follow-up testing. Thirty-nine patients underwent ELVR. Mean pre-procedure forced expiratory volume in 1 second (FEV1) was 0.75 L, residual volume (RV) was 225% predicted and total lung capacity was 129% predicted. Most common treated-lobe was left upper lobe. Post-procedure pneumothorax occurred in 36.5% of patients with 73% requiring intercostal catheter insertion for drainage. Mean FEV1improvement was +140 mL and 57% of patients achieved minimal clinical important difference FEV1increase of ≥ 12%. Maximal mean RV change was-1010 mL with 69% of patients achieving minimal clinical important difference RV decrease of ≥ 350 mL. Clinician-determined success of ELVR was 78%. Procedure-related mortality was absent. LVR using EBVs is safe and can lead to significant improvements in lung function, particularly reduction of gas trapping and hyperinflation. Occurrence of pneumothorax post-procedure is a complication that must be monitored for and managed appropriately.

DOI

10.1097/MD.0000000000034434

Creative Commons License

Creative Commons Attribution-Noncommercial 4.0 License
This work is licensed under a Creative Commons Attribution-Noncommercial 4.0 License

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