Lung-volume reduction surgery for COPD patients - chronic obstructive pulmonary disease - Tips from

Author: Linz Audain
Date: Feb 15, 1997

Recently, lung-volume reduction surgery has been used as a means of reducing hyper-inflation in selected patients with diffuse emphysema. However, lung-volume reduction surgery has not been recommended for patients who are in hypercapnic respiratory failure, such as patients with chronic obstructive pulmonary disease (COPD) who are ventilator-dependent. Criner and associates describe the results of a study in which lung-volume reduction surgery was performed in a group of ventilator-dependent COPD patients.

The authors selected three consecutive patients with severe COPD who were admitted to a ventilator rehabilitation unit for evaluation of weaning from the ventilator. Despite numerous attempts at different institutions, none of these patients could be successfully weaned from the ventilator. All three of the patients were offered lung-volume reduction surgery in view of their unresponsiveness to extensive medical therapy.

The first case involved a 53-year-old man with an 80 pack-year smoking history, a forced expiratory volume in one second ([FEV.sub.1]) of 0.41 and a partial pressure of arterial carbon dioxide ([Pa.sub.[CO.sub.2]]) of 70 mm Hg. The second case involved a 53-year-old woman with a 30 pack-year smoking history, an [FEV.sub.1] of 0.41 and a [Pa.sub.[CO.sub.2]] of 55 mm Hg. The third case involved a 60-year-old woman with a past history of heavy smoking and a [Pa.sub.[CO.sub.2] of 55 mm Hg; [FEV.sub.1] was unavailable. All three of the patients showed hyper-inflation as well as bilateral bullous changes and minimal perfusion to the upper lobes of the lungs on radiographic examination. The amount of each upper lobe resected during surgery ranged from 20 to 50 percent.

Postoperatively, all three of the patients were weaned from their ventilators and discharged home after 10 to 21 days. Lung function values were measured three to five months postoperatively. Measurements for patients 1, 2 and 3, respectively, were [FEV.sub.1]--1.16, 0.65 and 0.56, and [Pa.sub.[CO.sub.2]]--42 mm Hg, 43 mm Hg and 40 mm Hg. All three patients showed reduced lung volume and greater diaphragmatic curvature, as well as better approximation of lung tissue to the lateral chest wall on radiographic examination.

The authors emphasize that these three patients received optimal preoperative treatment. They conclude that, in selected ventilator-dependent COPD patients (i.e., patients with bullous changes, significant hyper-inflation, pulmonary hypertension), lung-volume reduction surgery may result in successful weaning from the ventilator with improvement in pulmonary function.

Criner GJ, et al. Lung volume reduction surgery in ventilator-dependent COPD patients. Chest 1996;110:877-84.

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